Johnson Lecture

Question 1

Answer 1

mitral stenosis

Question 2

Answer 2

aortic regurg

Question 3

Systolic murmurs

Answer 3

MR (MVP), TR

AS, PS, VSD
Aortopulmonary shunts: (early, mid, late, holosystolic/ pansystolic)

Question 4

diastolic murmurs

Answer 4

Diastolic – AR, PR - MS, TS

Atrial myxoma

Question 5

Pathophysiology AS•

Answer 5

Pathophysiology AS

Obstruction leads to pessure overload; LVH, increase LVED pressure

Gradientacrossvalve
• Severe AS if A oV<1.0cm2

Question 6

harsh systolic murmur in 2nd intercostal space that radiates into supra sternal notch/carotids

Answer 6

AS

Question 7

Gallavardin phenomenon

Answer 7

AS: means the AS murmur radiates to the apex like MR (imitates an MR)

Question 8

Answer 8

AS, severe

Question 9

TR

Answer 9

TR: V wave. Carvallo sign - murmur at LSB inc. w/ inspiration.

ass w/ pulmonary HTN, inferior MI,

Question 10

blowing murmur at LSB inc. w/ inspiration.

Answer 10

systolic murmur, carvello sign of TR

Question 11

decrescendo/crescendo murmur (“u” shape)

Answer 11

MS and TS, diastolic murmurs

Question 12

decrescendo murmur

Answer 12

PR and AR

AR: 3rd ICS LSB. Bunch of signs.

PR: Graham Steell.

Question 13

3rd ICS LSB, descescendo murmur

Answer 13

AR

AR: 3rd ICS LSB. Bunch of signs.

PR: Graham Steell.

Question 14

TS

Answer 14

Tricuspid Stenosis (TS)

Associated with MS, TR and RHD

Pathophysiology: Prominent “A” wave in

JVP ascites, hepatomegalia (may pulsate)

Diastolic murmur LSB; increase with inspiration (Carvallo’s sign) and decrease with expiration and valsalva.

Question 15

blowing murmur 2 SB

Answer 15

Pulmonic Regurgitation (PR or PI)

• Most cases are due to pulmonary HTN
• Diastolic, blowin gmurmur 2 SB (Graham Steell)

Question 16

systolic murmur and ejection click, radiates toward left shoulder and increases on RVH

Answer 16

Can cause angina and syncope

• Auscultation – systolic murmur, ejection click
• 2nd – 3rd ICS, LSB/radiates toward left shoulder and increases on inspiration/RVH
• Maybe associate with TOF or TGA
• May require balloon commissurotomy if pressure gradient > 50mmHg

Question 17

hoarse voice, trouble breathing while laying down

Answer 17

MS

DOE, cough orthopnea, PND, pulmonary

edema, hemoptysis, arterial emboli, A. fib

Ortner syndrome: hoarseness d/+ compression of left recurrent laryngeal nerve

Question 18

“A” wave vs “V” wave

Answer 18

TS: Prominent “A” wave in JVP, ascites, hepatomegalia (may pulsate)

TR: Prominant “U” wave in JVP

Question 19

Malar flush – ruddy cheeks, blue facies. Increase S1; opening shape (OS) after S2

Rumbling, low pitched; best heard at apex. Use bell.

Answer 19

MS

Question 20

Exertional dyspnea, angina, syncope, heart failure

Answer 20

AS

Exertional dyspnea, angina, syncope, heart failure

• Without treatment prognosis is poor
• Without treatment most will die within three years of developing syncope and within two years of onset of HF.

Question 21

Parvus/Tarvus, narrow pulse pressure

Answer 21

AS

Question 22

1) a crescendo-descendo vs 2) a click –> cresendo-decrescendo

Answer 22

2) pulmonary stenosis
1) AS

Question 23

Answer 23

AS

Question 24

Answer 24

PS