Heart Murmurs & Valve Disease (Exam 2)

Question 1

Define a grade 1 murmur.

Answer 1

very faint

Question 2

Define a grade 2 murmur.

Answer 2

quiet but heard immediately

Question 3

Define a grade 3 murmur.

Answer 3

moderately loud

Question 4

Define a grade 4 murmur.

Answer 4

loud

Question 5

Define a grade 5 murmur.

Answer 5

heard with stethoscope partly off the chest

Question 6

Define a grade 6 murmur.

Answer 6

no stethoscope needed

Question 7

What grade of murmurs are thrills associated?

Answer 7

Grades 4-6

Question 8

What murmur(s) does a standing heart sound auscultation accentuate? Soften?

Answer 8

may accentuate murmurs associated with mitral valve prolapseor hypertrophic cardiomyopathy. will make murmur of aortic stenosis softer.

Question 9

What does the squatting or valsalva ausculatation do in regards to murmurs?

Answer 9

accentuates murmur of aortic stenosis. will decrease intensity of mitral valve prolapse and hypertrophic cardiomyopathy.

Question 10

What does a leaning forward heart sound ausculation do in terms of murmurs.

Answer 10

can be done to more clearly assess aortic and pulmonic murmurs.

Question 11

Describe in relationship to systole and diastole aortic stenosis.

Answer 11

Flow across an abnormal SL valve or narrowed ventricular outflow tract. It is a midsystolic murmur.

Question 12

What are the causes of aortic stenosis?

Answer 12

degnerative (age>65)
bicuspid valve in the young
rheumatic
atherosclerosis
rare (irradiation, collagen, vascular disease)

Question 13

What are the symptoms of aortic stenosis?

Answer 13

angina-35% - half will die in 5 years
syncope-15% -half will die in 3 years
congestive heart failure-50% -half will dies in 2 years
most are asymptomatic, but once symptoms develop morbidity increases rapidly.

Question 14

What is the treatment for aortic stenosis in asymptomatic patients?

Answer 14

no competititve athletics

mild to moderate disease, need an echo every 2-5 years

Question 15

What is the treatment for aortic stenosis in symptomatic patients?

Answer 15

valve replacement for severe disease, if good surgical risk.
aortic stenosis with symptoms is lethal.

Question 16

What are the causes of mitral valve regurgitaion/insufficiency?

Answer 16

Primary: leaflet, annular, or chordae/papillary muscle abnormalities
secondary: left ventricle or endocardial cushion defect, usually associated with ischemic heart disease-IHD or mitral valve proplapse or infectious endocarditis.

Question 17

What are the symptoms of Mitral Valve Regurgitation/insufficiency?

Answer 17

frequently no symptoms
exercise intolerance
palpations long beore HF symptoms begin
ischemic heart symptoms-angina
in severe MR, high left atrial pressure cause dyspnea
as left atria enlarges Afib is common

Question 18

What is the Causes of Mitral stenosis?

Answer 18

rheumatic fever and RHD

Question 19

What are the symptoms of mitral stenosis?

Answer 19

• subtle and slow
• significant mitral stenosis is found in pt with little or no symptoms and very few will have a clear hx of rheumatic fever
• exercise intolerance
• palpitations as MS progresses
• congestive heart failure
• hoarseness develops as left atrium impinges on the recurrent laryngeal nerve
• A fib develops in elderly

Question 20

What is the management of mitral stenosis?

Answer 20

• yearly echo
• negative chronotropes (beta blcoker or ca+ channel blockers to decrease left atrial pressure)
• Surgical: balloon valvuloplasty for early disease and valve replacement for severe disease
• therapy for Afib

Question 21

What are the causes of aortic regurgitation/insufficiency?

Answer 21

• Acute: chest traum or endocarditis
• Mild: bicuspid valve with severe HTN
• Severe/chronic: degeneration of valve, bicuspid valve, RHD (with mitral disease), trauma and infective endocarditis
• Rare causes: connective tissure disorder or collagen vascular disorder

Question 22

What are the symptoms of aortic regurgitation/insufficiency?

Answer 22

• exercise intolerance
• dyspnea, othopnea
• congestive heart failure
• angina in only about 5%
• bounding periperal pulse

Question 23

Describe what you would hear for aortic regurgitaion/insufficiency.

Answer 23

• Best heard in the 2nd or 3rd ICS at the left sternal edge
• high pitched, decrescendo, early diastolic
• blowing quality=>may be mistaken for breathing sound
• radiation: to the sternal border

Question 24

What are the complications of mitral stenosis?

Answer 24

• as it progresses, left atrial enlargement occurs which can lead to mural thrombi, especially with A fib
• heart rate is critical in MS as HR increases, less time for diastolic ventricular filling, with leads to increased left atrial pressure which ends with pulmonary hypertension

Question 25

Describe what you would hear in aortic stenosis.

Answer 25

• classic crescendo-decrescendo (diamond) shaped murmur
• loudest in aortic area; radiates along the carotid arteries
• A2 decreases as the stenosis worsens

Question 26

Describe what you would hear in mitral valve regurgitaion/insufficiency.

Answer 26

• pansystolic murmur
• loudest at the left ventricular apex
• radiation reflects the direction of the regurgitant jet: to the axilla and back (flail anterior leaflet) to the base of the heart (flail posterior leaflet.
• usually associated with a systolic thrill, a soft S3

Question 27

Describe what you would hear in mitral stenosis.

Answer 27

• mid-diastolic murmur due to atrial contraction & rapid ventricular filling
• low-pitched and best heard over the apex (w/the bell)
• little or no radiation

Question 28

How does an aortic stenosis murmur fall in realtion to systole and diastole?

Answer 28

midsystolic-immediaely after s1 but stops halfway and doesn’t carry to s2

Question 29

How does an aortic regurgitation/insufficiency murmur fall in relation to systole and diastole?

Answer 29

early diastolic murmur

Question 30

How does a mitral stenosis murmur fall in relation to systole and diastole?

Answer 30

occurs in mid-diastole across AV valve

Question 31

How does a mitral valve regurgitaion/insufficiency murmur fall in relation to systole and diastole?

Answer 31

usually is associated with a systolic thrill, a soft s3. pansystolic murmur

Question 32

Define systole in terms of atrial and ventricular filling or contraction.

Answer 32

ventricular contraction, atrial filling

Question 33

Define diastole in terms of atrial and ventricular filling or contraction

Answer 33

atrial contraction, ventricular filling