Valvular Heart Disesases

Question 1

When listening to a Heart murmur what five things are you determining

Answer 1

Write The Word Left to Right

What - Systolic/Diastolic
Type - pansystolic/ejection systolic/early diastole/mid diastole
Where - Loudest over which area A/P/T/M
Level - How loud is it (1 very quiet, 6 heard without a stethoscope.
Radiation - you can hear it in the carotids - Aortic stenosis, you can hear it in the axilla - mitral regurgitation, feel collapsing radial pulse - aortic regurgitation.

Question 2

Which type of murmurs are always pathological; systolic or diastolic?

Answer 2

Diastolic murmurs.

Question 3

Which type of murmurs get louder with inspiration?

(So which ones get louder with expiration?

Answer 3

Right sided ones, Pulmonary valve (due to decreasing intrathoracic pressure leads to more blood entering the right side of the heart.

Left sided ones.

Question 4

Why can you hear murmurs in the heart?

Answer 4

It is due to turbulent blood flow.

Question 5

Why can you sometimes hear a splitting of the second heart sound?

Answer 5

It is due to inspiration causing the pulmonary valve to close a tiny bit after the aortic valve.

Question 6

When and why does the fourth heart sound occur?

Answer 6

It occurs just before the first heart sound, it is due to reduced compliance of the ventricle walls when atrial contraction occurs causing a rumbling sound.

Question 7

What causes the fourth heart sound to occur?

Answer 7

Aortic stenosis, heart failure and Ischaemia.

Question 8

How would you treat aortic stenosis?

Answer 8

Prosthetic heart valve.

Question 9

What might you hear upon auscultation of a patient with aortic stenosis?

Answer 9

It would be during systole.
It would be an ejection systolic murmur (get louder then softer).
It would radiate to the carotids.
It would be best heard during expiration.

Question 10

What would you hear with someone that had aortic regurgitation?

Answer 10

It would be best heard upon expiration and in early diastole and it would get softer.
You would do the test where you bring them forward and breath in and out and hold their breath and you would listen on the left sternal edge.

Question 11

What type of murmur would give a patient a collapsing pulse?

Answer 11

Aortic regurgitation.

Question 12

What would you hear in a patient that had mitral stenosis?

Answer 12

It would be best heard during expiration and in mid/late diastole.
Loud clicking sound followed by a rumble.
You would do the turn on left side test.

Question 13

What valve problem would be in a patient that had a tapping apex beat?

Answer 13

Mitral stenosis

Question 14

What can rheumatic disease typically cause in people later on in life?

Answer 14

Mitral stenosis.

Also the other valve problems but most likely mitral stenosis.

Question 15

What can cause aortic regurgitation?

Answer 15

Infective endocarditis.
Arch of the aorta dissection.
Rheumatic disease.

Question 16

What can cause mitral regurgitation?

Answer 16

Papillary muscle rupture.
Chordae rupture.
Infective endocarditis.
Degenerative.

Question 17

What would you hear in a patient with mitral regurgitation?

Answer 17

It would radiate to the axilla.
It would be a pansystolic murmur.
(continuous sound).

Question 18

If someone has a patent ductus arteriosus, what will you hear during auscultation?

Answer 18

Constant sound throughout.

Question 19

How would you differentiate between pulmonary stenosis and an atrial septal defect as both can be best heard as ejection systolic murmurs and in the pulmonary area?

Answer 19

Atrial septal defects cause a wide splitting of the s2 sound.

Question 20

When do you hear pulmonary stenosis?

Answer 20

During Systole (ejection systolic).