T3 L4: Valvular heart dysfunction

Question 1

What are murmers?

Answer 1

Sounds between diastole and systole

Question 2

What does a midsystolic murmer indicate?

Answer 2

Aortic stenosis, pulmonic stenosis, atrial septal defect or hypertrophic obstructive cardiomyopathy (HOCM)

Question 3

What does a holosystolic (throughout systole) murmur indicate?

Answer 3

Mitral regurgitation, tricuspid regurgitation or a ventricular septal defect

Question 4

What does a late systolic murmer indicate?

Answer 4

A mitral valve prolapse

Question 5

What is a valve prolapse?

Answer 5

When the valve doesn’t close smoothly or evenly often caused by overly stretchy valve leaflets

Question 6

What does a diastolic murmer indicate?

Answer 6

Aortic regurgitation, pulmonic regurgitation or austin-flint

Question 7

What is an austin-flint?

Answer 7

A murmer heard best at the apex of the heart. It can be indicative of severe aortic regurgitation

Question 8

What does a mid/late diastolic murmer indicate?

Answer 8

Mitral or tricuspid stenosis

Question 9

What is patent ductus arteriosus?

Answer 9

A condition when the ductus arteriosus fails to close and this will cause murmers

Question 10

When is the ‘lub’ sound heard?

Answer 10

S1, when the tricuspid and mitral valves close (beginning of systole)

Question 11

When is the ‘dub’ sound heard?

Answer 11

S2, when the aortic and pulmonary valves close ( end of systole/beginning of diastole)

Question 12

What is degenerative valve disease and what causes it?

Answer 12

When the valves fail to close properly because there’s a build up of calcification deposits

Question 13

Who is most likely to develop degenerative valve disease?

Answer 13

The aging population. The calcification deposits build up over time

Question 14

What causes rheumatic valve disease?

Answer 14

Post streptococcal rheumatic fever. Its a disease of poverty and overcrowding because in a developed community, the disease will be treated before the valve disease develops

Question 15

What is rheumatic fever and what causes it?

Answer 15

Streptococcus group A. It develops after a throat infection or scarlet fever

Question 16

Who is most likely to develop valvular disease caused by infection?

Answer 16

Those with ‘abnormal’ valves to begin with and the immunocompromised

Question 17

Which valve does rheumatic valve disease mostly affect and why?

Answer 17

The mitral valve because

Question 18

What is the SAD triad and what does it stand for?

Answer 18

A feature of severe aortic stenosis (Syncope, Angina, and Dyspnoea)

Question 19

Why does aortic stenosis cause left ventricular hypertrophy?

Answer 19

Because the blood fails to leave the left ventricle because the aortic valve isn’t opening enough so pressure builds up

Question 20

What happens in systole compared to diastole?

Answer 20

Blood flows out during systole and flows in during diastole

Question 21

Why does a quite murmur indicate higher severity of stenosis?

Answer 21

A quieter murmur indicates less turbulence but that means that the valve is opening less

Question 22

What does CREAM stand for with regards to aortic regurgitation?

Answer 22

Congenital
Rheumatic damage
Endocarditis
Aortic distention caused by high pressure 
Marfan's disease

Its the causes of the regurgitation

Question 23

Why does aortic regurgitation cause volume overload?

Answer 23

Because blood isn’t leaving the heart properly

Question 24

When would a murmur be heard with aortic regurgitation?

Answer 24

During early diastole because that when the blood flows

Question 25

What causes papillary muscle failure?

Answer 25

Ischaemia because it causes the muscles to stop working properly

Question 26

When would murmurs be heard with mitral regurgitation?

Answer 26

Throughout systole

Question 27

What is the main cause of mitral stenosis?

Answer 27

Rheumatic disease

Question 28

When would a mitral stenosis murmur be heard?

Answer 28

Mid-diastole as stenosis restricts blood flow across the mitral valve

Question 29

What is the gold standard diagnosis for valvular disease?

Answer 29

An echocardiography

Question 30

What are the 2 types of valves given as replacement?

Answer 30

Mechanical and biological

Question 31

What is patent ductus arteriosus?

Answer 31

When the ductus arteriosus doesn’t close before birth

Question 32

What causes cor-pulminarle?

Answer 32

The high pressure in the right ventricle and lungs that causes the right heart to fail