Heart Valve Diseases

Question 1

What are the abnormal heart sounds?

Answer 1

S3 & S4

• Both of them occur during diastole
• S3 is after S2, heard as Lub-Dub-Shhhh
• S4 is before S1, heard as Shhh-Lub-Dub
• S3 occurs due to volume overload (like in heart failure)
• S4 occurs due to pressure overload (due to the hypertrophy of muscles)

Question 1

What are the normal heart sounds?

Answer 1

We have S1 which is produced due to the closure of the AV valves and S2 due to the closure of the semilunar valves

• Between S1 & S2 we have the systolic phase (isovolumetric contraction & ventricular ajection), while between the S2 & S1 we have the isovolumetric relaxation and ventricular filling

Question 2

What is a murmur?

Answer 2

• Murmur is heard when there is a turbulence in flow due to a defect in the valve
• To Identify whether it’s a systolic or diastolic murmur you should listen to it and palpate the jugular artery at the same time if it is considered with the pulsation of the jugular artery then it is a systolic murmur otherwise it is a diastolic murmur
• Systolic murmurs indicate:
• Aortic & Pulmonary stenosis
• Mitral and Tricuspid Regurgitation

Question 3

What are the auscultatory locations for the valves?

Answer 3

1) Aortic valve:

• Right 2nd intercostal space

2) Pulmonary Valve:

• Left 2nd intercostal space

3) Erbs Point:

• Left 3rd intercostal space

4) Tricuspid Valve:

• Lower left sternal surface 4th intercostal space

5) Mitral Valve:

• Left 5th intercostal space

Question 4

What is meant by the parasternal heave?

Answer 4

Heave means that something is pushing against your hand, and you do this maneuver to the left of the sternum where if you feel a pushing towards your hand it means that there is a right ventricular hypertrophy, since it forms most of the sternocostal surface

Question 5

When is the sound of the right part of the heart most audible?

Answer 5

During inspiration (More venous return)

Question 6

What is meant by mitral stenosis?

Answer 6

It is the inability of the valve to open properly during diastole

Question 7

What is the aetiology of Mitral stenosis?

Answer 7

Rheumatic heart disease (95%)

• Other causes might be congenital or calcific degeneration

Question 8

What are the functional causes of Mitral Stenosis?

Answer 8

• Functional means that the structure of the valve is intact but the function has signs of stenosis:

1) Austin Flint murmur (Aortic regurgitation)
2) Curry coombs murmur (Inflammed valve)
3) Increased flow through the mitral valve

Question 9

What are the clinical manifestations of mitral stenosis?

Answer 9

• Less blood flows from the LA to the LV = Low cardiac output
• Clotting will develop in the LA
• Atrial fibrillation as the LA is distended stretching the heart’s electrical conduction system
• LA dilation due to the increased pressure in it
• Pulmonary hypertension due to the accumulation of blood in the LA, the blood will travel back to the pulmonary circulation, and the pulmonary vessels will constrict to reduce the edema occurring in them, and thus the right ventricle will hypertrophy and cause systemic congestion
• Plum colored cheeks

Question 10

What are the special investigations for mitral stenosis?

Answer 10

1) ECG (P-Mitrale, the p-wave will have a wide based notch due to the enlargement of the left atrium)

2) Chest X-ray (1.Butterfly Wing Apperance due to the pulmonary congestion, 2. Increased cardiac waist due to the Left atrium dilation, 3. Cardiomegaly due to right ventricle dilation)

3)