4.9.2013(valvular Heart Disease)

Question 0

Indications for anticoagulation in patients with MS

Answer 0

MS with AF
MS with previous history of embolism even if pt is in sinus rhythm
MS with LA thrombus

Question 1

Features of severe MS

Answer 1

Mean gradient of more than 10mm Hg
MVA less than 1cm2
PASP more than 50mm Hg

Question 2

Drugs useful for rate control in MS

Answer 2

CCB(non dihydropyridine)

Beta blockers

Question 3

Indications for PMBV

Answer 3

Symptomatic pts with moderate to severe stenosis without contraindications like LA clot or associated MR
Asymptomatic patients with PASP more than 50mm Hg at rest or 60mm Hg with exercise

Question 4

Hemodynamic results observed after PMBV

Answer 4

Cardiac output increases by 20%
Transmitral gradient decreases by 50%
Valve area increases to 2cm2

Question 5

Contraindications to PMBV

Answer 5

LA thrombus
MR
Echo score of more than 8

Question 6

Complications of PMBV

Answer 6

MR
ASD
stroke
Cardiac perforation

Question 7

Mean survival after development of severe pulmonary hypertension in MS

Answer 7

3 yrs

Question 8

Aortic sclerosis

Answer 8

Thickening of aortic valve resulting in turbulence and murmur but no gradient

Question 9

Difference between tricuspid and bicuspid aortic stenosis

Answer 9

Bicuspid stenosis
Presents earlier(60yrs)
More prone for infective endocarditis
Associated with dissection and aneurysms

Question 10

Presence of opening snap in aortic area

Answer 10

Bicuspid aortic valve

Question 11

Soft S2(diminished or absent A2)

Answer 11

Severe AS

Question 12

Severe AS

Answer 12

Peak jet velocity >4m/s
Mean gradient >40mm Hg
Valve area <1cm2

Question 13

Role of dobutamine stress ECHO in AS

Answer 13

When there is a discrepancy btw valve area and transvalvular pressure gradient

Question 14

Role of Cath in AS

Answer 14

Symptoms of angina in moderate AS to evaluate for CAD

In pts undergoing AVR at risk for CAD

Question 15

Rx of severe symptomatic AS

Answer 15

Surgery

No medical Rx

Question 16

Rx of severe AS with decompensated heart failure

Answer 16

IABP
sodium nitroprusside
Balloon aortic valvuloplasty

Question 17

Average survival of symptomatic AS pts

Answer 17

3 yrs

Question 18

Indications for AVR

Answer 18

Severe symptomatic AS
Before CABG in Severe AS pt
Before undergoing Sx on aorta or other valves
Severe AS with LV systolic dysfunction

Question 19

Most common papillary muscle to rupture in MI

Answer 19

Posteromedial

Question 20

Acute causes of MR

Answer 20

Ruptured papillary muscles
Ruptured chordae
IE

Question 21

Causes of MR

Answer 21

Rheumatic
MVP
Ischemic
SLE
amyloidosis
Congenital(cleft,parachute,fenestrated)
HOCM
drugs(phen-fen)
Para valvular prosthetic leak
Mitral annular calcification

Question 22

Radiation of murmur in MR

Answer 22

Anterior chest wall if posterior leaflet is prolapsed and vice versa

Question 23

LV dysfunction in MR

Answer 23

EF<60%

Question 24

Indications for surgery in MR

Answer 24

Symptomatic acute severe MR
Symptomatic chronic severe MR not associated with severe LV dysfunction(55mm
Asymptomatic chronic severe MR with mild to moderate LV dysfunction(EF40mm)

Question 25

Acute AR

Answer 25

IE
Trauma
Dissection of ascending aorta

Question 26

Causes of AR

Answer 26

Bicuspid aortic valve
RHD
Calcific degeneration
IE
idiopathic dilatation of aorta
Myxomatous degeneration
Systemic hypertension
Dissection of ascending aorta
Marfan
Trauma
AS,RA,reiter,whipple,giant cell aortitis
Syphilitic aortitis
Discrete subaortic stenosis
VSD with prolapse of an aortic cusp

Question 27

New conduction block in AR

Answer 27

Root abscess

Question 28

When should drugs be used in pre-hypertension

Answer 28

Evidence of target organ damage or diabetes

Question 29

Target BP in pts with diabetes or CKD

Answer 29

<130/80