237 valvular Heart Disease

Question 0

Earliest xray changes in MS

Answer 0

• straightening of upper left border of cardiac silhouette
• prominence of main pulmo arteries
• dilation of upper lobe pulmonary veins
• posterior displacement of esophagus by enlarged LA

Question 1

Resting mean pressure of LA when kerley b lines are present

Answer 1

20 mmHg

Question 2

Cause of kerley b lines

Answer 2

Distention of interlibular septae and lymphatics with edema

Question 3

Where kerley B lines are most prominent

Answer 3

Lower and mid-lung fields

Question 4

Normal mitral valve area

Answer 4

4-6 cm

Question 6

Hemodynamic hallmark of MS

Answer 6

Elevated left AV pressure gradient

Question 6

Murmur louder during inspiration and diminished during forced expiration

Answer 6

Carvallo's sign in
Tricuspid regurgitation (pulmo HTN)

Question 7

In Ms, the left atrial pressure required to maintain a normal cardiac output

Answer 7

25 mmHg

Question 8

High pitched diastolic decrescendo blowing murmur along the left sternal border

Answer 8

Graham steell murmur of PR

Question 9

Mitral valve disease and severe pulmonary hypertension murmur: resulting from dilation of pulmonary valve ring

Answer 9

Graham steell murmur of PR

Question 10

Diff PR from AR

Answer 10

PR has a palpable p2 and nay increase with inspiration

Question 11

Murmur softer with administration of amyl nitrite

Answer 11

Austin flint murmur

In severe AR

Question 12

MR may result from abnormality in 5 functional components of mitral calve apparatus

Answer 12

Leaflets
Annulus
Chordae tendinae
Papillary muscles
Subsequent myocardium

Question 13

Papillary muscle involved in acute MI, rupture of which results to MR

Answer 13

Posteromedial papillary muscle

Bec of singular blood supply

Question 14

Target inR MR

Answer 14

2-3

Question 15

ECG in MVP

Answer 15

Commonly normal,

Biphasic or inverted T waves in II, III, aVF

Question 16

Duration of mVP midsystolic click

Answer 16

0.14 s

Question 17

Barlow’s syndrome

Billowibg mitral leaflet syndrome

Answer 17

Mvp

Question 18

Common age MvP

Answer 18

15-30 yrs

Question 19

MC etiology of AS in adults

Answer 19

Degenerative calcification of aortic cusps

Question 20

MC congenital heart valve defect

Answer 20

Bicuspid aortic valve

Question 21

Mech dyspnea in AS

Answer 21

Elevated pulmo capillary pressure caused by elevations of LV diastolic pressures sec to reduced LV compliance

Question 22

Three cardinal symptoms of aortic stenosis

Answer 22

1. Dyspnea
2. Angina pectoris
3. Exertional syncope

Question 23

When murmur of AS is transmitted downward to the apex where it can be confused with systolic murmur of MR

Answer 23

Gallavardin effect

Question 24

Assoc with thrill or anacrotic shudder mc on left carotid

Answer 24

AS

Question 25

Murmur of AS

Answer 25

Early systolic shortly after s1 ends before Aortic valve closure best heard at 2nd ICS right parasternal line

Question 26

Mech for paradoxical splitting of s2

Answer 26

LV systole becomes so prolonged that AV valve closure now preceeds pulmonic valve closure

Question 27

S4 in AS

Answer 27

Presence of Lv hypertrophy | Elevated LV end diastolic pressure

Question 28

Valve area moderate AS

Answer 28

1-1.5 cm

Question 29

Water hammer pulse/corrigan's pulse

Answer 29

AR

Question 30

Alternate flushing a d paling of skin at root of nail while pressure is applied to the tip

Answer 30

Quinke's pulse (AR)

Question 31

Pistol shot sound over the femoral arteries

Answer 31

Traubes sign of AR

Question 32

To and fro murmur audible if femoral artery is lightly compressed with stethoscope

Answer 32

Duroziez sign

Question 33

Murmur of AR

Answer 33

High pitched blowing decrescendo diastolic murmur heard beat at 3rd IcS left sternal border

Question 34

Most characteristic auscultatory finding of MR

Answer 34

Systolic murmur of at least grade III/VI intensity

Question 35

Major hemodynamic compensation for AR

Answer 35

Increase in LV end diastolic volume

Question 36

Murmur of AR

Answer 36

Austin flint murmur

Question 37

Auscultatory features augmented by sustained hand grip

Answer 37

AR

Question 38

MS auscultation

Answer 38

Opening snap | Diastolic rumbling murmur

Question 39

In Ms | Needed to exclude presence of L atrial thrombus prior to PMBV

Answer 39

TEE

Question 40

Differential auscultate | MR vs MS

Answer 40

In MR OS and inc P2 absent S1 soft or absent S3 significant MR

Question 41

Sign of recurrent systemic embolization/ severe pulmonary hypertension in MS

Answer 41

PAP > 50 mmHg rest | >60 with exercise

Question 42

MR systolic murmur in | Ruptured chordae tendinae

Answer 42

Cooing or "sea gull" quality | Compared to flail leaflet Musical quality

Question 43

Mitral regurgitation Diff Acute severe MR Versus chronic severe MR

Answer 43

Acute - v wave is prominent - decrescendo ends before s2 Chronic - v wave less prominent - holosystolic murmur

Question 44

Patients with mild stenosis | Pmbv assess

Answer 44

Exercise Then yes if Pasp > 60 Pawp >= 25 MVG > 15

Question 45

Rx MS

Answer 45

``` Symptom control - Beta blockers - Non DHP CCBs Rate control- digoxin Cardiovert if new onset AF Diuretics ``` Natl history - AF: warfarin - prophylaxis RF

Question 46

Rx | Mitral regurgitation

Answer 46

``` Symptom control - diuretics for HF - vasodilators for acute MR Natural history - warfarin (AF) - vasodilators (HTN) ```

Question 47

In MVP | IE prophylaxis indication

Answer 47

Only for pt with prior hx of IE

Question 48

Indication for aspirin or warfarin in patients with MVP

Answer 48

Prevention of transient ischemic attack

Question 49

Genetic polymorphisms libked to development of calcific AS

Answer 49

Vit D receptor Eatrogen receptor IL 10 Apo E4

Question 50

Bicuspid aprtic valve defect

Answer 50

NOTCH1 gene

Question 51

Why is there a prominent a wave in AS

Answer 51

Diminished distensibility of the RV cavity caused by the bulging hypertrophied IVS

Question 52

Double apical impulse (palpable s4)

Answer 52

AS

Question 54

Carotid arterial pulse is 2 systolic waves separated by a trough

Answer 54

Bisferiens | AR

Question 55

Auscultatory features intensified by handgrip

Answer 55

AR | Increases systemic vascular resistance

Question 55

Defines Ts

Answer 55

Diastolic pressure gradient bet RA and RV

Question 56

2d echo characteristic finding of AR

Answer 56

Rapid high frequency diastolic fluttering of aNTERIOR mitral leaflet

Question 57

Mean diastolic pressure gadient in TS required to elevated RA pressure

Answer 57

4 mmHg

Question 58

PE | Anacrotic shudder heard over carotod arteries

Answer 58

AS