Valve disease

Question 1

Causes:

• Rheumatic heart dz
• LV dilation
• Coronary heart disease, damaging papillary muscle
• Mitral valve prolapse
• Infective endocarditis

Answer 1

Mitral regurgitation

Question 2

In mitral regurg, the blood flows from where to where?

Answer 2

Backwards from the LV to the LA

Question 3

LV volume increases progressively as severity of _____ _____ increases.

Answer 3

Mitral regurg

Question 4

LV function- well preserved initially; often deteriorates in later stages as does cardiac output (CO). LV compensates for volume overload via the Starling mechanism.

Answer 4

Mitral regurg

Question 5

Often asymptomatic for years

Fatigue, DOE, orthopnea- symptoms of left sided heart failure (detailed discussion later in CV system).

Answer 5

Mitral regurg

Question 6

Murmur over second right intercostal space
Mid systolic
Medium pitch; harsh

Answer 6

Aortic stenosis

Question 7

Carotid pulses are thready in aortic….

Answer 7

Stenosis

Question 8

Bounding pulses with widened pulse pressures are found in..

Answer 8

Aortic regurg (insufficiency)

Question 9

Murmur heard 2-4th LICS
*systolic and diastolic decrescendo
High pitch, blowing

Answer 9

Aortic regurgitation

Question 10

Murmur at apex
Diastolic
Low pitch

Answer 10

Mitral stenosis

Question 11

Murmur at apex
Systolic
Medium to high pitch, blowing

Answer 11

Mitral regurg

Question 12

____ murmurs are intensified when pt sits up and leans forward

Answer 12

Aortic

Question 13

____ murmurs are intensified when pt lays on left side (decubitus position)

Answer 13

Mitral

Question 14

Mid to late systolic click
High pitched late systolic murmur heard best at apex

*improves with squatting (heard louder when standing)

Answer 14

Mitral valve prolapse

Question 15

Right sided murmurs heard best with..

Answer 15

Inspiration

Question 16

Right ventricular outflow obstruction of blood

*almost always congenital…a dz of the young

Answer 16

Pulmonic stenosis

Question 17

Harsh mid systolic ejection cresc-decrescendo murmur (maximal at LUSB) radiates to neck

• *increases w inspiration
• signs of right sided HF
• systolic ejection click

Answer 17

Pulmonic stenosis

Question 18

Most commonly caused by pulmonary hypertension

Retrograde of blood flow from pulmonary after into right ventricle..R sided volume overload

Answer 18

Pulmonic stenosis

Question 19

Graham Steell Murmur: brief, decrescendo early diastolic murmur at LUSB (2nd LICS) with full inspiration

Answer 19

Pulmonic regurg

Question 20

Blood backs up into R atria…R atrial enlargement leading to R sided failure
*mid diastolic rumble at L lower sternal border

Answer 20

Tricuspid stenosis

Question 21

Blood flows from LV into LA
*sx of L sided HF
*systolic murmur (usually holosystolic)
**if severe enough, can have S3 gallop
HIGH PITCHED AND BLOWING*

Answer 21

Mitral regurg

Question 22

Females more common
Age 15-30
Arrhythmias common (PACs, PVCs, PSVT, etc)
*myxomatous degeneration of MV leaflet tissue

Answer 22

Mitral valve prolapse

Question 23

Valve leaflets thicken and calcify

*mostly caused by rheumatic fever

Answer 23

Mitral stenosis

Question 24

L atrial pressure rises in order to propel blood across the stenotic valve
*pulmonary congestion can develop

Answer 24

Mitral stenosis

Question 25

DOE, orthopnea
PACs, A fib**, A flutter

Opening “snap” of MV-apex heard after S2
Diastolic rumble after

Answer 25

Mitral stenosis

“lub dub snap”

Question 26

Percutaneous balloon valvuloplasty should be the first step in treating..

Answer 26

Mitral stenosis!!

Question 27

“wear and tear”
thickening/calcification without fusing
*seen commonly in aging

Answer 27

Aortic stenosis

Question 28

What happens to L ventricular pressure in aortic stenosis?

Answer 28

Increases!!

but the aortic pressure will be normal, so there will be a large gradient across the aortic valve

Question 29

Obstruction to LV outflow
Systolic gradient between LV and aorta
*cardiac output normal at rest but does not adequately rise w activity

Answer 29

Aortic stenosis

Question 30

Exertional dyspnea, Angina, Syncope

• S4 common
• Crescendo-decrescendo in mid to late systole
• harsh, low pitched
• best heard at base, radiates to carotids

Answer 30

Aortic stenosis

Question 31

Ace inhibitors and ARBs may decrease mortality in which valvular dz

Answer 31

Aortic stenosis

can replace valve if severe enough

Question 32

is Transcatheter Aortic Valve Implantation is a good technique?

Answer 32

No…lots of complications

Basically a last ditch effort

Question 33

75% male
Rheumatic heart dz
Infective endocarditis on previously deformed valve
Aortic root dz and dilation
Bicuspid aortic valve

Answer 33

Aortic regurg

Question 34

Increase LVEDV (Preload)
LV dilates to allow increased SV

*over time, LV function gradually declines and EF deteriorates

Answer 34

Aortic regurg

Question 35

Arterial pulse: rapid rising “water hammer pulse” and collapsing pulse

Answer 35

Aortic regurg

Question 36

“Quinke’s pulse”: alternate flushing and palling of the skin at nail root

• Pistol shot sound over femoral artery in systole
• Arterial pulse pressure widened

Answer 36

Aortic regurg

Question 37

Apex displaced laterally/inferiorly

• diastolic thrill may be present along LSB
• S3 common: high pitched, blowing diastolic decrescendo murmur (LSB)

BEST HEARD W DIAPHRAGM W PATIENT SITTING UPRIGHT/LEANING FORWARD

Answer 37

Aortic regurg

Question 38

Tx like CHF..AFTERLOAD REDUCTION WITH VASODILATORS

Answer 38

Aortic regurg

can also replace valve