Podcast
Questions and Answers
During which phase of the cardiac cycle is the mitral valve closed?
During which phase of the cardiac cycle is the mitral valve closed?
When does aortic insufficiency typically occur?
When does aortic insufficiency typically occur?
If the aortic valve is open, what phase is the pulmonic valve likely in?
If the aortic valve is open, what phase is the pulmonic valve likely in?
A murmur caused by a ventricular septal defect (VSD) is most likely heard during which phase?
A murmur caused by a ventricular septal defect (VSD) is most likely heard during which phase?
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Mitral valve regurgitation due to myocardial ischemia is most likely caused by dysfunction of which structures?
Mitral valve regurgitation due to myocardial ischemia is most likely caused by dysfunction of which structures?
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Where is a murmur caused by papillary muscle rupture typically loudest?
Where is a murmur caused by papillary muscle rupture typically loudest?
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When does mitral stenosis typically produce a murmur?
When does mitral stenosis typically produce a murmur?
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Which of the following is considered a surgical emergency?
Which of the following is considered a surgical emergency?
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During which phase of the cardiac cycle are the coronary arteries primarily perfused?
During which phase of the cardiac cycle are the coronary arteries primarily perfused?
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What causes the normal heart sounds, S1 and S2?
What causes the normal heart sounds, S1 and S2?
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What condition is associated with the murmur heard during diastole when the atrioventricular valves are open?
What condition is associated with the murmur heard during diastole when the atrioventricular valves are open?
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Which of the following best describes murmurs of insufficiency?
Which of the following best describes murmurs of insufficiency?
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If a patient has a systolic murmur due to mitral insufficiency, when would the murmur be present?
If a patient has a systolic murmur due to mitral insufficiency, when would the murmur be present?
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A patient with a bicuspid aortic valve is at higher risk for developing which valvular disease?
A patient with a bicuspid aortic valve is at higher risk for developing which valvular disease?
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If a patient has a systolic murmur heard at the left sternal border, 5th intercostal space, what might be the potential underlying condition?
If a patient has a systolic murmur heard at the left sternal border, 5th intercostal space, what might be the potential underlying condition?
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Why does cardiac output and blood pressure decrease with rapid heart rates?
Why does cardiac output and blood pressure decrease with rapid heart rates?
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Which condition is associated with atrial enlargement due to long term issues, that can lead to atrial fibrillation?
Which condition is associated with atrial enlargement due to long term issues, that can lead to atrial fibrillation?
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During which part of the cardiac cycle are the semilunar valves open?
During which part of the cardiac cycle are the semilunar valves open?
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A patient's heart murmur is heard during systole. Which of the following conditions could be the cause?
A patient's heart murmur is heard during systole. Which of the following conditions could be the cause?
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Which of the following is a cause of valvular disease that is genetic?
Which of the following is a cause of valvular disease that is genetic?
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A murmur of insufficiency is heard when which of these is true?
A murmur of insufficiency is heard when which of these is true?
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If a patient has a murmur indicative of tricuspid insufficiency, during which phase of the cardiac cycle would this murmur be heard?
If a patient has a murmur indicative of tricuspid insufficiency, during which phase of the cardiac cycle would this murmur be heard?
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Which of these statements best explains why coronary perfusion is highest during diastole?
Which of these statements best explains why coronary perfusion is highest during diastole?
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Which cardiac valve pathology is always chronic in nature?
Which cardiac valve pathology is always chronic in nature?
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A patient has a diastolic murmur, which of the following valvular conditions is the most likely cause?
A patient has a diastolic murmur, which of the following valvular conditions is the most likely cause?
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What causes heart valves to open and close?
What causes heart valves to open and close?
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A patient presenting with a ventricular septal defect (VSD) due to an acute MI would most likely have which type of murmur?
A patient presenting with a ventricular septal defect (VSD) due to an acute MI would most likely have which type of murmur?
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In a patient with mitral stenosis, why might atrial fibrillation develop over time?
In a patient with mitral stenosis, why might atrial fibrillation develop over time?
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What occurs when the mitral valve is open?
What occurs when the mitral valve is open?
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What phase occurs when the aortic valve is open?
What phase occurs when the aortic valve is open?
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Which valve is typically closed during Diastole?
Which valve is typically closed during Diastole?
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What is a key sign of acute mitral valve regurgitation?
What is a key sign of acute mitral valve regurgitation?
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During which phase is a ventricular septal defect (VSD) murmur typically heard?
During which phase is a ventricular septal defect (VSD) murmur typically heard?
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Which condition indicates a surgical emergency due to mitral valve function?
Which condition indicates a surgical emergency due to mitral valve function?
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Where is the murmur associated with aortic insufficiency typically best heard?
Where is the murmur associated with aortic insufficiency typically best heard?
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What structure attaches the mitral valve to the left ventricle wall?
What structure attaches the mitral valve to the left ventricle wall?
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If the tricuspid valve is open, which phase of the cardiac cycle is most likely occurring?
If the tricuspid valve is open, which phase of the cardiac cycle is most likely occurring?
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Aortic stenosis is characterized by a murmur that is auscultated when the aortic valve is:
Aortic stenosis is characterized by a murmur that is auscultated when the aortic valve is:
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Which of the following valve conditions occurs when the respective valve is closed?
Which of the following valve conditions occurs when the respective valve is closed?
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During which phase is the pulmonic valve typically closed?
During which phase is the pulmonic valve typically closed?
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A patient is experiencing acute mitral valve regurgitation following a myocardial infarction. Dysfunction of which structures are most likely the cause?
A patient is experiencing acute mitral valve regurgitation following a myocardial infarction. Dysfunction of which structures are most likely the cause?
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A murmur associated with a ventricular septal defect (VSD) is typically heard during which cardiac phase?
A murmur associated with a ventricular septal defect (VSD) is typically heard during which cardiac phase?
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Which of the following would be considered a high-grade and surgical emergency?
Which of the following would be considered a high-grade and surgical emergency?
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Mitral valve stenosis is characterized by a murmur that occurs when the mitral valve is:
Mitral valve stenosis is characterized by a murmur that occurs when the mitral valve is:
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During which phase of the cardiac cycle does the pressure in the ventricle exceed the pressure in the aorta, causing the aortic valve to open?
During which phase of the cardiac cycle does the pressure in the ventricle exceed the pressure in the aorta, causing the aortic valve to open?
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A patient is found to have a murmur that increases in intensity as the cardiac cycle progresses towards the second heart sound (S2). What type of murmur is most likely present?
A patient is found to have a murmur that increases in intensity as the cardiac cycle progresses towards the second heart sound (S2). What type of murmur is most likely present?
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A patient with a history of rheumatic fever is most likely to develop which valvular heart condition?
A patient with a history of rheumatic fever is most likely to develop which valvular heart condition?
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Which of the following best describes the mechanism that prevents backflow of blood through the aortic valve during diastole?
Which of the following best describes the mechanism that prevents backflow of blood through the aortic valve during diastole?
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Which statement correctly describes the timing of murmurs associated with valvular insufficiency?
Which statement correctly describes the timing of murmurs associated with valvular insufficiency?
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A patient with a rapid heart rate develops symptoms of decreased cardiac output and low blood pressure. Which underlying physiological process is the MOST likely cause?
A patient with a rapid heart rate develops symptoms of decreased cardiac output and low blood pressure. Which underlying physiological process is the MOST likely cause?
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A patient’s echocardiogram shows an enlarged left atrium with a long standing history of a mitral valve disorder. Which of the following is the MOST likely underlying cause?
A patient’s echocardiogram shows an enlarged left atrium with a long standing history of a mitral valve disorder. Which of the following is the MOST likely underlying cause?
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Which of the following is MOST accurate regarding the effect of cardiac cycle length, on coronary artery perfusion?
Which of the following is MOST accurate regarding the effect of cardiac cycle length, on coronary artery perfusion?
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A patient is found to have a 'lub-dub-shhh' murmur. Which of the following valvular conditions is MOST likely?
A patient is found to have a 'lub-dub-shhh' murmur. Which of the following valvular conditions is MOST likely?
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A ventricular septal defect (VSD) may result in a systolic murmur. Where is it most likely to be heard in this case?
A ventricular septal defect (VSD) may result in a systolic murmur. Where is it most likely to be heard in this case?
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Study Notes
Valvular Heart Disease
- Four heart valves can be affected by stenosis (narrowing) or insufficiency (regurgitation)
- Normal heart sounds (S1 and S2) are from valve closures
- Valves open/close based on pressure differences above and below them
- Systolic: high pressure, ejection
- Diastolic: low pressure, filling (longer than systole)
- Coronaries are perfused during diastole
- Reduced filling time lowers cardiac output, especially in tachyarrhythmias
- Pressure above valve higher than below-->valve opens
- Pressure above valve lower than below-->valve closes
Causes of Valvular Disease
- Coronary artery disease, ischemia, acute myocardial infarction
- Dilated cardiomyopathy
- Degeneration
- Bicuspid aortic valve (genetic)
- Rheumatic fever
- Infections
- Connective tissue disease
Murmurs
- Murmurs of insufficiency (regurgitation) occur when the valve is closed
- Can be acute or chronic
- Murmurs of stenosis occur when the valve is open
- Stenosis is always chronic, develops over time
- Stenosis is never acute
Systolic Murmurs
- Semilunar valves open during systole
- Aortic/pulmonic stenosis
- AV valves closed during systole
- Mitral insufficiency (large V waves on pulmonary artery occlusion tracing)
- Tricuspid insufficiency
Diastolic Murmurs
- Semilunar valves closed during diastole
- Aortic insufficiency
- Pulmonary insufficiency
- Mitral stenosis (associated with atrial fibrillation)
- Tricuspid stenosis
Murmur Summary
- Mitral insufficiency: murmur occurs when the mitral valve is closed (systole)
- Mitral stenosis: murmur occurs when the mitral valve is open (diastole)
- Aortic insufficiency: murmur occurs when the aortic valve is closed (diastole)
- Aortic stenosis: murmur occurs when the aortic valve is open (systole)
Murmurs and VSD
- Ventricular septal defect (VSD) is common in acute myocardial infarction (MI)
- Can lead to systolic murmur
- Murmurs during ejection/systole
- Associated with acute MI
Valve Function and Papillary Muscle Dysfunction
- Mitral valve attached to left ventricle via papillary muscles and chordae tendineae
- Myocardial ischemia/infarction can affect mitral valve function
- Papillary muscle dysfunction (grades I-II) loudest at apex/mitral area
- Papillary muscle rupture (grades V-VI) loudest at apex/mitral area is a surgical emergency
- Ventricular septal defect
- Murmur location important in diagnosis
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Description
This quiz covers the essential aspects of valvular heart disease, including the effects of stenosis and insufficiency on the heart valves. It also delves into the causes and characteristics of heart murmurs associated with valvular dysfunction. Test your knowledge on cardiac sounds, pressure dynamics, and clinical implications of valvular disease.