Understanding Heart Murmurs, Aortic and Mitral Valve Problems


(upbeat music) – I think sometimes it’s helpful to pause and go over terminology because although I’d love
to think that your doctor talks to you in English all the time, sometimes he talks to you in jargon. So let’s lay down some of the jargon. What’s a murmur? A murmur is simply turbulence of flow that the doctor can hear
with his stethoscope. Now what’s that? If you take your garden hose outside, you got the garden hose running. You put your hand on that hose, you probably don’t feel anything. If you were to kink that, you feel that shuddering in the line, that’s turbulent flow. That’s something in the system which is disrupting normal laminar flow, causing, if you will, eddy currents, and the turbulence that is
transferred into shuttering. Now if you could get your
ear on that garden hose, you’d hear it. And that’s all a murmur is. All a murmur means is turbulent flow. (heart beating) (heart beating loudly) A loud murmur is not necessarily
worse than a quiet murmur. It just indicates that there
may be a problem present. Or the disturbance in flow may be so minor that it’s inconsequential, ok. As far as valves are concerned, we already mentioned the aortic valve. A normal aortic valve has three leaflets and they block the flow of blood from regurgitating back into the heart. The mitral valve has two leaflets and they are called the anterior leaflet and the posterior
leaflet, very simply put. If a valve is stuck shut, the common term for that is that it is
stenotic, or has a stenosis, does not open all the way normally. If a valve is leaking, it can be called insufficient, because it isn’t sufficiently
stopping the flow, so it is insufficient, or sometimes because a
flow that has been ejected is regurgitating back through the valve, it’s called a regurgitant valve. So you may hear someone
talk about aortic stenosis, aortic insufficiency,
or aortic regurgitation, the latter two being the same, mitral stenosis, mitral insufficiency, or mitral regurgitation,
both of which are the same. And they come in degrees of severity. Let’s take one step further
with the mitral valve because the mitral valve is
a very complex structure. I’ma give you a crude analogy. If we have a circular train tunnel, and I take two parachutes and
tack the periphery of those up against the walls of the train tunnel, and I’ve got hold of the
strings of that parachute, and wind comes towards me, they’re gonna fold back
against the wall of the tunnel and the wind’s gonna come through. Cool. If the wind’s going the other way, and I hold tight, those parachutes are
gonna meet in the middle and airflow is gonna stop. Now that mitral valve,
because it’s complex, can leak for all sorts of reasons. If the tunnel is much bigger than the chutes are, they’re not gonna meet in the middle, no matter how hard I hold, they’re gonna leak. If I don’t hold, if I let go of the cords, which are called the chordae
tindineae of the mitral valve, that valve’s gonna leak. If the cords break or rupture, that valve’s gonna leak. So it can leak for all
sorts of different reasons. It can leak because where it’s anchored gets too big, the chordae tindineae break, or the muscle that’s holding
the chordae tindineae gets loose, or the mitral valve itself gets destroyed by some disease process that
causes it to shrink back. So you’ll hear your doctor talk about aortic stenosis,
aortic insufficiency, mitral stenosis, and mitral insufficiency, but they may have different causes, they’re various causes of
each of those disorders. (upbeat music)

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