Chapter 108: Valvular Heart Disease and Cardiac Murmurs Buttaro: Primary Care: A Collaborative Practice, 6th Edition

Multiple Choice

1. 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

ANS: B

These findings occur with hypertrophic cardiomyopathy. With aortic stenosis, the murmur is a harsh crescendo-decrescendo heard best at the right sternal border that decreases in intensity with the Valsalva maneuver. With mitral valve prolapse, the murmur is heard in mid- to late systole, is heard best at the left lower sternal border, and may have a click that moves to later systole or disappear with the Valsalva maneuver. With tricuspid regurgitation, the murmur may occur at early, mid, or late systole, is heard at the left lower sternal border, and decreases with the Valsalva maneuver.

2. 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?

NURSINGTB.COM 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.

ANS: B

Most patients with mitral valve prolapse are monitored every 3 years unless they have a systolic murmur. The provider should consult with the cardiologist. Hospital admission is not necessary since the patient is asymptomatic.

Multiple Response

1. Which are factors that can cause a heart murmur? (Select all that apply.)

a. Backward flow through a septal defect b. Backward flow into a normal vessel c. Forward flow into a dilated vessel d. High rates of flow through a normal valve e. Low rates of flow into a cardiac chamber

ANS: A, C, D

High rates of flow into either normal or abnormal vessels can cause murmurs. Backward flow into septal defects, regurgitant valves, or PDAs can cause murmurs. Forward flow into constricted or irregular valves or into a dilated vessel can cause murmur. Backward flow into a normal vessel and low flow rates are not responsible for murmurs.