[3] Valvular Heart Disease in Adults

Question 1

Define: Stenosis

Answer 1

Narrowing of heart valve

Question 2

Define: Regurgitation

Answer 2

Failure of heart valve to close

Question 3

Normal MV Orifice

Significant Obstruction

Answer 3

N: 4-6cm^2

SO: <2cm^2

Question 4

Smallest MV Orifice Compatible With Life

Answer 4

0.3cm^2

Question 5

[Pathophysiology of MS]

Left Atrium and Pulmonary Artery Wedge Pressure

Answer 5

Increased

Prominent A waves and gradual Y descent

Question 6

[Pathophysiology of MS]

Left Ventricular End Diastolic Pressure

Answer 6

Normal in MS

Question 7

[Pathophysiology of MS]

Cardiac Output

Answer 7

May be normal but generally worsens progressively

Question 8

[Symptoms and Complications]

Mitral Stenosis

Answer 8

1. Exertional Dyspnea, Orthopnea, PND
2. Acute Pulmonary Edema
3. Atrial Arrythmias
   4 Hemoptysis

Question 9

[Physical Findings]

Inspection of Mitral Stenosis

Answer 9

1. Malar flush with pinched and blue facies
2. Prominent alpha waves in JVP in sinus rhythm
3. Single c-v wave in AF

Question 10

[Physical Findings]

Palpation of Mitral Stenosis

Answer 10

1. Right ventricular tap with palpable S1

2. Diastolic Trill

Question 11

[Physical Findings]

Auscultation of Mitral Stenosis

Describe:
S1
P2

Answer 11

Low-pitched, rumbling, diastolic murmur

Accentuated and Snapping S1
Accentuated P2 in pulmonary hypertension
Opening snap follows P2

Question 12

[Laboratory Examination]

ECG of Mitral Stenosis

Answer 12

Left and Right Atrial Enlargement
Right Axis Deviation
Right Ventricular Enlargement

Question 13

What is the most sensitive and specific non-invasive method for diagnosis of Mitral Stenosis?

Answer 13

Echocardiogram

Question 14

Using cardiac catheterization should be applied in what age for Filipinos?

Answer 14

Males: > 55 yo
Females: > 60 yo

Question 15

Mitral Regurgitation is commonly caused by?

Answer 15

Chronic RHD in 90% of Cases

Question 16

Effect of MR on the LA and LV

Answer 16

Enlargement in both, the larger the LV gets, the worse the MR becomes

Question 17

[Auscultation of Mitral Regurgitation]

Describe Murmur

Answer 17

Grade III/IV Holosystolic Murmur at Apex and Radiates to Axilla

Question 18

[Auscultation of Mitral Regurgitation]

Describe S sounds

Answer 18

S1 Absent or Soft
S2 Widely Split
S3 Due to sudden tensing of papillary muscles
S4 Audible

Question 19

What is the most sensitive and specific non-invasive method for diagnosis of Mitral Regurgitation?

Answer 19

Echocardiogram

Question 20

Why do you give vasodilators to people with MR?

Answer 20

Lower the afterload

Question 21

Define: Critical Aortic Stenosis

Answer 21

Peak systolic pressure gradient of 50mmHg

AV Area < 0.5 cm^2

Question 22

[Aortic Stenosis]
CO at Rest
CO with Exercise

Answer 22

Normal

Subnormal Rise

Question 23

Why do you not perform Percutaneous Balloon Aortic Valvuloplasty on the elderly?

Answer 23

Usually have calcifications and this might cause an embolism

Question 24

Marfan’s Syndrome usually causes what valvular disease?

Answer 24

Aortic Regurgitation

Question 25

[Auscultation of Aortic Regurgitation] Describe Murmur

Answer 25

High-pitched, blowing, decrescendo diastolic murmur

Question 26

How do you intensify Aortic Regurgitation murmurs? How does this happen?

Answer 26

Handgrip Maneuver Increases the afterload, causing more regurgitation to occur

Question 27

What would cause increase in the sound of a murmur in Tricuspid Stenosis?

Answer 27

Inspiration Causes increased amounts of blood to flow into the heart, causing a larger sound

Question 28

Do you replace the Tricuspid Valve?

Answer 28

No, because low blood flow would make it prone to infection and increased chances of thrombus infection

Question 29

Why would Mitral Stenosis cause Hoarseness of Voice

Answer 29

Enlargement of LA can compress the Left Recurrent Laryngeal Nerve

Question 30

Pulsus parvus et tardus is found in which Valvular Disease?

Answer 30

Aortic Stenosis

Question 31

Bisferiens pulse is found in which Valvular Disease?

Answer 31

Aortic Stenosis

Question 32

Murmur heard in Aortic Stenosis

Answer 32

Systolic Crescendo-Decrescendo Murmur

Question 33

What is Demusset's Sign

Answer 33

Jarring of entire body | Head bobbing with each systole

Question 34

What is Corrigan's Pulse

Answer 34

"Water Hammer Pulse" | Collapses as arterial pressure falls rapidly during late systole and diastole

Question 35

What is Traube's Sign

Answer 35

Pistol shot pulse heard over femoral artery

Question 36

What is Quicke's Pulse

Answer 36

Capillary pulsations when pressure is applied to the nail

Question 37

What is Durozier's Sign

Answer 37

To-and-fro murmur with femoral artery compression

Question 38

Austin-Flint Murmurs are heard during which kind of Valvular Disease?

Answer 38

Mitral Regurgitation

Question 39

Carvallo's Sign is usually heard during what kind of Valvular Disease?

Answer 39

Tricuspid Regurgitation

Question 40

What is Carvallo's Sign?

Answer 40

Holosystolic murmurs intensified by inspiration