Valve disease

Question 1

pathway of blood through heart

Answer 1

1) body –> 2) inferior/superior vena cava –> 3) right atrium –> 4) tricuspid valve –> 5) right ventricle –> 6) pulmonary arteries –> 7) lungs –> 8) pulmonary veins –> 9) left atrium –> 10) mitral or bicuspid valve –> 11) left ventricle –> 12) aortic valve –> 13) aorta –> 14) body.

Question 2

systole

Answer 2

ventricle contract and the atrioventricular valves close and the semilunar valves open

Question 3

diastole

Answer 3

the semilunar valves close and the atrioventricular vales open

Question 4

Chordae tendineae and Papillary muscles

Answer 4

Prevent inversion of valves during
ventricular systole.
Can become damaged from MI
causing back flow “regurgitation”.

Question 5

what is the most common heart valve disease?

Answer 5

aortic stenosis

Question 6

Mitral Stenosis

Answer 6

Primarily occurs in females (66%)
Rheumatic heart disease- Primary Cause
Valve Leaflets don’t opening easily or completely
Decreases area and increases resistance to flow between A-V

Question 7

Mitral Regurgitation/Incompetence

Answer 7

MV does not close completely during systole (Incompetence)
Creates back flow (Regurgitation)
Stroke Volume increase to compensate for back flow
Eccentric hypertrophy to accommodate increased volume
L Atrium dilates due to back pressure

Question 8

Mitral Regurgitation/Incompetence epidemiology

Answer 8

20% people >55y/o have some degree of mitral regurgitation

~1/3 of all cases are caused by rheumatic heart disease.

Question 9

Mitral Regurgitation/Incompetence signs and symptoms

Answer 9

Anxiety and palpitations w/ exercise

Question 10

Mitral Valve Prolapse

Answer 10

LA Dilates
Pulmonary Congestion
left ventricular hypertrophy to compensate

Question 11

Mitral Valve Prolapse symptoms

Answer 11

Dyspnea of Exertion, Murmur

Question 12

Aortic Stenosis

Answer 12

Thickening, calcification, or both

Question 13

Aortic Stenosis epidemiology

Answer 13

~25% of the population >65y/o

Calcific aortic stenosis and congenital bicuspid aortic valve stenosis account for the overwhelming majority of cases

Question 14

Aortic Stenosis symptoms

Answer 14

Volume Overload- LVH to compensate

Dyspnea of Exertion

Suppressed BP Response

Orthopnea

Murmur

Question 15

Aortic Regurgitation/Incompetence causes

Answer 15

Congenital, rheumatic, endocarditis, age, chronic HTN

Question 16

Aortic Regurgitation/Incompetence volume overload

Answer 16

LV Dilates, possible LV & LA Conc Hypertrophy (late stage)

No pulmonary symptoms until very advanced stages

Question 17

Aortic Regurgitation/Incompetence symptoms

Answer 17

Dyspnea of Exertion

Murmur

Question 18

Exercise Considerations for aortic stenosis

Answer 18

Asymptomatic aortic stenosis: intensity should be low and progressed gradually

Question 19

Exercise Considerations for all valve disease

Answer 19

Suppressed BP response to exercise, possibly exaggerated HR
Angina may be a symptom but a predictable intensity/workload
Patients with symptomatic valve disease are typically not candidates for exercise programs!

Question 20

Pericarditis

Answer 20

Swelling and Irritation of the pericardium

Question 21

Pericarditis causes

Answer 21

Viral infections, Bacterial infections (less common), Fungal infections (rare)
May occur due to a heart attack, radiation
therapy and post open heart surgery

Question 22

Pericarditis symptoms

Answer 22

Sharp retrosternal pain with radiation to the back (lasting hours), fever,
Pain worsens with deep breathing or coughing
and when laying flat.
Pain is improved while sitting up and leaning forward
Friction rub on auscultation

Question 23

Pericardial Effusion

Answer 23

Accumulation of fluid in the pericardial sac.

Question 24

Pericardial Effusion causes

Answer 24

Viral infections, Bacterial infections (less common), Fungal infections (rare)
May occur due to a heart attack, radiation
therapy and post open heart surgery

Question 25

Pericardial Effusion symptoms

Answer 25

Pressure pain in chest, dysphagia, | dyspnea,

Question 26

Auscultation aortic region

Answer 26

Right 2nd intercostal space, parasternal

Question 27

Auscultation pulmonic region

Answer 27

Left 2nd intercostal space, parasternal

Question 28

Auscultation tricuspid region

Answer 28

Left 4th or 5th intercostal space, parasternal

Question 29

Auscultation mitral region

Answer 29

Left 4th or 5th intercostal space, midclavicular

Question 30

Apical Pulse Measurement

Answer 30

``` Most accurate measurement of heart rate by clinical examination. 5th intercostal space at the mid clavicular line Use when irregular rhythms are detected on exam. ```

Question 31

S1 “Lub” The first heart sound

Answer 31

Closure of the AV valves (Tricuspid and Mitral) Occurs with ventricular contraction Marks the approximate beginning of systole.

Question 32

S2 “Dub” The second heart sound

Answer 32

Closure of the Semilunar valves (Aortic and Pulmonic). Marks the end of systole and the beginning of ventricular relaxation (diastole).

Question 33

Splitting S1

Answer 33

Mitral and Triscupid valve sounds (M1 and T1) are slightly asychronous. Mitral closure may precede tricuspid closure by 20 to 30 msec (0.02 to 0.03 sec.). This is generally normal.

Question 34

Splitting S1 abnormalities

Answer 34

Wide splitting of the first sound is almost always abnormal and warrants further medical examination.

Question 35

Splitting S2

Answer 35

Two components, aortic (A2) and pulmonic sounds (P2), | (S2) is of shorter duration and higher frequency than S1.

Question 36

Physiologic splitting S2

Answer 36

is demonstrated during inspiration in healthy individuals, primarily due to a delayed P2. Common in children and well condition athletes

Question 37

Persistent splitting S2

Answer 37

may occur in supine or recumbent position however, the split should resolve on expiration following sitting, standing, or a Valsalva maneuver.

Question 38

S3 gallop

Answer 38

occurs at the beginning of diastole after S2 and is lower in pitch than S1 or S2 as it is not of valvular origin. Indicative of ventricular failure. you hear a slosh sound

Question 39

S4 gallop

Answer 39

Occurs prior to S1, produced by the sound of blood being forced into a stiff or hypertrophic ventricle. Indicative of LVH or HCM you hear a stiff wall

Question 40

Murmur

Answer 40

Extra sounds during the cardiac cycle, such as whooshing or swishing made by turbulent blood flow often due to a faulty valve or structural changes in the myocardium.

Question 41

Friction rub

Answer 41

Often due to pericarditis or pleuritis (lungs) | Place hand over ear and rub finger over hand, this is what a friction rub sounds like

Question 42

Murmurs should be assessed on the | following characteristics:

Answer 42

shape, location, timing, intensity and pitch

Question 43

Murmurs location

Answer 43

Determined by the site where the murmur originates A, P, T, M listening areas

Question 44

murmurs intensity

Answer 44

``` Graded on a 6 point scale Grade 1 = very faint Grade 2 = quiet but heard immediately Grade 3 = moderately loud Grade 4 = loud* Grade 5 = heard with stethoscope partly off the chest* Grade 6 = no stethoscope needed* ```