Valvular Heart Disease/Murmurs

Question 1

What are 3 etiologies of Valvular Heart Disease?

Answer 1

1. Degenerative (senile calficiation)
2. Myxomatous Degeneration
3. Congenital

Question 2

Murmurs result from?

Answer 2

Turbulence across a valve or increased blood flow

ex. anemia/pregnancy

Question 3

Stenosis impedes?

Answer 3

Forward flow

Question 4

What does stenosis lead to?

Answer 4

Pressure overload

=> Hypertrophy and heart failure

Question 5

Regurgitation is?

Answer 5

Reversal of flow, leaky valves or fail to close

Question 6

What does Regurgitation lead to?

Answer 6

Volume overload

=> Dilation

Question 7

What are 6 Systolic murmurs (between S1 and S2)?

Answer 7

Mitral Regurgitation
Tricuspid Regurgitation
Aortic Stenosis
Pulmonic Stenosis
VSD
ASD

Question 8

What are 6 systolic murmurs?

Answer 8

Mitral and Tricuspid Regurgitation
Aortic and Pulmonic Stenosis
VSD and ASD

Question 9

What are 4 Diastolic murmurs? (between S2 and S1)

Answer 9

Aortic Regurgitation
Pulmonic Regurgitation
Mitral Stenosis
Tricuspid Stenosis

Question 10

What are 4 diastolic murmurs?

Answer 10

Aortic and Pulmonic Regurgitation

Mitral and Tricuspid Stenosis

Question 11

Murmur grade 1

Answer 11

Barely audible

Question 12

Murmur grade 2

Answer 12

Soft and faint

Question 13

Murmur grade 3

Answer 13

Loud and easily heard

Question 14

Murmur grade 4

Answer 14

Loud with a thrill (palpable vibration)

Question 15

Murmur grade 5

Answer 15

Heard with stethoscope barely on chest and with a thrill (palpable vibration)

Question 16

Murmur grade 6

Answer 16

Heard without stethoscope on chest and with a thrill (palpable vibration)

Question 17

Mitral Regurgitation is associated with what?

Answer 17

Mitral Valve Prolapse

Question 18

Attributes and symptoms of Mitral Regurgitation

Answer 18

• Blowing at apex and radiates to axilla

- Variable clinical presentation

Question 19

Attributes and symptoms of Tricuspid Regurgitation

Answer 19

• Blowing at 4th ICS on left
• Increases on inspiration
• Prominent V wave in jugular venous pulse
• Asymptomatic

Question 20

Attributes and symptoms of Aortic Stenosis

Answer 20

• Crescendo-Decrescendo and radiates to sternal notch/carotids
• Narrow pulse pressure
• Parvus (weak) and Tardus (late) pulses
• Dyspnea, syncope, angina

Question 21

What will be seen on ECG with Aortic Stenosis if it causes LVH with strain?

Answer 21

Downsloping of ST segment

Question 22

Pulmonic stenosis is associated with?

Answer 22

Tetralogy of Fallot

Question 23

Attributes of Pulmonic Stenosis

Answer 23

• Crescendo-Decrescendo and radiates to left shoulder

Question 24

VSD is a ____ murmur

Answer 24

Holosystolic

Question 25

ASD involves?

Answer 25

Splitting of S2

Question 26

Attributes and symptoms of Mitral Stenosis

Answer 26

• Low pitch (use bell), rumbling and followed by opening snap
• Dyspnea, orthopnea, palpitations and hoarseness

Question 27

Attributes of Tricuspid Stenosis

Answer 27

• Increases with inspiration (carvallo sign)

- Prominent A wave in jugular vein

Question 28

Attributes of Aortic Regurgitation

Answer 28

• Decrescendo and wide pulse pressure
• • Demusset sign (head bobs with pulse)
• • Quincke’s sign (capillary nail pulsations)

Question 29

Acute and Chronic Aortic Regurgitation symptoms

Answer 29

Acute - pulmonary edema

Chronic - dyspnea, angina, orthopnea

Question 30

Attributes of Pulmonic Regurgitation

Answer 30

• Decrescendo

- - Associated with pulmonary hypertension

Question 31

Which valve murmurs are associated with the carvallo sign (increased with inspiration)?

Answer 31

Tricuspid

Question 32

Decrescendo murmurs

Answer 32

Aortic and Pulmonic Insufficiency (regurgitation)

Question 33

Crescendo-Decrescendo murmurs

Answer 33

Aortic and Pulmonic Stenosis