Question 1

A young adult patient is diagnosed with a mitral valve prolapse. During a routine 3-year health maintenance exam, the provider notes an apical systolic murmur and a mid-systolic click on auscultation. The patient denies chest pain, syncope, or palpitations. What action will the provider take?

A) Admit the patient to the hospital for evaluation and treatment.
B) Consult with the cardiologist to determine appropriate diagnostic tests.
C) Continue to monitor the patient every 3 years.
D) Reassure the patient that these findings are expected.

B

Accepted Answer

The provider should consult with a cardiologist to determine appropriate diagnostic tests, such as an echocardiogram or electrocardiogram, to further evaluate the mitral valve prolapse and the presence of the murmur and click. While the patient may not currently have symptoms, further evaluation and monitoring may be necessary to ensure proper management of the condition. Admitting the patient to the hospital is not necessary at this time and reassurance alone may not be sufficient if underlying issues are found. Continuing to monitor every 3 years may miss any changes or progression of the condition.

Question 2

A patient has a cardiac murmur that peaks in mid-systole and is best heard along the left sternal border. The provider determines that the murmur decreases in intensity when the patient changes from standing to squatting and increases in intensity with the Valsalva maneuver. Which will the provider suspect is causing this murmur?

A) Aortic stenosis
B) Hypertrophic cardiomyopathy
C) Mitral valve prolapse
D) Tricuspid regurgitation

B

Accepted Answer

The characteristics of the murmur (mid-systolic peaking, best heard along the left sternal border) are consistent with hypertrophic cardiomyopathy. The decrease in intensity during squatting and increase during Valsalva maneuver is known as the "squatting-to-standing" and "Valsalva" maneuvers, which are classic features of hypertrophic cardiomyopathy. Aortic stenosis would not decrease in intensity with squatting or increase with Valsalva maneuver. Mitral valve prolapse and tricuspid regurgitation would not peak in mid-systole.

Question 3

Which are factors that can cause a heart murmur? (Select all that apply.)&#10;A) Backward flow through a septal defect&#10;B) Backward flow into a normal vessel&#10;C) Forward flow into a dilated vessel&#10;D) High rates of flow through a normal valve&#10;E) Low rates of flow into a cardiac chamber

Accepted Answer

Backward flow through a septal defect (A), forward flow into a dilated vessel (C), and high rates of flow through a normal valve (D) can all cause turbulent blood flow, leading to a heart murmur.

Deck 108: Valvular Heart Disease and Cardiac Murmurs