Valve Disease

Question 1

What causes S1?

Answer 1

Closure of AV valves

Question 2

What causes S2?

Answer 2

Closure of SL valves

Question 3

In relation to S1 and S2 when does systole occur?

Answer 3

Between S1 and S2

Question 4

In relation to S1 and S2 when does diastole occur?

Answer 4

Between S2 and S1

Question 5

What is S3?

Answer 5

Vibration of ventricular wall as filling slows

Question 6

When does S3 occur?

Answer 6

Middle third of diastole

Question 7

When is S3 normal?

Answer 7

Children
Young adults
Pregnancy

Question 8

If pathological, what is S3 called?

Answer 8

Ventricular gallop

Question 9

If pathological what is S3 associated with?

Answer 9

CHF

Question 10

Where would you see S3 on a phonocardiogram?

Answer 10

Closer to and after S2

Question 11

When does S4 occur?

Answer 11

After atrial contraction

Question 12

In who can S4 be normal?

Answer 12

Elderly

Question 13

If pathological S4 is called?

Answer 13

Atrial gallop

Question 14

In what rhythm is S4 impossible, and why?

Answer 14

A fib, because atria arn’t contracting

Question 15

If pathological S4 can be seen with what conditions?

Answer 15

HTN
Atrial stenosis
Angina
MI

Question 16

Where would you see S4 on a phonocardiogram?

Answer 16

After S2 but closer to S1

Question 17

Where is auscultation of aortic valve?

Answer 17

Right sternal border

2nd intercostal space

Question 18

Where is auscultation of pulmonic valve?

Answer 18

Left sternal border

2nd intercostal space

Question 19

Where is auscultation of tricuspid valve?

Answer 19

Left sternal border

5th intercostal space

Question 20

Where is auscultation of mitral valve?

Answer 20

Mid-clavicular line

5th intercostal space

Question 21

What is valve stenosis?

Answer 21

Valve leaflets adhere and are difficult to open

Question 22

What is valve regurgitation/insufficiency?

Answer 22

Leaflets don’t seal and are difficult to close

Question 23

What causes the sound of a heart murmur?

Answer 23

Valve lesions cause turbulent flow which is heard as a murmur

Question 24

What valve diseases cause a systolic murmur?

Answer 24

Aortic stenosis

Mitral insufficiency

Question 25

What valve disease cause a diastolic murmur?

Answer 25

Aortic insufficiency | Mitral stenosis

Question 26

What murmur is the loudest of all the murmurs?

Answer 26

Aortic stenosis

Question 27

How does the normal valve function?

Answer 27

Responds to pressure gradients Opens easily Leaflet edges seal completely

Question 28

Describe a stenotic valve, it’s opening, and what kind of pressure is required

Answer 28

Stiff and calcified Difficult to open Requires greater pressure

Question 29

Describe the leaflets of a regurgent valve, and it’s seal

Answer 29

Leaflet edges are uneven Fails to seal so it leaks Difficult to close

Question 30

Which valves are the atrioventricular valves?

Answer 30

Right: tricuspid Left: mitral

Question 31

Which valves are the semilunar valves?

Answer 31

Right: pulmonic Left: aortic

Question 32

Systolic murmur would be heard when (in relation to S1 and S2)?

Answer 32

Between S1 and S2

Question 33

Diastolic murmurs would be heard when (in relation to S1 and S2)?

Answer 33

Between S2 and S1 | -think “luv dub whoosh”

Question 34

What is the primary hemodynamic effect of valve disease?

Answer 34

Decreased forward flow

Question 35

What are the secondary hemodynamic effects of valve disease?

Answer 35

Compensation maintains forward flow, but eventually decompensation occurs

Question 36

Some congenital syndromes involve what other valves?

Answer 36

Tricuspid or pulmonic

Question 37

In general adults get valve disease because of?

Answer 37

Congenital anomaly

Question 38

What other way does valve disease occur?

Answer 38

It’s acquired

Question 39

What causes chronic acquired valve disease?

Answer 39

Congenital anatomical anomaly Aging Associated disease: Marfan’s, lupus, cardiomyopathy, etc History of Rheumatic fever

Question 40

What causes acute acquired valve disease?

Answer 40

Acute events: Ischemia Endocarditis Trauma

Question 41

What is the problem with aortic valve disease?

Answer 41

Decreased forward SV

Question 42

What compensatory mechanisms occur with aortic valve disease?

Answer 42

LV hypertrophy | Increased blood volume

Question 43

Why does blood volume increase as a compensatory mechanism of aortic valve disease?

Answer 43

Decreased forward flows causes renal retention of fluid | RBCs increase in response to tissue hypoxia

Question 44

How does increased blood volume help compensate with aortic valve disease?

Answer 44

Helps maintain venous return | Increases LVEDP and LVEDV

Question 45

How does LV hypertrophy help with compensation of AV valve disease?

Answer 45

Hypertrophied muscle increases force of contraction

Question 46

How/why does AV valve disease lead to ischemia without CAD? (4)

Answer 46

Increased ventricular SBP inhibits coronary flow Increased muscle mass means increased O2 need Increased LVEDP means decreased CPP DBP is decreased in aortic regurgitation

Question 47

Anything that increases LVEDP decreases ______?

Answer 47

CPP

Question 48

CPP =

Answer 48

DBP-LVEDP

Question 49

What is the overall problem with mitral valve disease?

Answer 49

Decreased forward SV

Question 50

What are the compensatory mechanisms with MV disease?

Answer 50

Increased blood volume

Question 51

How does increased blood volume help compensate for MV disease?

Answer 51

Decreased forward SV causes renal retention which helps maintain venous return

Question 52

What are the consequences of MV disease? (4)

Answer 52

Enlarged LA Pulmonary edema Atrial dysrhythmia Loss of atrial kick

Question 53

What is the overall goal of valve disease?

Answer 53

Promote forward flow

Question 54

Stenotic valve diseases are described by?

Answer 54

Pressure gradient across the valve