Heart Sounds and Valvular Disorders

Question 1

When would you hear a murmur caused by mitral stenosis?

Answer 1

Diastole

Question 2

When would you hear a murmur caused by mitral regurgitation?

Answer 2

Systole

Question 3

When would you hear a murmur caused by aortic stenosis?

Answer 3

Systole

Question 4

When would you hear a murmur caused by aortic valve regurgitation?

Answer 4

Diastole (blood rushes back into LV from systemic circulation)

Question 5

From Powerpoint:
On cardiac auscultation, she has an opening snap and a grade III/VI diastolic rumbling murmur.

What is going on with her mitral valve?

Answer 5

Rheumatic Heart Disease: Mitral Stenosis

OPENING SNAP and a RUMBLING MURMUR are characteristic of Mitral Stenosis.

(FISHMOUTH mitral valve)

It takes force to snap open the valve and even then the blood flow through it is turbulent (Rumble)

Question 6

You hear a mid systolic click followed by a regurgitation murmur. What is going on with the left side of the heart?

Answer 6

Mitral Valve Prolapse.

The mid-systolic click is the valve opening up like a parachute and the regurg murmur is the blood flowing through the now-open mitral valve.

Question 7

What sound would you hear if your patient had mitral regurgitation?

Answer 7

A Holosystolic blowing murmur

(Gets louder with squatting cause you’re increasing after load by physically compressing the peripheral vessels… the ventricle doesn’t push out as much blood, but pushes more into the atrium because the pressure is lower. LOUDER BLOW)

Question 8

Mitral regurgitation eventually leads to…..

Answer 8

Volume overload and left sided heart failure.

Question 9

Mitral stenosis (seen with chronic Rheumatic Valve Disease) eventually leads to what?

Answer 9

Volume overload of the left atrium leads to dilation, which causes pulmonary congestion, pulmonary HTN, and eventually right sided heart failure.

Left Vent. dilation also leads to Atrial Fibrillation, with associated risk of MURAL THROMBI (stroke)

Question 10

You hear a systolic click with a crescendo-decrescendo murmur. What are you hearing?

Answer 10

Aortic Stenosis

Clicks generally indicate the forced opening of a valve, and one at the start of systole means aortic.

Question 11

You hear a click at the beginning of diastole. What valve is it?

Answer 11

Mitral. During diastole, it’s open, allowing blood to flow from atria to ventricles.

Question 12

Aortic Stenosis is caused by what 2 things? How do you tell them apart?

Answer 12

Most commonly caused by calcification and fibrosis (wear and tear with age).

With this, you’d see calcific deposits in the cusps of valsalva, with NO commisural fusion. Mitral valve not effected.

Second cause is Chronic Rheumatic Valve Disease. You’d see commisural fusion. Also, the mitral valve would be stenosed too. It always stenoses first in Rheumatic Valve disease.

Question 13

You hear an early blowing diastolic murmur. What are you hearing?

Answer 13

Aortic Valve Regurgitation

A SURGICAL EMERGENCY

Question 14

How can you physically tell if your patient has Aortic Valve Regurg?

Answer 14

Bounding pulse, Pulsating nail beds, Hyperdynamic circulation, because the pulse pressure is increased.

How? Diastolic pressure is decreased via regurg, and systolic pressure is increased due to increased stroke volume.

Question 15

When is an S3 heart sound not pathologic?

Answer 15

When your patient is a CHILD.

S3 is common to hear in children.

Question 16

S4 heart sound indicates what?

Answer 16

Atrial kick –> the blood hits a noncompliant ventricle.

Question 17

S3 gallops are heard best when?

Answer 17

Early diastole

Question 18

S4 heart sounds are heard when?

Answer 18

Late diastole

Question 19

What side of the stethoscope is used for low sounds?

Give an example

Answer 19

The bell.

touch it lightly to the skin

Question 20

What side of the stethoscope is better for picking up high pitched sounds?

Answer 20

The diaphragm

Pericardial friction rubs and other soft murmurs

Question 21

Why does an S3 heart sound happen?

Answer 21

S3 results from the impact of inflowing blood against a distended or incompliant ventricle in mid diastole.

Question 22

What is the go-to diagnostic test for assessing a murmur?

Answer 22

Echocardiogram

Question 23

What physical findings will you see in Aortic Regurgitation?

Answer 23

Bounding systolic pulse and dilated (eccentric) hypertrophy of the ventricles.

Question 24

What happens to the pulse pressure in Aortic Regurgitation?

Answer 24

It increases.

Example: 210/30

The systolic goes up cause you increase preload

The diastolic pressure is physiologically due cause of the elastic recoil. Usually, it squirts blood systemically. In this case, it can go back into the ventricle (lower pressure system) as well as systemically, so the diastolic pressure is lower.

Question 25

What is the most common valvular disorder?

What is the second most common?

Answer 25

1. Mitral Valve Prolapse (AD genetic)

2. Aortic stenosis due to degenerative calcification.

Question 26

You hear a harsh crescendo-decrescendo murmur along the sternal border. What is it?

Answer 26

Aortic Stenosis

The murmur also radiates to the carotids.

Question 27

Why does syncope occur during exercise with aortic stenosis?

Answer 27

Exercise induces skeletal muscle vasodilation, which normally would result in an increased HR to maintain CO.

You can only pump a set amount of blood with aortic stenosis, so blood flow to the brain is diminished = done fell out.

Question 28

Your patient presents with a high pitched sound after S2, followed by a rumbling murmur. What does she have? What is the pathology behind it, usually?

Answer 28

Mitral stenosis. Diastolic click followed by a low rumbling murmur.

Rheumatic heart disease is generally the cause.