Valvular disease

Question 1

What valvular diseases can cause a displaced, volume loaded apex beat?

Answer 1

AR

MR

Question 2

What valvular diseases can cause a non-displaced, sustained volume apex beat?

Answer 2

AS

Question 3

What are the physiological changes caused by AS?

Answer 3

Reduced CO
Compensatory increased HR- tachycardia
Reduced CO= reduced volume and narrow pulse pressure
LV hypertrophies

Question 4

What are the physiological changes caused by AR?

Answer 4

Diastolic return of blood back into the ventricle via the aortic valve
Increases preload
LV dilates
Compensatory increase in stroke volume
Overall, cardiac output increases
BP increases (e.g. 200/70)

Question 5

What are the physiological changes caused by MS?

Answer 5

Increased pressure in LA, as LA has to contract harder to fill LV
Dilatation of LA can cause AF

Question 6

What are the physiological changes caused by MR?

Answer 6

Gradual LA dilatation

LV dilatation

Question 7

What signs are caused by AS?

Answer 7

Tachycardia
Slow rising carotid pulse
Pressure loaded apex, non displaced
Systolic thrill
Ejection systolic murmur (crescendo decrescendo)

Question 8

What signs are caused by AR?

Answer 8

Large volume, collapsing pulse
Displaced apex
Volume loaded/hyperdynamic apex
Early diastolic murmur (decrescendo)

Question 9

What signs are caused by MS?

Answer 9

Irregularly irregular pulse (due to LA dilatation)
Tapping apex beat (opening snap of MS)
RV heave in severe MS
Very quiet mid diastolic murmur

Question 10

What signs are caused by MR?

Answer 10

Sometimes AF
Displaced apex beat (LV dilatation)
Apical pan-systolic murmur- radiating into apex

Question 11

What are the consequences of AS?

Answer 11

Pulmonary venous congestion
Episodes of acute pulmonary oedema
Left sided heart failure

Question 12

What are the consequences of AR?

Answer 12

Peripheral oedema

Left sided heart failure

Question 13

What are the consequences of MS?

Answer 13

Pulmonary venous congestion (inc LA pressure) = pulmonary oedema
Or, pulmonary hypertension
= RV hypertrophy and dilatation
= Tricuspid regurgitation
= Right heart failure

Question 14

What are the consequences of MR?

Answer 14

Pulmonary congestion
Left sided heart failure
= Right sided heart failure
Pulmonary hypertension

Question 15

What manoeuvre will accentuate a MR murmur?

Answer 15

Roll the patient onto their left side and listen over the mitral area with the diaphragm of the stethoscope during expiration

Question 16

What manoeuvre will accentuate a AS murmur?

Answer 16

Auscultate the carotid arteries using the diaphragm of the stethoscope whilst the patient holds their breath

Question 17

What manoeuvre will accentuate a AR murmur?

Answer 17

Sit the patient forwards and auscultate over the aortic area with the diaphragm of the stethoscope during expiration

Question 18

What murmur will lying on the left and listening with the diaphragm accentuate?

Answer 18

MR- Apical pan-systolic murmur- radiating into apex

Question 19

What murmur will lying on the left and listening with the bell accentuate?

Answer 19

MS- Very quiet mid diastolic murmur

Question 20

What murmur will sitting the patient forwards and auscultating over the aortic area with the diaphragm of the stethoscope during expiration accentuate?

Answer 20

AR- Early diastolic murmur (decrescendo)

Question 21

What murmur will auscultating the carotid arteries using the diaphragm of the stethoscope whilst the patient holds their breath accentuate?

Answer 21

AS- Ejection systolic murmur (crescendo decrescendo)

Question 22

What murmur will auscultating the carotid arteries using the diaphragm of the stethoscope whilst the patient holds their breath accentuate?

Answer 22

AS- Ejection systolic murmur (crescendo decrescendo)