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Valvular Disorders Covered on the Physician Assistant Exam

The most common valvular issues you’ll likely be tested on for your Physician Assistant Exam are problems with the mitral and aortic valves. The other valves are important as well, but the good stuff occurs with the first two valves. Not only should you be familiar with the clinical presentations and causes of some of these valvular problems, but you need to know the pertinent clinical exam findings for each.

The mitral valve is located in between the left atrium and the left ventricle. You need to be familiar with three murmurs concerning the mitral valve: mitral stenosis, mitral valve prolapse, and mitral regurgitation.

Mitral stenosis

Mitral stenosis is a failure of the mitral valve to fully open over time. The most common cause of this condition is rheumatic fever. Your physical examination findings can vary, depending on whether you’re talking about early mitral stenosis or late mitral stenosis.

Early on, you may hear a very loud S1 and an opening snap after the S2. As the stenosis progresses, the S1 is very decreased or absent. On an echocardiogram, you may see an enlarged left atrium.

Mitral valve prolapse

Mitral valve prolapse (MVP) is a common murmur in young people, particularly women. You’ll likely see a test question in which MVP is linked to anxiety and panic disorder.

Here are two key physical examination points concerning MVP:

  • On cardiac auscultation, you hear a midsystolic click followed by a late systolic murmur, which is best heard at the heart apex.

  • The intensity of MVP is increased by the Valsalva maneuver and by the handgrip maneuver.

    For test-taking purposes, the two cardiac conditions in which the intensity of the murmur increases with Valsalva are MVP and hypertrophic cardiomyopathy. The Valsalva decreases the volume of fluid going into the left ventricle, so it accentuates these murmurs.

Mitral regurgitation

Mitral regurgitation refers to an incompetent mitral valve. The mitral valve doesn’t close properly when the heart pumps out blood, so blood leaks from the left ventricle through the mitral valve into the left atrium. It’s a common valvular problem in older people and can be a cause of congestive heart failure.

On physical examination, you can hear a holosystolic murmur, usually heard best at the left sternal base. The severity of the murmur may vary, with mild, moderate, and severe degrees.

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