bm
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correct me if i'm wrong: systolic is ventricular contraction and diastolic is ventricular filling right? meaning the aortic and pulmonic valves would be opening and closing during systole, while the mitral and tricuspid does the same during diastole.
how come the question in the usmleasy: "A diastolic murmur accompanied by an increased preload can be caused by which of the following?" the answer was aortic regurgitation, instead of mitral stenosis?
help!
may
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| rida
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Well technially mitral and tricuspid are also closed during systole, because if they weren't, then as the ventricle is contracting, the blood can go back into the atria, so its important for them to be closed as well, all valves play a part in systole and diastole. About your question, when it comes to murmurs, try to visualize the heard in your head. During mitral stenosis, the mitral valve is narrowed, so it will be hard to get the blood from left atria to left ventricle during DIASTOLE, hence you would hear a murmur when the ventricle would be trying to be filled, BUT, PRELOAD would not increase because recall that preload is End diastolic volume, which is the volume in the ventricle at the end of diastole, when the ventricle is relaxed, that would be DECREASED in mitral stenosis because blood can't get thru to the ventricle. So you would see an enlarged left atria trying to work harder to push that blood.
Now lets take aortic regurg, again, this is a diastolic murmur because as the left ventricle is relaxing, the aortic valve is suppose to be close, but its opened so blood will go back into the ventricle hence INCREASE preload or end diastolic volue, so by the time ventricle will relax, not only will it have blood from left atria but also the aorta. Hope this helps you!!!
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| bm
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thank you sooo much rida!
i got confused with the question. at first i answered aortic regurgitation coz of the increase in preload, and then i changed my answer to mitral stenosis coz of the diastolic murmur (systolic-diastolic concept) 
may
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| rida
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no problem, just remember, diastolic murmur is seen in both aortic regurg and mitral stenosis, however, in mitral stenosis, you would see an enlarged atria and in aortic regurg there will be an increase in preload.
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| Bela
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bm, also remember the pneumonic:
MIS ASS (sorry if sounds rude)
Mitral
Insuficiency (regurg)
Systolic
Aortic
Stenosis
Systolic
So, if u know the systolic problems, for the diastolic it's the opposite
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| bm
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:lol:
i don't think it's rude bela, in fact i think it's humorous, and i'll definitely remember it, thanks!
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