Heart murmurs

Question 1

valve stenosis

Answer 1

narrowing of affected valve that causes decreased flow of blood through the valve which results in backing up of blood before the valve

Question 2

valve regurgitation

Answer 2

valve cannot properly close. This causes some back flow of blood through the valve in the reverse direction when, or after, the heart contracts.

Question 3

regurgitation also called

Answer 3

incompetence insufficiency

Question 4

Valve stenosis and regurgitation have different effects depending

Answer 4

which valve they affects

Question 5

The different pathologies will also have differing

Answer 5

sounds and patterns on auscultation.

Question 6

the sound produced during the auscultation of a heart murmur is caused by

Answer 6

turbulent blood flow generated by pathology affecting the heart valve

Question 7

four valves of the heart

Answer 7

tricuspid (RA) mitral (LA) pulmonary aortic

Question 8

which valves are commonly affected with murmus

Answer 8

mitral aortic

Question 9

listening to the heart sounds acronymn

Answer 9

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Question 10

All

Answer 10

aortic - Second right intercostal space (ICS), right sternal border

Question 11

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Answer 11

pulmonary - Second left intercostal space (ICS), left sternal border

Question 12

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Answer 12

tricuspid - Fourth left ICS, left sternal border

Question 13

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Answer 13

mitral - Fifth ICS, left mid-clavicular line

Question 14

first heart sound (S1) represents

Answer 14

• closure of mitral valve and tricuspid valve - beginning of ventricular systole - loudest at the apex and lower left sternal border

Question 15

second heart sound (S2) represents

Answer 15

• closure of aortic valve and pulmonary valve - end of ventricular systole - loudest at the base

Question 16

mitral valve stenosis

Answer 16

narrowing of the mitral valvae

Question 17

why does mitral valve stenosis occur

Answer 17

rheumatic fever (99.9%) - commissural fusion of valve leaflets

Question 18

mitral valve stenosis affects

Answer 18

pulmonary circulation and the left atria

Question 19

mitral valve stenosis and pulmonary ciruclation

Answer 19

backing up of blood into the pulmonary circulation causes damage and fibrosis of the vasculature which leads to increases RESISTANCE to blood flow - results in pulmonary hypertension

Question 20

pulmonary hypertension (caused by mitral valve stenosis) causes

Answer 20

fluid to be forced out of the capillaries causing pulmonary oedema

Question 21

mitral valve stenos and left atrial dilation

Answer 21

occurs as the atria tries to pump harder agains the stressed valve to move blood through it. - leads to fibrosis and remodelling fo the atria to repair damaged tissue caused by stretching of the atria

Question 22

fibrosis of the heart

Answer 22

interrupts electrical pathways leading to ectopic beats which can cause atrial fibrillation

Question 23

side affects of left atrial dilation

Answer 23

can compress the oesophagus causing dysphagia can impress the recurrent laryngeal never which runs close to the oesophagus–> give patient a hoarse voice

Question 24

how is mitral valve stenosis heard

Answer 24

diastolic rumble murmur between S2 and S1

Question 25

aortic valve stnesosi

Answer 25

narrowing of the aortic valve

Question 26

causes of aortic valve stenosis (3)

Answer 26

1. degeneration of the valve e.g. due to calcification or fibrosis with age 2. congenital bicuspid valve (endocarditis) 3. chronic rheumatic fever which causes commissural fusion of the valve leaflets

Question 27

effects of aortic valve stenosis (2)

Answer 27

1. **Left ventricular hypertorphy** as the ventricle must pump harder to focer the blood through the narrowed valve ( can lead to left sided heart failure) 2. **Microangiopathic haemolytic anaemia (MAHA)**

Question 28

how is aortic stneosis heard?

Answer 28

as a cresendo-decresendo murmur

Question 29

Microangiopathic haemolytic anaemia (MAHA)

Answer 29

RBCs are sheared/ damaged as they are pumped through the stenosed valve

Question 30

mitral valve regurgitiation

Answer 30

pathology affecting the mitral valve resulting in blood flowing backwards through it on ventiruclar contraction

Question 31

causes of mitral valve regurgitation (4)

Answer 31

1. **Myxomatous degeneration** - degeneration of the valve (idiopathic) 2. **Damage to the papillary muscles after MI.** 3. **Left sided heart falure which causes left ventiruclar dilation** 4. **Rheumatic fever which causes fibrosis odf the valve which disrupts the seal fo the valve allowing blood to leak through**

Question 32

mitral regurg and damave to the papillary muscles after MI

Answer 32

Damage to the papillary muscle means it is less effective at anchoring the chordae tendineae and therefore less effective at preventing the valves from prolapsing. This allows blood to flow backwards through the prolapsed mitral valve.

Question 33

mitral regurg and left sided heart failure which causes left ventiruclar dilation

Answer 33

. This dilation causes stretching of the valve so it no longer forms a tight seal, allowing blood to leak through.

Question 34

how is mitral valve regurg heard

Answer 34

as a holosytolic murmur

Question 35

effects of mitral valve regurg

Answer 35

Mitral valve regurgitation allows blood to leak back into the left atrium. This increases the preload of the ventricle as more blood enters the ventricle on diastole. The left ventricle hypertrophies to cope with the increased volume of blood which can lead to left sided heart failure.

Question 36

aortic valve regurgitation

Answer 36

is pathology affecting the aortic valve resulting in blood flowing backwards though it after ventricular contraction

Question 37

causes of aortic valve regurg (3)

Answer 37

1. aortic root dilation which causes the leaflelt sto be pulled apars so they no longer form a tight seal 2. valve damage caused by endocarditis or rheumatic fever 3. connective tissue disorder e.g. marfans syndrome

Question 38

effects of of aortic valve regurg (2)

Answer 38

1. Blood flows back intot he elfgt ventircle during diastole causing a reduced diastolic pressure. Systolic pressure does not change * decreased diastolic pressure increases the pulse pressure and can be felt as a bounding pulse 2. Blood flows back intot he left venticle which increases the stroke volume. Heart hypertorphies to cope with increased storke volume- left sided failure

Question 39

how is aortic valve regurg heart

Answer 39

as a decrescendo early diastolic murmur between S1 and S2