Valve Abnormalities

Question 1

Systolic Murmurs

Answer 1

Mitral Regurg

Aortic Stenosis

Question 2

Diastolic Murmurs

Answer 2

Mitral Stenosis

Aortic Regurg

Question 3

Describe pressure and volume changes as they pertain to Mitral regurgitation

Answer 3

LV pressure is decreased

LV Volume is INCREASED

Question 4

Auscultatory sounds of MR

Answer 4

Holosysystolic murmur: loudest at the apex and radiates to the axilla

Present S3

Question 5

Causes of Mitral regurgitation

Answer 5

Ruptured papillary muscle in MI

Rheumatic heart disease

Mitral valve prolapse

infective endocarditis

dilated cardiomyopathy

Question 6

What is the best indicator o the severity of MR

Answer 6

audible S3

Question 7

Auscultatory findings of MVP

Answer 7

Mid systolic click followed by a mid-late systolic murmur

Question 8

Compare and contrast the changes in Acute, chronic and decompensated chronic MR as it pertains to:

preload:

afterload:

contractile function:

Ejection Fraction

forward stroke volume

Answer 8

Preload: All increased, most in acute MR

Afterload: Acute (decreased), Chronic (no change), Chronic Decompensated:(increased)

Contractile function: only chronic decompensated MR changes (decreased)

Ejection Fraction: Only decompensated MR decreases

Forward Stroke volume: Acute and decompensated decrease, chronic MR doesnt change

Question 9

Another name for MVP

Answer 9

Myxomatous Degeneration of the Mitral Valve

Question 10

Describe pressure and volume changes as they pertain to Aortic Stenosis

Answer 10

Describe pressure and volume changes as they pertain to LVEDP and LVEDV

Question 11

Auscultatory sounds of Aortic Stenosis

Answer 11

Harsh Crescendo-decrescendo systolic ejection murmur

loudest at the R upper sternal border with radiation to the carotids, down the left sternal border and the apex

S4

Question 12

Causes of Aortic Stenosis

Answer 12

senile degeneration/ calcification

Bicuspid/ Hypertrophic Aortic Valve

Rheumatic Endocarditis

Question 13

signs of fixed LV obstruction in Aortic Stenosis

Answer 13

weakened parvus and delayed tardus upstroke of the carotid

Question 14

what causes the S4 in Aortic Stenosis

Answer 14

Atrial contraction into the still LV

Question 15

Morphology of Aortic Stenosis

Answer 15

calcified valvular degeneration with nodular masses of calcium within the sinuses of the Valsalva fibrosa of the outflow surface

Question 16

Morphological differences between calcific aortic stenosis and congenital bicuspid aortic valve

Answer 16

Senile type: mounded calcified masses within the aortic cusps that ultimately protrude through te outflow surfaces into the sinuses of Valsava

Congenital Type: only 2 functional cusps f the valve, usually unequal in size with the larger having a midline raphe where calcified masses attach

Question 17

Complications/ Associations of Senile Aortic Stenosis

Answer 17

Cardiac decompensation

CHF

Question 18

Complications/ Associations of Congenital Bicuspid aortic valve

Answer 18

Aortic Stenosis

Aortic regurg

infective endocarditis

aortic dissection

Associated with loss of function mutations to NOTCH of chromosome 9

Question 19

Describe pressure and volume changes as they pertain to Aortic Regurg

Answer 19

increased LVEDV

decreased aortic diastolic pressure

Question 20

Auscultatory findings of Aortic Regurgitation

Answer 20

Blowing Diastolic decrescendo murmur

loudest along the left sternal border

radiation to the apex and right sternal border

best heard while leaning forward

Question 21

Causes of Aortic regurgitation

Answer 21

syphilitic aortitis

ankylosing spondylitis

RA

Marfan Syndrome

Question 22

signs of Aortic Regurgitation

Answer 22

laterally displaced apical impulse

Corrigan Pulse: sudden rise and drop in pressure

Quinke Pulse- atrial pulsation seen in the nailbed

DeMusset Sign: head bobbing

Muller sign: rhythmic pulsation of the uvula

Question 23

Describe pressure and volume changes as they pertain to Mitral stenosis

Answer 23

decreased pressure and volume

Question 24

Auscultatory findings of Mitral stenosis

Answer 24

delayed diastolic decrescendo murmur usually localized to the apex

Question 25

Auscultatory findings of Mitral stenosis

Answer 25

high pitched opening snap following S2 with a low rumbling descrescendo diastolic rumble

Question 26

how does one get dyspnea, hemoptysis and RHF from Mitra stenosis

Answer 26

**Dyspnea:** increase pulmonary venous pressure leads to transudation of plasma into lung interstitium and alveoli **Hemoptysis**: increased pulmonary venous pressure leads to collaterals opening between bronchial and pulmonary veins. rupturing of these veins causes hemoptysis **RF**: LF backflow

Question 27

most common cause of tricuspid regurgitation

Answer 27

IV Drug abuse

Question 28

clinical presentation of Rheumatic heart disease

Answer 28

Joint pain Carditis Nodules Erythema marginatum Sydenham Chorea 10days -6 weeks after a strep infection

Question 29

morphology of rheumatic heart disease

Answer 29

focal inflammatory lesions with Aschoff bodies and Anitschkow cells Inflammation of the endocardium with L sided valve fibrinoid necrosis within the tendinous cords small verrucous vegetations along the valve closure lines

Question 30

Clinical Presentation of Infective Endocarditis

Answer 30

splinter hemorrhages fever/ malaise arthralgias/myalgias hemorrhagic nontender lesions on palms and soles subQ nodules on the pulp of the digits retinal hemorrhages

Question 31

discern between acute subacute prosthetic valve endocarditis

Answer 31

**acute**: \< 2 weeks with quick progression **subacute**: \>2 weeks but \< 60 days with slow progression **prosthetic valve endocarditis:** onsets at least 60 days after surgery

Question 32

Auscultatory findings of Infective endocarditis

Answer 32

**Mitral valve regurg:** holosystolic murmur heard loudest at the apex and radiates to the axilla **Aortic regurg:** early diastolic murmur

Question 33

Morphology of infective endocarditis

Answer 33

friable bulky lesions containing inflammatory cells, fibrin and infectious bacteria that possibly erode into underlying myocardium possible access and fibrosis at the base of the erosions with calcification of tendinous cords and chronic inflammation

Question 34

complications of infectious endocarditis

Answer 34

bacterial thromboemboli formation of immune complexes and antibodies against tissue antigens glomerulonephritis Valve regurgitation heart block bacteremia

Question 35

causes of Nonbacterial thrombotic endocarditis

Answer 35

underlying trauma from an indwelling catheter malignancy hypercoagulability states autoimmune disorders

Question 36

Morphology of NBTE

Answer 36

deposition of small sterile thrombi on the leaflets of the cardiac valves without inflammatory reaction

Question 37

where do vegetations typically occur in Leibman Sachs Endocarditis

Answer 37

undersurfaces of the AV valves valvular endocardium chords mural endocardium of atria and ventricles

Question 38

complications of Leibman sachs endocarditis

Answer 38

mitral and tricuspid valvulitis