USMLE Step 1 Physiology Review 56 03 Valve lesions & murmers – valvular stenosis (1_2)

USMLE Step 1 Physiology Review 56 03 Valve lesions & murmers – valvular stenosis (1_2)

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Play USMLE Audio MP3 56 03 Valve lesions & murmers – valvular stenosis (1_2) Below

Begin 56 03 Valve lesions & murmers – valvular stenosis (1_2) Transcription

Now for some questions about valve lesions and murmurs. What two conditions are caused by abnormal heart valves?

  • Abnormal blood flow and abnormal pressure gradients.

 What are the three ways that valve lesions affect the circulation?

  • First reducing cardiac output, Second imposing additional work on the heart, Third, producing a backup of blood.

 Murmurs are important signs of valve lesions. What are the two causes of heart murmurs?

  • Turbulent blood flow through a narrowed valve or the reversal of the flow of blood.

 Lamina flow is streamlined and silent whereas turbulent flow create vibrations in the tissues. When can murmurs occur, there are three times, list them alphabetically?

  • First, continuously. Second, during diastole. Third, during systole.

 Student doctor please pause the tape and summarize the information discussed this far on valve lesions and murmurs.

  • Abnormal blood flow and abnormal pressure gradients are caused by abnormal heart valves. Valve lesions affect the circulation by reducing cardiac output, imposing additional work on the heart, and producing a backup of blood. Murmurs are important signs of valve lesions. Heart murmurs are caused by turbulent blood flow through a narrowed valve or the reversal of the flow of blood. Lamina flow is streamlined and silent whereas turbulent flow create vibrations in the tissues. Murmurs occur continuously, during diastole, or during systole.

 Now for more questions on murmurs. Where are murmurs best heard, there are two places (Please pause the tape)?

  • Murmurs are best heard on the chest wall closest to their point of origin and in the downstream direction from their point of origin that is the origin of  the murmur

 If a murmur where caused by a stenosis of the aortic valve what two place first describe the chest wall location and then the downstream location?

  • First the right sternal border in the right inner space, second over the vessels of the neck

 What condition is described by the narrow of the valve orifice impeded the forward flow of blood?

  • Valvular stenosis

 A ventricular systolic pressure which is much higher than the systolic pressure in the respective artery is pathognomonic of what?

  • Semilunar valve stenosis

 During what procedure can the pressure gradient caused by semilunar valve stenosis be detected?

  • During Cardiac catheterization

 How will the murmur of a semilunar valve stenosis sound?

  • It will be a crescendo-decrescendo systolic murmur

 What will the shape of the murmur be on the phonocardiogram?

  • Diamond shaped

 Student doctor please pause the tape and described the information discussed on valve lesions and murmurs since the last summary.

  • The first question was about where murmurs are best heard. Murmurs are best heard on the chest wall closest to their point of origin and in the downstream direction from their point of origin. If a murmur where caused by a stenosis of the aortic valve, you can hear it best at the right sternal border in the inner space, and over the vessels of the neck.  Valvular stenosis is the narrowing of the valve orifice impeded the forward flow of blood. A ventricular systolic pressure that is much higher than the systolic pressure in the respective artery is pathognomonic of semilunar valve stenosis. The pressure gradient caused by semilunar valve stenosis can be detected during Cardiac catheterization. The murmur of a semilunar valve stenosis will be a crescendo-decrescendo systolic murmur. The shape of the murmur on the phonocardiogram will be a diamond shaped.

 

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