Valve Diseases + Heart Sounds

Question 1

How many leaflets does the mitral valve have?

Answer 1

two - anterior and posterior

Question 2

What does the mitral valve separate?

Answer 2

left atrium and left ventricle

Question 3

Describe when the mitral valve is open and closed

Answer 3

closed during systole, so blood is pumped out via the aorta
open during diastole, so left ventricle can fill

Question 4

Describe the pathology of regurgitation

Answer 4

valve doesn’t close all the way, meaning some blood flows backwards

Question 5

Describe the pathology of stenosis

Answer 5

valve doesn’t open enough, limiting the volume of blood that can be pumped around the body

Question 6

What is the most common cause of mitral regurgitation?

Answer 6

mitral valve prolapse

Question 7

What is mitral valve prolapse?

Answer 7

weak connective tissue/heart strings means that the pressure in the ventricles during systole causes the leaflets of the mitral valve to fold up into the left atrium - in some cases the chordae tendineae can rupture

Question 8

List some possible causes of mitral valve prolapse

Answer 8

CTD’s e.g., Marfan’s, EDS

Question 9

Describe the heart murmur heard in mitral regurgitation

Answer 9

mid-systolic click followed by a systolic murmur

Question 10

What is the most common presentation of mitral regurgitation?

Answer 10

usually asymptomatic unless it causes complications

Question 11

What is unique about the murmur heard in mitral prolapse (+ hypertrophic cardiomyopathy)?

Answer 11

murmur is heard later when squatting and earlier when standing, due to changes in venous return

Question 12

List some causes of mitral regurgitation, other than mitral prolapse

Answer 12

damage from previous MI
left sided heart failure, leading to left ventricular dilation
rheumatic fever + rheumatic heart disease

Question 13

What can be a complication from mitral regurgitation?

Answer 13

left sided heart failure + hypertrophy

Question 14

What is the most common cause of mitral stenosis?

Answer 14

rheumatic fever

Question 15

Describe how rheumatic fever can cause mitral/aortic stenosis

Answer 15

inflammation causes commissural fusion of the valve leaflets

Question 16

Describe the pressure changes in the heart, caused by mitral stenosis

Answer 16

increased volume of blood in atrium increases the pressure in both the left AND right atria
there is higher pressure in pulmonary circulation (pulmonary hypertension)

Question 17

Describe the heart murmur heard in mitral stenosis

Answer 17

snap sound, followed by diastolic rumble

Question 18

Why is pulmonary congestion and oedema seen in mitral stenosis?

Answer 18

increased pressure in the left atrium leads to atrial dilation
blood can get ‘backed up’ into pulmonary circulation

Question 19

What is there an increased risk of in mitral stenosis?

Answer 19

AF (and therefore clot formation)

Question 20

Why may patients with mitral stenosis suffer from dysphagia?

Answer 20

dilated atria may compress the oesophagus

Question 21

What is the treatment for patients severely impacted my mitral regurgitation/stenosis?

Answer 21

valve repair or replacement surgeries

Question 22

How many leaflets make up the aortic valve?

Answer 22

three - left, right and posterior

Question 23

When is the aortic valve open and closed?

Answer 23

open during systole, to allow blood to be pumped to the rest of the body
closed during diastole, to allow blood to fill the ventricle

Question 24

What can cause aortic stenosis?

Answer 24

mechanical stress over time that damages endothelial cells
chronic rheumatic fever
bicuspid aortic valve

Question 25

What naturally-occurring structural difference can increase the risk of aortic stenosis?

Answer 25

having a bicuspid (instead of a tricuspid) aortic valve

Question 26

Describe the heart murmur heard in aortic stenosis

Answer 26

ejection 'click' systolic murmur gets louder and then quieter (crescendo -> decrescendo murmur)

Question 27

What is concentric left ventricular hypertrophy and why is it seen in aortic stenosis?

Answer 27

thickening of the wall of the LV, occurs in aortic stenosis because the LV needs to generate higher pressures to pump enough blood around the body

Question 28

What are two possible complications from aortic stenosis?

Answer 28

heart failure microangiopathic haemolytic anaemia

Question 29

What symptoms may be seen in aortic stenosis?

Answer 29

heart failure symptoms - breathlessness, oedema etc. syncope chest pain symptoms during exercise

Question 30

What is the treatment for aortic stenosis/regurgitation?

Answer 30

valve replacement after onset of symptoms

Question 31

Give another name for aortic regurgitation

Answer 31

aortic insufficiency

Question 32

What accounts for around 50% of causes of aortic regurgitation?

Answer 32

aortic root dilation, meaning the leaflets are pulled apart

Question 33

What can cause aortic regurgitation (other than aortic root dilation)?

Answer 33

valvular damage e.g., that seen in infective endocarditis chronic rheumatic fever

Question 34

Describe the heart murmur heard in aortic regurgitation

Answer 34

early decrescendo diastolic murmur

Question 35

How can aortic regurgitation affect blood pressure?

Answer 35

systolic BP may increase - more pressure needed due to higher stroke volume diastolic BP may reduce - due to lower blood volume during diastole

Question 36

What is pulse pressure?

Answer 36

systolic BP - diastolic BP

Question 37

What is the effect of aortic regurgitation on pulse pressure?

Answer 37

increases, due to higher systolic BP and lower diastolic BP

Question 38

What is meant by 'hyperdynamic circulation'?

Answer 38

pt has increased pulse pressure

Question 39

What are the signs of a high pulse pressure?

Answer 39

bounding pulse/water-hammer pulse this can cause head-bobbing in severe cases pulsating capillary beds of fingernails

Question 40

What causes S1?

Answer 40

closure of AV valves during systole

Question 41

What causes S2?

Answer 41

closure of semi-lunar valves during diastole

Question 42

Where should the mitral valve be auscultated?

Answer 42

over apex beat, in 5th intercostal space, left midclavicular line

Question 43

Where should the aortic valve be auscultated?

Answer 43

2nd intercostal space, right side of sternum

Question 44

Give an example of what could cause a split S1 heart sound

Answer 44

RBBB

Question 45

Why is S2 split?

Answer 45

the aortic valve closes slightly before the pulmonary valve