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00000 CARDIO > 263 Mitral Stenosis > Flashcards

263 Mitral Stenosis Flashcards

1
Q

leading cause of mitral stenosis

A

Rheumatic fever

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2
Q

Give at least 2 other major causes of mitral stenosis apart from rheumatic fever

A
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3
Q

In normal adults, the area of the mitral valve orifice is ….

A

4–6 cm2

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4
Q

hemodynamic hallmark of MS

A

abnormally elevated left atrioventricular pressure gradient

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5
Q

value mitral valve orifice and LA pressure for severe MS

A
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6
Q

LV diastolic pressure and ejection fraction (EF) are ELEVATED in isolated MS. True or False

A

False.

LV diastolic pressure and ejection fraction (EF) are NORMAL in isolated MS.

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7
Q

In Mitral Stenosis, “a wave” stands for

A
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8
Q

In Mitral Stenosis, “y descent” stands for

A
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9
Q

mitral valve orifice size in severe versus VERY severe mitral stenosis

A
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10
Q

Cardiac output in severe versus VERY severe mitral stenosis

A

`

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11
Q

the** latent period** between the initial attack of rheumatic carditis (in the increasingly rare circumstances in which a history of one can be elicited) and the development of symptoms due to MS is…

A

generally about two decades

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12
Q

once a patient with MS became seriously symptomatic, the disease progressed inexorably to death within HOW MANY YEARS

A

within 2–5 years

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13
Q

A parasternal lift in MS signifies what anatomic cardiac change?

A

enlarged RV

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14
Q

Thoughts on S1, S2, and P2 on px with Mitral Stenosis

A
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15
Q

The opening snap (OS) of the mitral valve is most readily audible in what condition/position

A

in expiration at, or just medial to, the cardiac apex.

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16
Q

The sound of the Opening snap (OS) of mitral valve generally follows the sound of the closure of what valve

A

aortic valve closure

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17
Q

The OS is followed by a low-pitched, rumbling, diastolic murmur, heard best at what part of heart

A

the apex heart with the patient in the left lateral recumbent position

`

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18
Q

With severe pulmonary hypertension, a pansystolic murmur
produced by functional TR may be audible at what area of precordium

A

along the left sternal border.

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19
Q

What is Carvallo’s sign?

A

Means the murmur is usually louder during inspiration and diminishes during forced expiration

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20
Q

When does “silent murmur” occur in MS

A

When the CO is markedly reduced in MS, the typical auscultatory findings, including the diastolic rumbling murmur, may not be detectable (silent MS), but they may reappear as compensation is restored

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21
Q
  • a high-pitched, diastolic, decrescendo blowing murmur along the left sternal border,
  • results from dilation of the pulmonary valve ring and occurs in patients with mitral valve disease and severe pulmonary hypertension
A

Graham Steell murmur of PR

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22
Q

the P wave in MS usually suggests…

A

LA enlargement

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23
Q

P wave in MS may become tall and peaked in lead II and upright in lead V 1 in this condition…

A

when severe pulmonary hypertension or TS complicates MS and right atrial (RA) enlargement develops.

24
Q

QRS complex in MS…

A

usually normal

25
Q

Indication for TEE in patients with MS

A

especially indicated to exclude the presence of LA thrombus prior to PMBC

26
Q

earliest changes in CXR in patients with MS

A
  • straightening of the upper left border of the cardiac silhouette,
  • prominence of the main PAs,
  • dilation of the upper lobe pulmonary veins,
  • and posterior displacement of the esophagus by an enlarged LA
27
Q

What are Kerley B lines

A
  • result from distention of interlobular septae and lymphatics with edema when the resting mean LA pressure exceeds ~20 mmHg
  • are fine, dense, opaque, horizontal lines
  • are most prominent in the lower and mid-lung fields
28
Q

This DDx of MS may also be associated with a prominent diastolic murmur at the apex due to increased antegrade transmitral flow,

A
29
Q

Difference of diastolic murmur in MS vs MR

A
30
Q

Opening snap and increased P 2 are present or absent in MR?

A

Absent in MR
Present in MS

31
Q

These findings suggest significant MR

A
32
Q

DDx of MS presenting with apical mid-diastolic murmur

A
33
Q

Austin Flint murmur is present in what valve pathology

A
34
Q

AR can be differentiated from MS (2 aspects)

A
35
Q

Comment on TS (one of DDx of MS) regarding relationship with inspiration

A
36
Q

Comment on TS (one of DDx of MS) regarding y descent

A
37
Q

2 similarities of MS and ASD

A
38
Q

These findings (4) favor atrial septal defect over MS

A
39
Q

This DDx of MS may obstruct LA emptying, causing dyspnea, a diastolic murmur, and hemodynamic changes resembling those of MS.

A
40
Q

This DDx of MS have features suggestive of a systemic disease,
such as weight loss, fever, anemia, systemic emboli, and elevated serum IgG and interleukin 6 (IL-6) concentrations.

A
41
Q

This DDx of MS …..diagnosis can be established by the demonstration of a characteristic echo-producing mass in the LA with TTE.

A
42
Q

can be useful when there is a discrepancy between the clinical and noninvasive findings, including those from TEE and exercise echocardiographic testing when appropriate.

A

Left and right heart catheterization

43
Q

secondary prevention of rheumatic fever

A

Penicillin prophylaxis of group A β-hemolytic streptococcal infections

44
Q

Warfarin should be administered indefinitely to patients with MS who have… ( 3 indications)

A
45
Q

Timing of cardioversion in MS patients with AF

A
46
Q

mitral commissurotomy is indicated in… (3)

A
47
Q

the procedure of choice for MS patients when it can be performed by a skilled operator in a high-volume center

A

PMBC

48
Q

what is “echo score” in relation to MS

A
49
Q

This procedure indicated in patients in whom PMBC is not possible or unsuccessful, or in many patients with restenosis after previous surgery,

A

“open” surgical commissurotomy

50
Q

A successful commissurotomy is defined by…

A
51
Q

commissurotomy is not recommended for patients who are …. (2)

A
52
Q

When there is little symptomatic improvement after commissurotomy…. these are 3 possible explanations….

A
53
Q

About half of all patients undergoing surgical mitral commissurotomy require reoperation by HOW MANY years

A

10 years

54
Q

In the pregnant patient with MS,
commissurotomy should be carried out if…

A
55
Q

preferred commisurotomy strategy for pregnant px with MS

A
56
Q

Because there are also long-term complications of valve replacement, patients in whom preoperative evaluation suggests the possibility that MVR may be required should be operated on only if they have…. (3)

A

00000 CARDIO (9 decks)

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