CVS Valvular Disease

Question 1

Aortic root dilation: Marfan syndrome, syphilis
Post-inflammatory: RHD, infective endocarditis
Structural: bicuspid aortic valve (age < 65), aortic dissection

Answer 1

AR

Question 2

2 common presentation for AS

Answer 2

Congenital bicuspid aortic valve : Patient < 65 yo

Degenerative” or senile calcific aortic stenosis:
patients > 65 yo

Question 3

Systolic & diastolic bruit when femoral artery is compressed

Answer 3

Duroziez’s sign

Question 4

Hx:
Fatigue, exertional dyspnea, and orthopnea (severe stenosis)
Hemoptysis, hoarseness (Ortner’s syndrome)
Edema, ascites if with pulmonary HTN
Atrial fibrillation, systemic thromboembolism

Physical exam: 
Inspection: 
Malar flush
Precordial bulge, diffuse pulsation
Palpation: 
RV heave if with pulmonary HTN + palpable P2

Answer 4

Mitral Stenosis (MS)

Question 5

LA enlarges progressively progressive exertional dyspnea and fatigue
RHD
MVP (myxomatous degeneration of MV leaflets and chordae)
Infective endocarditis
HTN
Ischemic heart disease
HOCM

Answer 5

CHRONIC MR

Question 6

Visible pulsations of retinal arteries and pupils

Answer 6

Becker’s sign

Question 7

deMusset’s sign

Answer 7

Head-bobbing synchronous with the heartbeat

Question 8

increase in afterload
Incomplete emptying of LA
LV hypertrophy
decrease CO
RV strain
Pulmonary congestion

Answer 8

AS

Question 9

A 50-year-old female presents with a holosystolic murmur heard best over the apex, radiating to the axilla. She has no signs of pulmonary hypertension or edema. What best explains her lack of symptoms?

a) The right ventricle is compensating with decreased compliance
b) The left atrium is compensating with increased compliance
c) The aorta is compensating with increased compliance
d) There is only a ballooning of the valve which would not result in any hemodynamic changes in the heart

Answer 9

B

Question 10

confirmatory of valvular disease

Answer 10

Transthoracic echocardiography (TTE)

Question 11

Murmurs:
Decrescendo, diastolic holodiastolic
Loudest along Erb’s point when leaning forward, on full expiration

Answer 11

AR

Question 12

Physical exam:
Inspection: Downward displacement of apical impulse
Palpation: Forceful, brisk PMI
Heart sounds:
Widely-split S2 (early closure of aortic valve)
S3 (indicates severity of regurgitation)

Holosystolic, blowing, high-pitched, loudest over apex, radiates to the L axilla (+ L infrascapular)

Answer 12

MR

Question 13

abrupt ↑ in LA pressure  pulmonary edema
Rupture of chordae tendinae or papillary muscle (MI)
Infective endocarditis

Answer 13

acute MR

Question 14

Pulsatile nailbeds

Answer 14

Quincke’s pulse

Question 15

Corrigan’s pulse

Answer 15

Waterhammer pulse in the carotid area

Question 16

‘a’ wave of JVP
S4
pre-systolic accentuation of MS

Answer 16

These are lost in atrial fibrillation:

Question 17

A 20-year-old female with a recent history of panic attacks presents with chest pain with no specific triggers. She has a family history of CAD in her grandfather. Physical examination reveals tachycardia and an apical mid-systolic click that is followed by a murmur. Which of the following maneuvers and effect are expected?

a) Passive leg raising will cause the murmur to disappear
b) Valsalva maneuver will cause the click to occur earlier
c) Passive leg raising will lengthen the murmur duration
d) Passive leg raising will cause the click to occur earlier
e) Valsalva maneuver will shorten the murmur duration

Answer 17

B