Heart Valves

Question 1

S1 vs S2

Answer 1

• S1=Lub
  
  • aka First Heart sound; Systolic Heart Sound
  • Isovolumic Contraction/systole
    
    • AV valve close
• S2=Dub
  
  • aka Second Heart Sound; Diastolic Heart Sound
  • Isovolumic relaxation/diastole
    
    • Semilunar valves close (Split)
      
      • Aortic valve closes before pulmonic valve bc stronger pressure gradient
      • Deep Breathe->delays closure of pulmonic valve=Increase Right Ventricle Filling=Prolong Right Ventricle Ejection
      • Best cahnce to heart=Peak inspiration
        *

Question 2

Pressure throughout the heart:

Answer 2

• Right Atrium
  
  • 2-8
• Right Ventricle
  
  • 15-30/2-8
• Pulmonary Artery
  
  • 15-30/4-12
• Lungs: PCW
  
  • 2-10
• Left Atrium:
  
  • 2-10
• Left Ventricle:
  
  • 100-140/2-10
• Aorta:
  
  • 100-140/60-90

Question 3

Regurgitation:

Answer 3

• Incompetence
• Retrograde flow (insufficiency)
• No pressure gradient across valve
• Net Cardiac Output is impaired
• Causes:
  
  • HTN/ Pulmonary HTN
  • Congenital
  • Infections
  • Myocardial Infarction
• Effects:
  
  • Increase Back flow
  • Decrease flow to downstream targets (perfusion)

Question 4

Stenosis:

Answer 4

narrowing

• A pressure gradient develops across valve
• causes:
  
  • Increased age
  • Congenital:
    
    • Bicuspid aortic valve 1%-Aortic valve has 2 leafts instead of 3 leaflets
  • Calcification
  • Infections
• Effects:
  
  • Turbulant blood flow
  • Less efficient blood movemnt forward
  • excess volume left behind
  • Reduced blood flow to downstream targets

Question 5

Auscultation:

Answer 5

• Auscultaiton point line up with anatomical position of the heart
  
  • Aortic Valve:
    
    • Right 2nd ICS
  • Pulmonic Valve:
    
    • Left 2nd ICS
  • Tricuspid Valve:
    
    • Left 4th ICS
  • Mitral Valve:
    
    • Left 5th ICS (more mid clavicular)
    • apex of heart
• Place the stethoscope in line w/driection of flow coming out through valve

Question 6

Murmur descriptoin:

Answer 6

• Grade: 1-6
  
  • how loud it is based on volume
  • Low pressures=low volume=muted/softer
  • High pressure=high volume=louder
• Duration:
  
  • pan or holo
    
    • lasts throughout systole or diasotle
  • early
  • mid
  • late
• Location
• Pitch: (intenisty)
  
  • how much pressure is behind the sound
  • Low pressure=lower pitch
  • High pressure-high pitch
• Shape:
  
  • cresendo/decresendo
• Radiation
  
  • can you hear it beyond the place wher eyou normally should
• Quality?
  
  • harsh
  • blowing

Question 7

Types of Murmurs

Answer 7

• Systolic Murmur: S1=Lub
  
  • isovolumic systole
  • between S1 and S2
  • Aortic Stenosis (LATE)
    
    • pulmonic stenosis
  • Mitral regurgitation (EARLY)
    
    • Tricuspid Regurgitation
  • Mitral Valve prolapse:
    
    • subset of mitral regurgitation
    • different sound
• Diastolic Murmur: S2= DUB
  
  • isovolumic relaxation
  • S2-S1; After S2
  • Mitral Stenosis (late)
    
    • Tricuspid Stenosis
  • Aortic Regurgitation (early)
    
    • Pulmonic Regurgitation
    • ​Aortic closes before pulmonic vavle
• Constant Machine-like
  
  • Patent Ductus Arteriosus (PDA)
    
    • doesn’t close
    • congenital

Question 8

8 possible murmurs

Answer 8

1. Mitral stenosis
2. Mitral regurgitation/incompetence
3. Tricuspid stenosis
4. Tricuspid regurgitation/incompetence
5. Aortic stenosis
6. Aortic regurgitation/incompetance
7. Pulmonic stenosis
8. Pulmonic regurgitation/incomplete

Question 9

Normal System: What occurs during Systole vs diastole:

inflow vs outflow valves

Answer 9

Question 10

Systolic Murmur sound patterns:

Answer 10

• Ejection type:
  
  • crescendo/decrescendo
• Pansystolic (holosystolic)
  
  • same intensity throughout
• Late systolic:
  
  • Click=leaflet gives out, pressure is to high
    
    • only works up to a certain pressure

Question 11

Mitral regurgitation (prolapse/Incompetence)

Answer 11

• systolic murmur: Pansystolic
• Hear in mitral area: Over the Left Ventricle apex
  
  • Left 5th ICS=more midclavicular
  • radiate to left maxilla-depending on how bad it is.
• Allows flow into L atrium from both: pulmonary veins (normal) and left ventricle (Backflow) during ventricular systole
  
  • acutely raises left atrial pressure (Tall V wave)
• Left ventricle and aortic pressure may fall
• Remodel: return pressure to normal
  
  • reduces flow through Left ventricle (decreased aortic ejection) causes LV dilation and hypertrophy
  • Chamber size> wall thickness due to excess preload
• Risk in pulmonary congestion (edema)
  
  • because back up in the Left atrium- Increase LA pressure
  • Increase Pulmonary veins
  • Increase hydrostatic pressure in pulmonary capillaries=increased filtration into interstitial space
• New Onset Mitral Regurgitation:
  
  • Acute Onset Mitral Regurgiation
  • High Left Atrial Pressure causes Pulmonary edema
  • Tall V wave
• Chronic Mitral Regurgitation:
  
  • Remodeled=no pulmonary edema
  • Dilated Left atrium w/normal pressure
    
    • limited capacity
    • eventually edema will reemerge
    • Increased risk of arrhythmia: delaying repolarization in the atria
• Tricuspid Regurgitation:
  
  • same type of murmur but on the right side
  • Does not radiate into axilla; more midline

Question 12

Aortic Stenosis:

Answer 12

• Systolic Murmur
• Hear: Right 2nd ICS
• Pressure gradient b/w Left ventricle and aorta
  
  • Left ventricular pressure elevated