Left Valves and MVP

Question 1

This murmur results from dilation of the aortic root and sometimes the ascending aorta as well

Answer 1

aortic insufficiency

Question 2

What is the most common cause of AI?

Answer 2

congenital–bicuspid valve

Question 3

Where can you hear AI? When can you hear it? What does it sound like?

Answer 3

LLSB, early diastole, blowing

Question 4

What is a common and unique symptoms of AI? What is this caused by?

Answer 4

“pounding’ heart beat/palpitations. Caused by hyperdynamic pulse that occurs with large stroke volume and rapid runoff. (Basically the LV pumps out a lot of blood creating a big systolic pressure, and then a lot of it rushes back into the LV and does not participate with diastolic pressure)

Question 5

What is another murmur that occurs in diastole? It is low pitched and heard at the apex. We were told to “just be aware”

Answer 5

Austin Flint

Question 6

Are there any additional heart sounds that can be heard in AI?

Answer 6

S3, occasionally

Question 7

What’s the difference b/t chronic and acute AI?

Answer 7

Chronic AI gives heart time to adapt and compensate by dilating or with hypertrophy. Acute AI give heart no time to adapt and LV will be overwhelmed with blood supply. Back up will cause flash pulm edema.

Question 8

How do you treat AI?

Answer 8

mild–vasodilators (ACEI and CCB) to reduce afterload

severe–valve replacement

Question 9

This murmur is typically acquired. Symptoms often don’t develop for years, but once they present patients have a rapid decline in mortality. Symptoms most often include angina, syncope, and CHF

Answer 9

Aortic Stenosis

Question 10

Does AS occur in systole or diastole?

Answer 10

systole

Question 11

What does AS sound like?

Answer 11

systolic crescendo-decrescendo

Question 12

Are there extra heart sounds in AS?

Answer 12

S4, occasionally

Question 13

What are the important causes of AS?

Answer 13

Acquired: calcification or rheumatic dz
Congenital: bicuspid valve

Question 14

What are the 3 key symptoms/complications of AS?

Answer 14

angina, syncope, CHF

Question 15

During your physical exam of a patient with suspected AS, what else might you classically notice?

Answer 15

pulsus parvus et tardus–weak and late carotid pulse

Question 16

This diastolic murmur is most commonly caused by rheumatic disease, and is therefore very rare in the western world. It is characterized by an opening snap, diastolic “rumbling” murmur, and can be heard best at the apex.

Answer 16

Mitral stenosis

Question 17

What symptoms are commonly a/w MS?

Answer 17

insidious onset, dyspnea, and AFIB

Question 18

Why would you suspect afib in MS?

Answer 18

back up of blood into the LA may cause dilation of the LA…dilation/stretch will irritate those myocytes and trigger afib

Question 19

What is your treatment for MS?

Answer 19

Valvuloplasty (temporary) replace valve! (can manage symptoms with diuretics. Maintain good rhythm and HR)

Question 20

What is the most common cause of mitral regurgitation?

Answer 20

MVP

Question 21

How can you diagnose MVP?

Answer 21

echo! is the only way to see prolapse

Question 22

What demographic of patients most commonly has MVP?

Answer 22

women

Question 23

What symptoms will you expect in MVP patients? What has this historically been a problem?

Answer 23

CP, palpitations, dizziness, anxiety–problematic b/c this is often mistaken for panic attack.

Question 24

What does MVP sound like on PE?

Answer 24

midsystolic click (will eventually develop systolic murmur with development of MR)

Question 25

How do you treat MVP?

Answer 25

usually don’t, symptomatic patients can be given BB. Consider valve replacement only with progressing MR

Question 26

This is a blowing holosystolic murmur that radiates to the axilla. It can be heard at the LLSB and apex.

Answer 26

Mitral regurgitation

Question 27

What causes MR? (chronically)

Answer 27

#1) MVP-most common
2)  rheumatic dz also causes

Question 28

How do MR patients typically present?

Answer 28

Usually have a prolonged asymptomatic period, but develop AFIB (dilation LA) and CHF (and CHF symptoms). Usually also have MVP symptoms as well.

Question 29

What is something special you might notice on PE for an MR patient?

Answer 29

Laterally placed PMI

Question 30

What might cause an acute mitral regurge?

Answer 30

ischemia, rupture of chordae tendinae

Question 31

Why would ischemia cause an acute MR?

Answer 31

the posteriomedial papillary muscle only has a single blood supply (posterior descending artery)

Question 32

How would you manage acute MR?

Answer 32

SURGERY, ASAP (stabilize until sx with Na Nitroprusside, Inotropes, or balloon)

Question 33

How would you manage chronic MR?

Answer 33

reduce afterload (ACEI), decrease preload (diuretics) and valve replacement

Question 34

When would you do a valve replacement for MR?

Answer 34

for symptomatic patients, or asymptomatic patients who’s EF <55%

Question 35

What murmur radiates to the carotid?

Answer 35

Aortic stenosis

Question 36

What murmur radiates to the axilla or back?

Answer 36

mitral regurge

Question 37

what murmur has a loud S1 and has an opening snap and is heard at the apex?

Answer 37

MS

Question 38

what murmur is blowing holosystolic and is heard best at apex or LLSB

Answer 38

MR

Question 39

What murmur is blowing early diastolic and heard at the LLSB (sometimes S3)

Answer 39

AI

Question 40

What murmur is a/w a water hammer pulse?

Answer 40

AI

Question 41

What murmur is heard at the RUSB during systole with an S4 heart sound?J

Answer 41

AS