Heart Valves

Question 1

Which type of murmurs begin and end in the LV?

Answer 1

Systolic begin and Diastolic end

Question 2

How does mitral regurgitation affect cardiac output and preload?

Answer 2

Decrease forward cardiac output

Increased preload

Question 3

What will cause a new systolic murmur after MI?

New Diastolic murmur associated with chest pain?

Answer 3

New VSD or New MR

Aortic regurgitation after dissection

Question 4

Why might MR happen after MI?

Answer 4

Ruptured chordae tendinae

Question 5

What physical features maybe associated with MVP?

Answer 5

Scoliosis and pectus excavatum

Question 6

What is the MVP murmur?

Answer 6

Mid-systolic click with possible late systolic murmur

Question 7

MR symptoms?

Answer 7

LVHF

RVHF with increasing severity

Question 8

MR murmur?

Answer 8

Holosystolic murmur that radiates to axilla (often has a thrill)

Question 9

Why is there an S3 in MR?

Also has what other heart sound?

Answer 9

Rapid filling of the ventricle b the large volume of blood accumulated in the left atrium during systole.

Widely split s2

Question 10

What may your ekg show for MR?

What’s the Dx TOC?

Answer 10

LVH, LAE

Echo

Question 11

management of MR?

Answer 11

Vasodilator (ACEI) - reduce resistance to aortic flow

Surgery severe

Question 12

Narrowing of the aortic valve causes a pressure overload on what? Leading to?

Answer 12

LV

LVH

Question 13

Risk factors for AS?

3

Answer 13

HTN
High cholesterol
Smoking

Question 14

Symptoms of AS? 3

Answer 14

Syncope
Angina- hypertrophied left ventricle, lack of flow to CA
Dyspnea

Question 15

Sign of AS?

Answer 15

Delayed carotid upstroke

Question 16

What is the AS murmur?

Answer 16

Harsh crescendo-decrescendo systolic ejection murmur

Question 17

What will you find on ekg with AS?

Answer 17

LVH

Question 18

Treatment of AS?

Answer 18

Maybe diuretics

Valve replacement

Question 19

Possible causes of AR?

4 (MC)

Answer 19

HTN
Syphilis
SLE
Marfan

Question 20

AR symptoms?

Answer 20

Left ventricular failure

Syncope

Question 21

AR murmur?
Radiates to?
Heard best how?

Answer 21

High pitched decrescendo blowing diastolic murmur
Apex
Leaning forward or PT sitting

Question 22

What is another murmur associated with AR?

Answer 22

Austin flint murmur

Question 23

AR is associated with which physical exam signs? 2

Answer 23

Increased stroke volume and wide pulse pressure

Question 24

AR ekg?

TX?

Answer 24

LVH

Surgery

Question 25

MC Etiology of mitral stenosis?

Answer 25

Rheumatic

Question 26

MS causes which kind of structural heart issues?

Answer 26

LVHF progressing to RVHF

Question 27

MS can cause which symptoms? 2

Answer 27

Hemoptysis

Hoarseness

Question 28

MS murmur?

Answer 28

Diastolic low pitched rumble

Question 29

EKG for MS? 3

Answer 29

Atrial fibrillation, LAE, RVH

Question 30

MS opening snap caused by what?

Answer 30

By delay of thick stenotic valve to finally open

Question 31

TX of MS?

3

Answer 31

Diuretics are mainstay of TX!
BB
Surgery for severe

Question 32

What are the three types of continuous murmurs?

Answer 32

Pericardial friction rub
PDA- systolic
Venous hum- diastolic

Question 33

Which maneuvers accentuate HOCM and MVP?

Mitral regurgitation?

Answer 33

Standing increases murmur (dec LV size)
Squatting decreases murmur (inc LV size)

Standing decreased
Squatting increased

Question 34

Major criteria for jones?
Minor?
How many  for dx?
Which valve?
TX?

Answer 34

Carditis, polyarthritis, chorea, erythema marginatum, nodules

Fever, arthralgias, prolonged QT, increased ESR, CRP

2 major, 1 major and 2 minor

Mitral

Penicillin or Erythromycin

Question 35

Most common bugs in Endocarditis:
Native valve? (Acute, subacute)
IVDU?
Prosthetic valve?

Answer 35

Staph, Strep (viridans)
Staph with the tricuspid
Staph

Question 36

Signs of endocarditis? 4
DX?
TX?

Answer 36

Splinter hemorrhages
Osler’s nodes
Jane way lesions
Roth Spots

Blood cultures
Echo

Empiric: Vanco and Ceftriaxone
Staph: Naph and Vanco
Strep: IV pen