Valvular Heart Disease

Question 1

what are the most common etiologies of VHD?

Answer 1

myxomatous degeneration (MVP)
congenital (bicuspid aortic valve)

Question 2

what causes a murmur?

Answer 2

turbulent blood flow across a valve or increased blood flow

Question 3

what are the systolic murmurs (S1)?

Answer 3

MR
TR
AS
PS
VSD
ASD

Question 4

what are the diastolic murmurs (S2)?

Answer 4

AI/AR
PI/PR
MS
TS
atrial myxoma

Question 5

1/6 murmur

Answer 5

barely audible

Question 6

2/6 murmur

Answer 6

faint, soft

Question 7

3/6 murmur

Answer 7

easily heard with a stethoscope

Question 8

4/6 murmur

Answer 8

very loud with palpable thrill (vibration)

Question 9

5/6 murmur

Answer 9

heard with stethoscope barely touching the chest with thrill

Question 10

6/6 murmur

Answer 10

can hear without stethoscope or can hear with stethoscope close to chest

palpable thrill

Question 11

what are the causes of MR?

Answer 11

ischemic papillary muscle dysfunction (CAD or MI)
ruptured chordae tendinae 
infective endocarditis
volume overload
MVP

Question 12

what is heard on auscultation with MR?

Answer 12

systolic murmur
blowing at apex
radiates to left axilla

Question 13

what is heard on auscultation with MVP?

Answer 13

systolic murmur at apex with click/murmur increased with standing

Question 14

what are the causes of TR?

Answer 14

pulm HTN
lung disease
RV infarction
inferior wall MI
pacemaker

Question 15

what is heard on auscultation with TR?

Answer 15

blowing, systolic murmur at the 4th ICS LSB

increases with inspiration (Carvallo sign)

Question 16

what causes AS?

Answer 16

degenerative calcification or bicuspid leaflets
pressure overload
LVH

Question 17

what is heard on auscultation with AS?

Answer 17

systolic murmur
crescendo-decrescendo
harsh 2nd ICS RSV
radiates into sternal notch/carotids
diminished S2

Question 18

what causes pulmonic stenosis?

Answer 18

congenital only

Question 19

what is heard on auscultation with PS?

Answer 19

systolic murmur
crescendo-decrescendo
2-3 ICS LSB
radiates to left shoulder/clavicle

Question 20

what is heard on auscultation with VSD?

Answer 20

holosystolic murmur
left lower sternal border with thrill
increases with handgrip

Question 21

what is heard on auscultation with ASD?

Answer 21

systolic murmur

upper LSB with fixed splitting of S2

Question 22

what causes mitral stenosis?

Answer 22

rheumatic heart disease
congenital
mitral annular calcification

Question 23

what is heard on auscultation with MS?

Answer 23

diastolic murmur
low pitch
rumbling at apex
increased S1 and S2 (P2) followed by opening snap

Question 24

what causes tricuspid stenosis?

Answer 24

rheumatic heart disease

Question 25

what is heard on auscultation with TS?

Answer 25

diastolic murmur
LSB
increases with inspiration (Carvallo sign)

Question 26

what causes aortic insufficiency/regurgitation?

Answer 26

infective endocarditis
aortic dissection
chest trauma
calcific degeneration
dilated aortic root
rheumatic heart disease

Question 27

what is heard on auscultation with AI/AR?

Answer 27

diastolic decrescendo murmur
3rd ICS 
LSB
can mimic MS
Soft S2 (A2)

Question 28

what other signs are associated with AI/AR?

Answer 28

DeMusset’s sign - head bob with beats
Quincke’s sign - capillary nail pulsations
Traube sign - “pistol shot” over femoral artery
Duroziez’s sign - diastolic murmur over femoral artery when compressed with stethoscope

Question 29

what causes pulmonary insufficiency/regurgitation?

Answer 29

Pulm HTN

Question 30

what is heard on auscultation with PI/PR?

Answer 30

diastolic decrescendo murmur
2nd ICS
LSB