CH 18 : Heart valve disease Flashcards
Question 1 of 5
In relation to the S1 and S2 heart sounds, which of the following statements are true? Select all that apply.
Diastole occurs between S2 and S1. Systole occurs immediately prior to S1. Systole occurs between S1 and S2. S1 marks the end of diastole. S2 marks the end of systole.
Diastole occurs between S2 and S1.
Systole occurs between S1 and S2.
S1 marks the end of diastole.
S2 marks the end of systole.
Question 2 of 5
To hear murmurs associated with the mitral valve, which of the following locations would be best?
Fifth intercostal space, mid-clavicular
First intercostal space, right side of sternum
First intercostal space, left side of sternum
Second intercostal space, right side of sternum
First intercostal space, left side of sternum
Question 3 of 5
A client with known mitral stenosis presents with left-sided weakness and slurred speech. What would a nurse suspect as the cause of the client’s clinical presentation?
Diminished coronary artery blood flow
An embolic stroke
Diminished blood volume in the pulmonary artery
Pulmonary hypertension
An embolic stroke
Question 4 of 5
Which of the following are systolic murmurs? Select all that apply.
Aortic valve stenosis Mitral valve stenosis Mitral valve insufficiency Pulmonic valve stenosis Tricuspid valve insufficiency
Aortic valve stenosis
Mitral valve insufficiency
Pulmonic valve stenosis
Tricuspid valve insufficiency
(Pre-)Question 5 of 5 (4 out of 5 correct)
Systemic edema and jugular vein distention may result from ______________. Select all that apply.
pulmonic valve stenosis mitral valve insufficiency mitral valve stenosis aortic valve stenosis tricuspid valve insufficiency
pulmonic valve stenosis
tricuspid valve insufficiency
Question 1 of 9
Helen, age 58, is a former schoolteacher with a history of rheumatic fever. She is currently on anticoagulant therapy and beta blockers for her valve disorder. Auscultation over the apex revealed a murmur present during diastole and appearing with an opening snap. Helen complains of dyspnea on exertion and extreme fatigue “whenever she tries to do anything.”
What valve disorder does Helen have?
Make the connection between clinical findings and underlying pathophysiology. For each clinical scenario, drag and drop the disorder that is best exemplified by that scenario.
aortic insufficiency
aortic stenosis
mitral insufficiency
mitral stenosis
mitral valve prolapse
pulmonic insufficiency
pulmonic stenosis
tricuspid insufficiency
tricuspid stenosis
mitral stenosis
Helen’s history of rheumatic fever is a major risk factor for valvular disorders. The diastolic murmur over the apex indicates mitral valve involvement. The murmur reflects blood flow from the left atrium to the left ventricle during diastole. Helen’s dyspnea and fatigue are likely related to left-side back-up of blood into lungs. Assessment findings and signs and symptoms indicate Helen has mitral stenosis.
Question 2 of 9
William comes to the emergency department complaining of dyspnea, chest pain, and syncope upon exertion. He states that he is worried because his condition seems to be worsening. William is 72 years old and has a history of cardiac issues. In addition to blood laboratory work and an ECG, the physician orders an echocardiogram. Echocardiogram results reveal left ventricular enlargement and left ventricular hypertrophy. Auscultation reveals a systolic murmur with an opening snap. The murmur ends at S2.
What valve disorder does William have?
Make the connection between clinical findings and underlying pathophysiology. For each clinical scenario, drag and drop the disorder that is best exemplified by that scenario.
aortic insufficiency
aortic stenosis
mitral insufficiency
mitral stenosis
mitral valve prolapse
pulmonic insufficiency
pulmonic stenosis
tricuspid insufficiency
tricuspid stenosis
aortic stenosis
William’s age (above 65 years) and history of cardiac problems are consistent with aortic valve stenosis. The systolic murmur indicates a problem with ejection of blood (blood cannot exit the left ventricle due to resistance of the aortic valve). The opening snap sound indicates the valve does not open easily. The echocardiogram shows left ventricular involvement, likely accounting for William’s signs and symptoms.
Question 3 of 9
Leigh, a 62-year-old patient with pulmonary hypertension, is a current patient. She appears to be doing well. Leigh does not have jugular vein distention, ascites, or ankle edema.
Upon auscultation, you detect a Graham Steell murmur following S2. The murmur is detected in second intercostal space, left sternal border, and is high-pitched and blowing.
What valve disorder does Leigh have?
Make the connection between clinical findings and underlying pathophysiology. For each clinical scenario, drag and drop the disorder that is best exemplified by that scenario.
aortic insufficiency
aortic stenosis
mitral insufficiency
mitral stenosis
mitral valve prolapse
pulmonic insufficiency
pulmonic stenosis
tricuspid insufficiency
tricuspid stenosis
pulmonic insufficiency
Pulmonary hypertension is the most common cause of pulmonic insufficiency. Graham Steell murmurs are heard with pulmonic valve insufficiency. The pulmonary valve does not close completely, causing regurgitation of blood back into the right ventricle during diastole after S2.
Question 4 of 9
John arrives at the acute care center complaining of fatigue that worsens when he tries to exercise. He complains that he can’t catch his breath and must sleep with several pillows to facilitate breathing. John has a history of rheumatic fever. The health care provider orders laboratory work, an ECG, and echocardiogram. Findings include left ventricle dilatation and left ventricular impulse displacement. Auscultation reveals a murmur in the third intercostal space, pronounced during diastole with diastolic thrill.
Which valve disorder does John have?
Make the connection between clinical findings and underlying pathophysiology. For each clinical scenario, drag and drop the disorder that is best exemplified by that scenario.
aortic insufficiency
aortic stenosis
mitral insufficiency
mitral stenosis
mitral valve prolapse
pulmonic insufficiency
pulmonic stenosis
tricuspid insufficiency
tricuspid stenosis
aortic insufficiency
Rheumatic fever can damage the aortic valve. Left ventricle dilatation indicates excess fluid in the left ventricle. John’s murmur occurs during diastole when the heart is trying to fill. The aortic valve should be closed, but blood is leaking through during diastole. As blood flows backwards into the left ventricle because of improper closure of the aortic valve, tissue perfusion is compromised, especially during activity. John has aortic insufficiency.
Question 5 of 9
Paul recently suffered a bout of infectious endocarditis. He is at high risk for this disease because he is an intravenous drug user. In his most recent appointment, auscultation revealed a diastolic murmur over the left lower sternal border. When Paul was asked to take a deep breath, the murmur was more pronounced. In addition, physical assessment revealed a slight jugular vein distention.
What valve disorder is Paul experiencing?
Make the connection between clinical findings and underlying pathophysiology. For each clinical scenario, drag and drop the disorder that is best exemplified by that scenario.
aortic insufficiency
aortic stenosis
mitral insufficiency
mitral stenosis
mitral valve prolapse
pulmonic insufficiency
pulmonic stenosis
tricuspid insufficiency
tricuspid stenosis
tricuspid stenosis
Because bacteria enter into the venous injection site, intravenous drug users are at risk for endocarditis. Tricuspid stenosis is often a sequela of infective endocarditis. Tricuspid valve murmurs appear at left lower sternal border during diastole, as blood cannot move easily from the right atrium to the right ventricle. Blood pools in the venous system, causing jugular vein distention.
Question 6 of 9
On a routine physical examination, Sadie’s health care provider heard a systolic murmur with a midsystolic click. Sadie has no other apparent signs. The cause of her underlying issue is myxomatous degeneration of the valve due to unknown reasons. At this point, no treatment is needed for Sadie’s disorder.
Which valve disorder does Sadie have?
Make the connection between clinical findings and underlying pathophysiology. For each clinical scenario, drag and drop the disorder that is best exemplified by that scenario.
aortic insufficiency
aortic stenosis
mitral insufficiency
mitral stenosis
mitral valve prolapse
pulmonic insufficiency
pulmonic stenosis
tricuspid insufficiency
tricuspid stenosis
mitral valve prolapse
Mitral valve prolapse (MVP) is more common in women and can be present with no signs or symptoms. MVP allows blood to regurgitate from the left ventricle into the left atrium, thus creating a systolic murmur (occurring during contraction of the left ventricle).
Question 7 of 9
After experiencing a recent myocardial infarction, Hank, a 62-year-old retail supervisor, has done little to improve his cardiac health. Hank feels he is doing “worse” and “on his way to another heart attack.” He presents with the primary complaint of angina.
When asked about any other changes, Hanks report he struggles to breathe at night even while “just sleeping.” Auscultation reveals a holosystolic murmur and S3 sound. Further evaluation with echocardiography confirms an enlarged left atrium.
What valve disorder does Hank have?
Make the connection between clinical findings and underlying pathophysiology. For each clinical scenario, drag and drop the disorder that is best exemplified by that scenario.
aortic insufficiency
aortic stenosis
mitral insufficiency
mitral stenosis
mitral valve prolapse
pulmonic insufficiency
pulmonic stenosis
tricuspid insufficiency
tricuspid stenosis
mitral insufficiency
Problems breathing may indicate left-side heart problems. Holosystolic murmur (abnormal sound during contraction) combined with left atrial enlargement indicates back flow into the left atrium. The myocardial infarction that Hank experienced may have damaged the tissues surrounding the mitral valve, preventing proper closure of the valve. Hank has mitral insufficiency.
Question 8 of 9
Maryann visited the clinic today after a heart rhythm disturbance. She is very worried about the possibility of another heart attack and notes that her heart “races and races sometimes.” Maryann has a history of myocardial infarction of the right ventricle. She has completed cardiac rehabilitation and she states she has been fine since her last heart attack.
An echocardiogram reveals right atrial dilatation. ECG results show that Maryann’s sense of a “racing” heart is likely due to atrial fibrillation. She also tells you that she has experienced swelling in her abdomen and ankles recently.
Which valve disorder to you suspect Maryann has?
Make the connection between clinical findings and underlying pathophysiology. For each clinical scenario, drag and drop the disorder that is best exemplified by that scenario.
aortic insufficiency
aortic stenosis
mitral insufficiency
mitral stenosis
mitral valve prolapse
pulmonic insufficiency
pulmonic stenosis
tricuspid insufficiency
tricuspid stenosis
tricuspid insufficiency
An MI in the right ventricle may damage the papillary muscles preventing the tricuspid valve from closing properly. This results in backflow of fluid from the right ventricle into the right atrium, causing right atrium dilatation. The stretch on the right atrium increases the risk for rhythm disturbances. You suspect Maryann has tricuspid insufficiency.
Question 9 of 9
Examination reveals that Fred, age 62, has a murmur in the second intercostal space. The murmur occurs during systole, with a late S2, and has a crescendo-decrescendo sound. The physician explains to Fred that if his disorder becomes severe, he may develop JVD, ascites, and hepatosplenomegaly.
What valve disorder does Fred have?
Make the connection between clinical findings and underlying pathophysiology. For each clinical scenario, drag and drop the disorder that is best exemplified by that scenario.
aortic insufficiency
aortic stenosis
mitral insufficiency
mitral stenosis
mitral valve prolapse
pulmonic insufficiency
pulmonic stenosis
tricuspid insufficiency
tricuspid stenosis
pulmonic stenosis
Fred’s heart murmur occurs during systole, indicating ejection of blood from the ventricles. Detection of the murmur in the second intercostal space reveals involvement of the pulmonary valve. A delayed S2 indicates slow opening and closing of the valve. Potential complications of JVD and ascites may develop if the stenosis of the valve worsens, preventing ejection of blood from the right ventricle and the backing up of blood into the jugular veins and abdomen. Fred has pulmonic stenosis.
Question 1 of 5
The S1 heart sound is due to ________________.
opening of the atrioventricular valves.
blood rushing into the atria
opening of the semi-lunar valves.
closure of the atrioventricular valves.
closure of the atrioventricular valves.
