Aortic and Mitral Diseases

Question 1

Challenge in aortic stenosis

Answer 1

Heart is pumping to overcome pressure overload (L ventricle pressure must overcome the aortic pressure)

Question 2

Best imaging tool for aortic valve stenosis

Answer 2

echocardiogram can assess severity and effect of aortic stenosis

CXR usually shows normal cardiac size
EKG tells only about hypertrophy

Question 3

Gorlin’s formula takeaway

Answer 3

valve area can be calculated if you know the flow and valve gradient (pressure difference) –>

Gradient varies greatly with flow and with valve area!

Question 4

High pressure gradient in aortic stenosis leads to

Answer 4

left ventricle thickening, stiffening, non-compliance –>

LV filling at diastole very dependent on timing, strong atrial contraction –>

rhythm disturbances lead to significant hypotension

Question 5

Aortic valve stenosis symptoms

Answer 5

angina pectoris
syncope (typically with exertion)
dyspnea (on exertion)
(cardinal triad)

+ sudden cardiac death, endocarditis, systemic emboli

Question 6

Chronic Aortic regurgitation symptoms

Answer 6

angina
dyspnea (on exertion, may progess to at rest)
exertional fatigue (L valve lesions)
palpitations
inappropriate sweating

unusual: syncope

Question 7

Aortic regurg murmur occurs during

Answer 7

diastole, S2

High pitched blowing sound

Question 8

Present with high systolic pressure, hyperkinetic pulse, widened pulse pressure, low diastolic pressure

Answer 8

Chronic aortic regurgitation:

Volume overload + pressure overload

Question 9

Mitral insufficiency symptoms

Answer 9

Mostly benign!
slow progression of exertional SOB, fatigue

Minority have chronic mitral regurge requiring surgery, endocarditis, disrhythmias, sudden cardiac death

Question 10

What are the four possible etiologies of mitral valve insufficiency?

Answer 10

Leaflet (shortening, redundancy, deformity)
MV annulus (calcification)
Chordae tendineae (rupture)
Papillary muscle (dysfunction, malalignment)

Question 11

Diagnosis of mitral insufficiency

Answer 11

Classic physical exam

Echocardiogram useful to assess amount of regurg, LV function, also to r/o Marfan’s

Question 12

Mitral Insufficiency is

Answer 12

Big left ventricle trying to compensate for volume overload

Question 13

Diseases affecting the aortic valve

Diseases affecting the aorta

Answer 13

Rheumatic, Congenital bicuspid, Endocarditis

Annuloaortic ectasia, bicuspid aortopathy, connective tissue diseases, dissecting aortic aneurysm, inflammatory arthritic syndroms, syphilis

Question 14

Timing of murmur relative to S1 pertains to

Answer 14

changes in LV volume/shape –> positions that reduce LV volume enhance redundancy, click/murmur closer to S1

Question 15

Mitral regurgitation murmur is best described as ______ and best heard __________________.

Answer 15

blowing

at apex, radiating to axilla

Question 16

Three etiologies of aortic stenosis

Answer 16

Congenital 
--> unicuspid 
--> bicuspid (may become calcified)
Rheumatic
Degenerative calcific

Question 17

Small volume carotid pulse with sustained upstroke is typical of

Answer 17

Aortic stenosis

BP normal or decreased pulse pressure

Question 18

If S2a is absent or decreased (no S2 heard at apex), suspect

Answer 18

aortic stenosis

calcification of valve

Question 19

How does the left ventricle respond to aortic regurgitation?

Answer 19

hypertrophy + dilatation in proportion to amount of regurg during diastole

Question 20

high frequency diastolic decrescendo murmur along left sternal border is typical of

Answer 20

aortic regurgitation

Question 21

A cresendo-decresendo systolic murmur is typical of

Answer 21

aortic stenosis

Question 22

What does imaging show in aortic regurgitation?

Answer 22

EKG: left ventrical hypertrophy

CXR: enlarged LV with apex displaced down/out, dilated aorta

Echo to assess severity, LV size, LV function

Question 23

Pressure overload means

Answer 23

Ventricle must have a lot of strength to overcome resistance to blood leaving ventricle (not concerned about volume)

Question 24

Exertional angina + SYNCOPE + Dyspnea —> —>

Answer 24

Aortic valve stenosis

Question 25

How does the onset of symptoms for severe aortic stenosis impact survival?

Answer 25

Onset -> mortality very short time frame

Question 26

Exertional FATIGUE + angina + dyspnea –> –>

Answer 26

Aortic regurgitation

fatigue is characteristic of L heart valve insufficiency

Question 27

Calcification of the valve in aortic stenosis leads to

Answer 27

• Decreased pulse pressure (caress)
• absent S2A at apex
• forceful apical impulse
• crescendo-decrescendo systolic murmur
• brief AR murmur

Question 28

Click + murmur accentuated by reduced ventricular volumes

Answer 28

Mitral valve prolapse

Question 29

What are the etiologies of aortic regurgitation?

Answer 29

Diseases of aortic valve (rheumatic, congenital bicuspid, endocarditis)
OR
Disease of aorta (ectasia, Marfan’s, inf/infl –> dilation)

Question 30

Mitral valve diagnosis relies on

Answer 30

Classic physical exam + Echocardiogram if necessary

Question 31

Saggy leaflet creating turbulence murmur

Answer 31

Mitral valve prolapse

Question 32

Blowing apical systolic murmur, often holosystolic, radiating toward the axilla

Answer 32

Mitral valve insufficiency

Question 33

May hear S3 gallop or diastolic flow rumble

Answer 33

Mitral valve insufficiency