100314 valvular disease cases

Question 1

BP that could happen for aortic regurgitation?

Answer 1

160/50

Question 2

most common cause of aortic stenosis

Answer 2

calcific degeneration

rheumatic heart disease is less common cause and almost always involves mitral valve also

Question 3

aortic stenosis PE findings

Answer 3

sustained LV impulse
pulsus parvus et tardus (weak and late)
absent A2 or paradoxically split A2
systolic crescendo decrescendo
heart at base of heart or right upper sternal border-radiates to carotids

Question 4

when symptoms develop of aortic stenosis, what should you do?

Answer 4

intervene-surgery

Question 5

causes of aortic regurg

Answer 5

abnormalities of valve leaflets (congential bicuspid valve, endocarditis, rheumatic)

dilation of aortic root

Question 6

in chronic aortic regurg, what do you see of the L atrium and pulmonary vasculature?

Answer 6

load on them is reduced as compared to acute aortic regurg b/c the ventricle has increased compliance (has dilated over time)

Question 7

presentation of chronic aortic regurg

Answer 7

dyspnea on exertion
fatigue
decreased exercise tolerance
chest pain

Question 8

PE findings for chronic aortic regurg

Answer 8

hyperdynamic pulses, head bobbing

widened pulse pressure

decrescendo DIASTOLIC MURMUR-increases with increased SVR

Question 9

aortic regurgitation tx

Answer 9

for acute-surgical emergency–needs replacement

for chronic severe aortic regurg:
if asymptomatic and normal LVEF of greater than 50%, do f/u with ECHO. consider afterload reduction
if asymptomatic and low LVEF, refer for surgery for valve replacement.
if symptomatic and normal LVEF, refer for surgery

Question 10

causes of mitral valve regurg

Answer 10

organic (primary):
myxomatous disease (degenerative)
rheumatic valve disease
endocarditis
congenital (cleft leaflet)

functional (secondary):
ischemic CM
dilated CM
hypertrophic CM

Question 11

auscultation of mitral vaLVE regurg

Answer 11

holosystolic murmur at apex of heart

Question 12

chronic mitral valve regurg managment

Answer 12

management is based on development of symptoms and loss of L ventricular systolic fxn

if acute-stabilize with diuretics and vasodilators and consider emergent surgery

if chronic:
if asymptomatic-monitor
if symptomatic and severe mitral regurg, repair or replace valve
if severe L ventricular dysfxn, often little can be done at this point

Question 13

etiology of mitral stenosis

Answer 13

rheumatic fever is MOST COMMON

Question 14

symptoms of mitral stenosis

Answer 14

dyspnea and reduced exercise capacity

in more severe, SOB at rest and symptoms of heart failure with orthopnea, paroxysmal nocturnal dyspnea. can also develop signs of R side heart failure.

Question 15

PE of mitral stenosis

Answer 15

early disease: opening snap and murmur

late: opening snap and murmur. RV lift

Question 16

severe mitral stenosis measurements for area and graident

Answer 16

area under 1.0 cm2

gradient greater than 10 mmHg

Question 17

tx of mitral valve stenosis

Answer 17

diuretics if symptoms of vascular congestion

if atrial fib, treat with beta blockers, calcium ch blockers, or digoxin. chronic anticoagulant.

if meds don’t work or if there’s significant pulmonary HTN, then balloon vauvulopasty or valve replacement

Question 18

look at quick review slide at end

Answer 18

study 4 types

Question 19

in chronic AS and MS when should you start tx?

Answer 19

when symptoms develop w/ severe disease

Question 20

aortic stenosis w/ symptoms- only treatment

Answer 20

replacement of valve

Question 21

what do you see widened pulse pres in?

Answer 21

aortic regurg

Question 22

what do you see for aortic regurg and mitral regurg if acute?

Answer 22

pulmonary edema rapidly