Valvular Disease

Question 1

Aortic stenosis PE findings

Answer 1

bibasilar crackles, weak/delayed pulses, harsh systolic murmur radiating to the carotids

Question 2

Thin individuals often have more

Answer 2

vertically oriented hearts

Angle may be accentuated with obesity

Question 3

Which valves are associated w/ chord tendinaea and papillary mm

Answer 3

mitral and tricuspid (AV valves)

Question 4

S1 heart sound

Answer 4

MV and TV closing just prior to systole

Question 5

S2 heart sound

Answer 5

AV and PV closing at the end of systole

Question 6

Physiological splitting of S2

Answer 6

inspiration (decrease intrathoracic P, greater venous return, greater filling of Right heart, delayed closure of Pulmonic valve)

Question 7

S3 is heard typically in

Answer 7

older pts w/ HF

Question 8

S3 is heard d/t

Answer 8

oscillation of blood b/w ventricular walls during rapid filling (mid-diastole)

Question 9

S3 may be physiologic in

Answer 9

kids, competitive athletes,

pts < 40

Question 10

S4 is NEVER

Answer 10

physiologic

Question 11

S4 is heard d/t

Answer 11

atria contracting against a non-compliant ventricle

Question 12

S4 is heard typically in

Answer 12

Post-MI, fibrosis, LVH, aortic stenosis, chronic HTN

Question 13

Causes of Mitral Stenosis

Answer 13

Rheumatic, Congenital, Calcific, Post-Valvuloplasty

Question 14

PE findings in Mitral Stenosis

Answer 14

thrill at PMI, precordial bulge, malar flushing

Question 15

Heart Sounds associated w/ Mitral stenosis

Answer 15

Late diastolic low pitched “rumble” that merges w/ S1; opening snap

Question 16

Opening snap and late diastolic low pitched “rumble” that merges w/ S1

Answer 16

Mitral Stenosis

Question 17

Sx of Mitral Stenosis

Answer 17

exertional dyspnea, PND, Afib (d/t hypertrophy of Left atrium), Sx during pregnancy, palpitations, SOB

Question 18

Mild/Moderate Mitral Stenosis

Answer 18

Sx w/ exertion

Question 19

Severe Mitral Stenosis

Answer 19

reduced CO, RSHF, pHTN

Question 20

Treatment for Mitral Stenosis

Answer 20

balloon valvuloplasty, valve replacement, anticoags for Afib

Question 21

Mitral Regurgitation causes

Answer 21

Infective endocarditis, papillary mm dysfunction or rupture post-MI, chronic rheumatic disease

Question 22

Mitral Regurgitation PE findings

Answer 22

hyperdynamic PMI, brisk PMI + systolic thrill, brisk carotid upstroke

Question 23

Mitral Regurgitation Heart Sounds

Answer 23

pansystolic high pitched blowing/harsh murmur, S3

Question 24

Maneuvers that increase intensity of Mitral Regurgitation murmur

Answer 24

hand grip

Question 25

Maneuvers that decrease intensity of Mitral Regurgitation murmur

Answer 25

Valsalva, standing

Question 26

Sx of Mitral Regurgitation

Answer 26

asymptomatic, exertional dyspnea, fatigue, LSHF, LVH -> DCM and LAH -> AFib

Question 27

Mitral Valve Prolapse Causes

Answer 27

Hyperadrenergic state, often 10% in young, healthy females, CT disease (Marfan’s, Ehler-Danlos)

Question 28

Mitral Valve Prolapse Heart Sounds

Answer 28

mid-systolic click at apex + late systolic rumble

Question 29

Maneuvers that increase Mitral Valve Prolapse murmurs

Answer 29

Standing and Hand grip and possibly Valsalva (may inc or decr)

Question 30

Sx of Mitral Valve Prolapse

Answer 30

asymptomatic, chest pain, palpitations, fatigue, dyspnea

Question 31

Tx of Mitral Valve Prolapse

Answer 31

if hyperadrenergic -> b-Blockers+SSRI; Mitral valve repair, endocarditis prophylaxis

Question 32

Cause of Aortic Stenosis

Answer 32

Congenital (bicuspid valve), Calcific (Notch1 mut.), Dyslipidemia, HTN, smoking

Question 33

Findings w/ Aortic Stenosis

Answer 33

: sustained PMI, precordial heave, stsolic thrill over sternal notch, weak/late pulses

Question 34

Heart Sounds of Aortic Stenosis

Answer 34

Harsh crescendo-decrescendo murmur heart over R 2nd ICS transmitted to carotids

Question 35

Maneuvers that increase Aortic Stenosis murmur intensity

Answer 35

Standing

Question 36

Maneuvers that decrease Aortic Stenosis murmur intensity

Answer 36

Hand grip and Valsalva;

Question 37

Sx of Aortic Stenosis

Answer 37

angina, exertional syncope, exertional dyspnea

Question 38

Tx for Aortic Stenosis

Answer 38

valve replacement or balloon valvuloplasty

Question 39

Cause of Aortic Regurgitation

Answer 39

Rheumatic, congenital, infective endocarditis, HTN, Aortic route dilatation (Marfan’s), Inflammatory (AS, Reactive arthritis)

Question 40

Findings w/ Aortic Regurgitation

Answer 40

hyperdynamic PMI, visible carotid pulsations, prominent, rapidly rising and collapsing pulses (WIDE pulse pressures)

Question 41

Heart Sounds of Aortic Regurgitation

Answer 41

diastolic blowing murmur radiating to the R sternal border

Question 42

Sx of Aortic Regurgitation

Answer 42

: asymptomatic, exertional dyspnea, fatigue, PND, pulmonary edema, angina

Question 43

Tx of Aortic Regurgitation

Answer 43

b-Blockers, ARB, surgery if EF < 55%

Question 44

Cause of Tricuspid Stenosis

Answer 44

Rheumatic, carcinoid, Congenital, Post-TV rapair/replacement

Question 45

Findings w/ Tricuspid Stenosis

Answer 45

A-wave in JVP, peripheral edema, ascites

Question 46

Heart Sounds of Tricuspid Stenosis

Answer 46

low pitch rumbling radiating to apex

Question 47

Sx of Tricuspid Stenosis

Answer 47

RSHF, edema, ascites, Hepatiosplenomegaly

Question 48

Tx for Tricuspid Stenosis

Answer 48

diuretics, aldo inhibitors, valve replacement

Question 49

Causes of Tricuspid Regurgitation

Answer 49

secondary to dilated RV, RVH d/t MI, LSHF, pHTN, Sarcoidosis, IVDU

Question 50

Findings w/ Tricuspid Regurgitation

Answer 50

V-wave in JVP, peripheral edema, ascites, RV pulsation and pulsation of liver during systole

Question 51

Heart Sounds of Tricuspid Regurgitation

Answer 51

blowing, coarse systolic murmur

Question 52

Tx for Tricuspid Regurgitation

Answer 52

diuretics, valve replacement