Right Heart Valvular Disease - Pulmonary Valve

Question 1

How many leaflets does the pulmonary valve have?

1 - 4
2 - 3
3 - 2
4 - 1

Answer 1

2 - 3
- however, some patients can have a bicuspid valve due to genetics

Question 2

Does the aortic valve open during systole or diastole?

Answer 2

• systole
• pumps blood around the body

Question 3

Does the aortic valve close during systole or diastole?

Answer 3

• diastole
• allows left ventricle to be filled

Question 4

When we listen to the heart we should be able to hear 2 separate sounds, S1 and S2. What does S1 relate to?

1 - closing of the tricuspid and mitral valves
2 - closing of tricuspid and aortic valves
3 - closing of mitral and aortic valves
4 - closing of aortic and pulmonary valves

Answer 4

1 - closing of the tricuspid and mitral valves
- also called the atrioventricular valves, as these 2 valves relate to the atrium

Question 5

Does the S1 heart sound occur at the start of diastole or systole?

Answer 5

• systole
• mitral and tricuspid valves close to stop blood moving back into the atrium

Question 6

When we listen to the heart we should be able to hear 2 separate sounds, S1 and S2. What does S2 relate to?

1 - closing of the tricuspid and mitral valves
2 - closing of tricuspid and aortic valves
3 - closing of mitral and aortic valves
4 - closing of aortic and pulmonary valves

Answer 6

4 - closing of aortic and pulmonary valves

Question 7

Does the S2 heart sound occur at the start of diastole or systole?

Answer 7

• diastole
• aortic and pulmonary valves close to allow atria to pump blood into ventricles

Question 8

In some patients a 3rd heart sound can be heard, S3, which occurs just after S2. What causes this 3rd heart sound?

1 - mitral regurgitation
2 - ventricular septal defect
3 - chordae tendineae pulling
4 - aortic regurgitation

Answer 8

3 - chordae tendineae pulling
- papillary muscles contract and pull chordae tendineae which attach to mitral valves

• sound is because they pull so hard to fully expand the left ventricle
• can be heard in some younger patients, BUT can signify HR in older patients

Question 9

All of the following are causes of pulmonary valve stenosis, but what is the leading cause?

1 - idiopathic/degenerative
2 - rheumatic
3 - congenital
4 - carcinoid syndrome

Answer 9

3 - congenital
- Tetralogy of Fallot = 4 congenital heart problems

Question 10

Patients may have all of the following symptoms, EXCEPT which one?

1 - dyspnoea
2 - fatigue
3 - malar flush
4 - oedema
5 - ascites

Answer 10

3 - malar flush
- flushing of the cheeks is not common

Question 11

Patients may have all of the following clinical signs, EXCEPT which one?

1 - renal failure
2 - raised JVP with a wave
3 - RV heave
4 - dysmorphic facies
5 - right ventricle hypertrophy

Answer 11

1 - renal failure
- not common

• dysmorphic facies = congenital defect affecting mental capacity and lack of language

Question 12

When a patient has pulmonary stenosis a murmur can be heard. At what time point around other heart sounds can this murmur be heard?

1 - after S2
2 - after S1
3 - after S3
4 - throughout S1 to S2

Answer 12

2 - after S1
- can radiate to the left shoulder
- can be heard as ejection click as the valve remains closed until the pressure builds up and forces it open

Question 13

All of the following are tests to diagnose a patient with suspected pulmonary regurgitation, but which generally provides a definitive diagnosis and is regularly used?

1 - echocardiogram
2 - ECG
3 - CXR
4 - transoesophageal echocardiogram
5 - cardiac catheterisation

Answer 13

1 - echocardiogram
- commonly used BUT cardiac catheterisation is diagnostic

• ECG will show RVH and potentially RBBB

Question 14

If a patient has significant pulmonary stenosis that is symptomatic, which 2 of the following should be performed (only 1 actually done though)?

1 - pulmonary valvotomy
2 - lifelong diuretics and BP medication
3 - monitor in hospital
4 - pulmonary valvuloplasty

Answer 14

1 - pulmonary valvotomy
4 - pulmonary valvuloplasty

Question 15

What is the leading cause of pulmonary valve regurgitation?

1 - idiopathic/degenerative
2 - rheumatic
3 - congenital
4 - pulmonary hypertension

Answer 15

4 - pulmonary hypertension
- cause if irrelevant, all forms can cause pulmonary valve regurgitation

Question 16

When a patient has pulmonary regurgitation a murmur can be heard. At what time point around other heart sounds can this murmur be heard?

1 - after S2
2 - after S1
3 - after S3
4 - throughout S1 to S2

Answer 16

1 - after S2

Question 17

In pulmonary regurgitation can result in all of the following, EXCEPT which one?

1 - eccentric RV hypertrophy
2 - left sided heart failure
3 - raised JVP
4 - peripheral oedema
5 - hepatosplenomegaly

Answer 17

2 - left sided heart failure
- leads to right sided heart failure

Question 18

All of the following are tests to diagnose a patient with suspected pulmonary regurgitation, but which generally provides a definitive diagnosis and is regularly used?

1 - echocardiogram
2 - ECG
3 - CXR
4 - transoesophageal echocardiogram
5 - cardiac catheterisation

Answer 18

1 - echocardiogram

Question 19

If a patient has significant pulmonary regurgitation that is symptomatic, which 2 of the following should be performed (only 1 actually done though)?

1 - pulmonary valvotomy
2 - lifelong diuretics and BP medication
3 - monitor in hospital
4 - pulmonary valvuloplasty

Answer 19

1 - pulmonary valvotomy
4 - pulmonary valvuloplasty

Question 20

Complete the table below using the labels below using systole or diastole of when you would hear the murmurs:

Answer 20