OnlineMedEd: Cardiology - "Valvular Disease"

Question 1

Review the murmur grading system.

Answer 1

• I: S1 and S2 are louder than the murmur
• II: S1 and S2 are equal to the murmur
• III: S1 and S2 are softer than the murmur
• IV: III criteria plus a palpable thrill
• V: being able to hear the murmur with the stethoscope half off the chest
• VI: hearing the murmur without a stethoscope

Question 2

What murmurs need to be worked up?

Answer 2

• Systolic murmurs greater than II/VI intensity

* Any diastolic murmur

Question 3

Murmurs that need to be worked up should be evaluated with _______________.

Answer 3

echocardiography

Question 4

Mitral stenosis leads to what blood flow abnormality?

Answer 4

Pulmonary edema

Question 5

Patients with mitral stenosis often present with two other cardiac disorders: ______________.

Answer 5

CHF or atrial fibrillation

Question 6

Mitral stenosis causes what murmur?

Answer 6

Rumbling diastolic murmur with an opening snap that radiates to the axilla

Question 7

Why is the first-line treatment for mitral stenosis balloon valvuloplasty?

Answer 7

Patients with mitral stenosis are usually much younger than other valvular patients, and artificial valves don’t last very long. Valve replacement requires sternotomies, and you want to avoid repeat sternotomies in a young person.

Question 8

Discuss the different presentations of acute and chronic aortic insufficiency.

Answer 8

• Acute (often caused by aortic dissection):

• Cardiogenic shock
• Sudden pulmonary edema
• Chest pain

•Chronic:
- CHF

Question 9

Aortic insufficiency results in what murmur?

Answer 9

Early diastolic decrescendo murmur heard over the base of the heart

Question 10

The only treatment for aortic insufficiency is _______________.

Answer 10

valve replacement

Question 11

The two etiologies of mitral insufficiency are _______________.

Answer 11

infection and infarction

Question 12

The acute and chronic presentations of mitral insufficiency are very similar to _______________.

Answer 12

aortic insufficiency: acute (cardiogenic shock and flash pulmonary edema) and chronic (CHF and atrial fibrillation)

Question 13

People with HOCM typically have mutations in _____________.

Answer 13

the sarcomere

Question 14

HOCM and aortic stenosis both present with systolic ejection murmurs. How can you differentiate the two?

Answer 14

The murmur of AS increases with increased preload, while that of HOCM decreases with increased preload.

Question 15

Like HOCM, the treatment for ______________ also entails beta-blockade and avoidance of dehydration.

Answer 15

mitral valve prolapse