Valvular Disease

Question 1

MR explain the relationship between volume status and Mitral regurg

Answer 1

Volume status plays a large role in MR symptomology when patients are volume up there MR will be much worse and vice versa.

Question 2

HOCM murmur louder and softer?

Answer 2

The patient has a murmur and a family history concerning for hypertrophic cardiomyopathy. The murmur of hypertrophic cardiomyopathy is due to left ventricular outflow tract obstruction secondary to septal hypertrophy and systolic anterior motion of the mitral valve. The classic description is noted above: a crescendo-decrescendo systolic murmur that begins after S1 and is heard best at the apex and lower left sternal border. Unlike aortic stenosis, this murmur does not usually radiate to the neck. Additionally, aortic stenosis is very rare in younger patients, as in this one.

The murmur associated with hypertrophic cardiomyopathy is less intense when the left ventricle is filled with more blood which keeps the outflow tract open longer and therefore diminishes the intensity. Anything that increases preload or increases afterload will decrease the murmur. Beta-blockers will increase preload by allowing more filling time during diastole and can therefore soften the murmur. Medications that decrease preload and end-diastolic filling, such as vasodilators and diuretics, should be used cautiously in these patients as these can worsen left ventricular outflow tract obstruction and heart failure symptoms.

Answer 3

Hypertrophic Cardiomyopathy Squatting: Decrease
Standing Increase Valsalva: Increase

Mitral Valve Prolapse Decrease Increase Increase
Aortic Stenosis Increase Decrease/No Change Decrease/No Change
Aortic Regurgitation Increase Decrease/No Change Decrease/No Change
Mitral Stenosis Increase Decrease/No Change Decrease/No Change
Mitral Regurgitation Increase Decrease/No Change Decrease/No Change
Flow Murmur Increase Decrease/No Change Decrease/No Change