Case Studies in Valve Diseases-Kobal

Question 1

What is the connection of blood pressure in severe aortic stenosis?

Answer 1

None, 50% of autopsies show elevated blood pressure in severe aortic stenosis.

Question 2

What is the rate or prolonged carotid upstroke in aortic stenosis?

Answer 2

3% in mild aortic stenosis. In severe, may have pulsus parvus et tardus but may have normal upstroke if carotid arteries calcified and distensibility reduced.

Question 3

How does S2 relate to aortic stenosis?

Answer 3

Disappears in severe aortic stenosis. Can have any combination. If no aortic stenosis: splitting of second sound with pulmonary valve later.

Question 4

How can loudness and radiation of the murmur relate to aortic stenosis?

Answer 4

Not a signal of severity. Can be used to say there is aortic stenosis, but can’t use loudness or radiation for assessment of severity.

Question 5

What can cause a single S2 and 3/6 early systolic murmur?

Answer 5

Aortic stenosis

Question 6

What is normal mitral valve area?

Answer 6

4-6 cm^2

Question 7

What is normal aortic valve area?

Answer 7

2-4 cm^2

Question 8

What are the indications for aortic valve replacement?

Answer 8

Symptoms (angina and LVH), aortic area

Question 9

LaPlace’s law and its relation to LVH

Answer 9

T = ( P * r ) / M. T=tension, M=wall tension. Stress=PxV/LVH.

Question 10

What causes the midsystolic click?

Answer 10

In mitral regurgitation/mitral valve prolapse, the cordae tendinae are floppy and happens when flaps stop moving.

Question 11

What are the indications for mitral valve replacement?

Answer 11

Symptoms, LVEF>55% or LVESD is >45mm to prevent irreversible myocardial damage.

Question 12

What are indications for mitral valve repair?

Answer 12

Thromboembolic events or higher pulmonary hypertension.