Valvular Heart Disease

Question 1

Etiologies of valvular heart disease

Answer 1

• Degenerative (senile calcification)
• Myxomatous degeneration (i.e. MVP)
• Congenital (bicuspid aortic valve)

Question 2

Which murmurs are heard during systole? (6)

Answer 2

MR/MVP
TR
AS
PS
VSD
ASD

Question 3

Which murmurs are heard during diastole? (5)

Answer 3

AR
PR
MS
TS
Atrial Myxoma

Question 4

Murmur grading:

1/6

Answer 4

1/6 = barely audible

1/6 = barely audible
2/6 = faint, soft
3/6 = louder, easily heard
4/6 = very loud with palpable thrill
5/6 = heard with stethoscope barely touching chest, with thrill
6/6 = can hear clearly without stethoscope or stethoscope close to chest, palpable thrill

Question 5

Murmur grading:

2/6

Answer 5

2/6 = faint, soft

1/6 = barely audible
2/6 = faint, soft
3/6 = louder, easily heard
4/6 = very loud with palpable thrill
5/6 = heard with stethoscope barely touching chest, with thrill
6/6 = can hear clearly without stethoscope or stethoscope close to chest, palpable thrill

Question 6

Murmur grading:

3/6

Answer 6

3/6 = louder, easily heard

1/6 = barely audible
2/6 = faint, soft
3/6 = louder, easily heard
4/6 = very loud with palpable thrill
5/6 = heard with stethoscope barely touching chest, with thrill
6/6 = can hear clearly without stethoscope or stethoscope close to chest, palpable thrill

Question 7

Murmur grading:

4/6

Answer 7

4/6 = very loud with palpable thrill

1/6 = barely audible
2/6 = faint, soft
3/6 = louder, easily heard
4/6 = very loud with palpable thrill
5/6 = heard with stethoscope barely touching chest, with thrill
6/6 = can hear clearly without stethoscope or stethoscope close to chest, palpable thrill

Question 8

Murmur grading:

5/6

Answer 8

5/6 = heard with stethoscope barely touching chest, with thrill

1/6 = barely audible
2/6 = faint, soft
3/6 = louder, easily heard
4/6 = very loud with palpable thrill
5/6 = heard with stethoscope barely touching chest, with thrill
6/6 = can hear clearly without stethoscope or stethoscope close to chest, palpable thrill

Question 9

Murmur grading:

6/6

Answer 9

6/6 = can hear clearly without stethoscope or stethoscope close to chest, palpable thrill

1/6 = barely audible
2/6 = faint, soft
3/6 = louder, easily heard
4/6 = very loud with palpable thrill
5/6 = heard with stethoscope barely touching chest, with thrill
6/6 = can hear clearly without stethoscope or stethoscope close to chest, palpable thrill

Question 10

Blowing systolic murmur at the apex, radiates to the left axilla

Answer 10

Mitral regurgitation (MR)

may progress to MVP if chronic

Question 11

Systolic murmur heard at the apex with midsystolic click. Murmur increases with Valsalva

Answer 11

Mitral valve prolapse (MVP)

*things just click when you play with the MVP

Question 12

Blowing systolic murmur heard at 4th ICS left sternal border. Increases on inspiration.

Answer 12

Tricuspid regurgitation (TR)

Question 13

Systolic cresendo-decresendo murmur heard at the 2nd ICS right sternal border. Radiates to carotids.

Answer 13

Aortic stenosis (AS)

*typically due to degenerative calcification

Question 14

Systolic cresendo-decresendo murmur heard at the 2nd ICS left sternal border. Radiates to left shoulder.

Answer 14

Pulmonic stenosis (PS)

*congenital eitiology

Question 15

Holosystolic murmur heard at the left lower sternal border. Increases with handgrip.

Answer 15

Ventricular septal defect (VSD)

Question 16

Systolic murmur heard at the upper left sternal border with fixed splitting of S2.

Answer 16

Atrial septal defect (ASD)

Question 17

Diastolic murmur heard with rumbling at the apex. Opening snap.

Answer 17

Mitral stenosis (MS)

Question 18

Diastolic murmur heard at the left sternal border that increases on inspiration.

Answer 18

Tricuspid stenosis (TS)

Question 19

Diastolic decresendo murmur heard at the 3rd ICS left sternal border. Wide pulse pressure. All kinds of signs named after people.

Answer 19

Aortic regurgitation / insufficiency (AR or AI)

Question 20

Diastolic decresendo murmur heard at the 2nd ICS left sternal border. Associated with pulm HTN.

Answer 20

Pulmonic regurgitation (PR or PI)