murmurs

Question 1

Types of diastolic murmurs?

Answer 1

Aortic regurgitation, pulmonary regurgitation, mitral stenosis, tricuspid stenosis

Question 2

Type of systolic murmus?

Answer 2

Aortic stenosis
pulmonary stenosis
mitral regurgitation
Tricuspid regurgitation

Question 3

Causes of aortic stenosis

Answer 3

Acquired
- Calcific
-Rheumatic
- Prosthetic valve thrombosis
Congenital
- Bicuspid aortic valve

Question 4

Symptoms Aortic stenosis

Answer 4

DAS= dyspnea, angina, syncope

Pulsus parvus et tardus (=small, volume, slow-rising pulse)

Question 5

auscultation of Aortic stenosis

Answer 5

Mid-systolic crescendo-decrescendo
Possible S4
S2 - soft or absent

Question 6

Causes of Aortic regurgitation

Answer 6

Most common cause in systemic hypertension. 
Rheumatic
degenerative
congenital
connective tissue disorder
infectious endocarditis 
Bicuspid aortic valve
Aortic dissection
Trauma

Question 7

Symptoms Aortic regurgitation

Answer 7

Dyspnea - most common.
Duroziez sign - murmur over femoral artery when it is compressed.
Waterhammer pulse - forceful + rapidly ↑ and collapsing

Question 8

auscultation of Aortic regurgitation

Answer 8

Diastolic decrescendo murmur

S3 - w/dilated LV

Question 9

Treatment og aortic regurgitation

Answer 9

Salt restriction
Diuretics
Vasodilators
ACEi
β-blockers
Surgical when symptoms have developed or evidence of significant LV dysfunction.

Question 10

Mitral regurgitation causes?

Answer 10

infections, AMI, trauma, mitral valve prolapse, rheumatic heart disease, LVH

Question 11

Mitral regurgitation treatment

Answer 11

When waiting for surgery: ACE or ARB, Diuretics, Digoxin, anticoagulants in case of A-fib or thrombus.

Question 12

Mitral regurgitation auscultation

Answer 12

Pansystolic

S3

Question 13

Risk factors for heart disease

Answer 13

Major modifiable:

• Smoking (↑ HR+BP, platelet activation, coronary artery spams, LDL↑, ↓HDL)
• HTN (Goal: <140/90 or 130/80 in DM, can use ACEi, ARB, CCB, βblockers)
• Hyper/dyspilidemia
• DM ( ↑ platelet adhesion and aggregation, ↑ plasma coagulation)
• Obesity (LDL <1,8mmol/L)

Non-modifiable

• Age
• Gender (males)
• Family history

Other: Alcohol consumption, exercise, diet, uric acid and homocysteine levels.

Question 14

Secondary prevention of CV eventes

Answer 14

Lifestyle change
Drugs
- Statins
- Antiplatelet (clopidrogrel)
- ACEi, ARB
-β-blockers

Question 15

Silent ischemia classification

Answer 15

Chon’s classification
Class I: Totally asymptomatic pt. w/severe obstructive CAD
ClassII: Silent ischemia in pt.after dokumented MI
Class III: this form of ischemia occurs in patients with chronic stable angina, unstable angina or Prinzmetal angina, causing the pt. to be unable to tell that something «extraordinary» is happening. this is the most common type of silent ischemia.