Valvular Abnormalities Short Case

Question 1

A 75-year-old male presents with chest pain, syncope, and dyspnea on exertion. Auscultation reveals an ejection systolic murmur at the 2nd right intercostal space. What is the most likely diagnosis?

Answer 1

Aortic stenosis.

Question 2

A patient with a bicuspid aortic valve develops progressive exertional dyspnea. What is the most likely underlying pathology?

Answer 2

Aortic stenosis.

Question 3

What is the most common cause of aortic stenosis in elderly patients?

Answer 3

Age-related degenerative calcific aortic stenosis.

Question 4

A 65-year-old man has a harsh systolic murmur that radiates to the carotids. What valvular abnormality is suspected?

Answer 4

Aortic stenosis.

Question 5

A patient presents with a collapsing pulse and a high-pitched diastolic murmur at Erb’s point. What is the likely diagnosis?

Answer 5

Aortic regurgitation.

Question 6

What is the most common cause of AS in North America and Europe?

Answer 6

Age-related degenerative calcific AS (senile/sclerocalcific AS).

Question 7

What are common symptoms of AS?

Answer 7

Angina pectoris, syncope, dyspnea, and CHF.

Question 8

What is the average survival after AS symptom onset?

Answer 8

Angina pectoris (3 years), syncope (3 years), dyspnea (2 years), CHF (1.5-2 years).

Question 9

What type of murmur is associated with AS?

Answer 9

Ejection systolic murmur, best heard at the 2nd right intercostal space.

Question 10

How does an ejection systolic murmur change with severity?

Answer 10

It disappears when the valve becomes calcified and rigid.

Question 11

What is aortic regurgitation (AR)?

Answer 11

Backflow of blood into the left ventricle from the aorta during diastole.

Question 12

What is the 10-year survival rate for mild-moderate AR?

Answer 12

80-95%.

Question 13

What is the average survival after CHF onset in AR?

Answer 13

Less than 2 years.

Question 14

What are congenital causes of AR?

Answer 14

Bicuspid aortic valve, aortopathy, cystic medial necrosis, connective tissue disorders (e.g., Marfan’s).

Question 15

What are acquired causes of AR?

Answer 15

Rheumatic heart disease, hypertension, syphilis, aortic dissection, infective endocarditis, trauma.

Question 16

What murmur is characteristic of AR?

Answer 16

High-pitched, blowing, decrescendo diastolic murmur at Erb’s point.

Question 17

What is Austin Flint murmur?

Answer 17

A low-pitched mid-diastolic murmur due to AR jet striking the anterior mitral leaflet.

Question 18

What physical exam findings indicate severe chronic AR?

Answer 18

De Musset’s sign, Corrigan’s pulse, Mueller’s sign, Traube’s sign, Duroziez’s sign.

Question 19

What is De Musset’s sign?

Answer 19

Head bobbing with each systolic pulsation.

Question 20

What is Corrigan’s pulse?

Answer 20

Bounding ‘pistol shot’ pulses over carotid arteries.

Question 21

What is mitral stenosis (MS)?

Answer 21

Obstruction of left ventricular inflow due to mitral valve abnormality.

Question 22

What is the most common cause of MS?

Answer 22

Rheumatic fever.

Question 23

What pathological changes occur in rheumatic MS?

Answer 23

Inflammatory foci (Aschoff bodies), calcification, commissural adhesion.

Question 24

What are other causes of MS?

Answer 24

Congenital MS, carcinoid disease, lupus, rheumatoid arthritis, mucopolysaccharidoses, Fabry disease.

Question 25

What are the key auscultatory findings in MS?

Answer 25

Loud S1, opening snap, diastolic rumble.

Question 26

What factors accentuate the murmur in MS?

Answer 26

Exercise increases murmur; Valsalva maneuver decreases it.

Question 27

What is mitral regurgitation (MR)?

Answer 27

Abnormal reversal of blood flow from the left ventricle to the left atrium.

Question 28

What are the common causes of MR?

Answer 28

Cardiomyopathy, mitral valve prolapse, rheumatic heart disease, infective endocarditis, ischemic heart disease.

Question 29

What auscultatory findings are characteristic of MR?

Answer 29

Diminished S1, wide splitting of S2, S3 sound, pansystolic murmur.

Question 30

What causes a wide split of S2 in MR?

Answer 30

Early closure of the aortic valve.

Question 31

What murmur is characteristic of MR?

Answer 31

Pansystolic murmur (or mid-systolic in mitral valve prolapse).

Question 32

What is the pathophysiology of valvular regurgitation?

Answer 32

Backward blood flow leads to volume overload and heart failure.

Question 33

What is the pathophysiology of valvular stenosis?

Answer 33

Increased pressure behind the valve causes hypertrophy and cardiac remodeling.

Question 34

What condition can result in syncope due to insufficient pressure ahead of a blocked valve?

Answer 34

Aortic stenosis.

Question 35

What is the most common valvular abnormality in North America?

Answer 35

Aortic stenosis due to degenerative calcification.

Question 36

What is the cause of a soft or absent A2 in severe AR?

Answer 36

The aortic valve fails to close properly.

Question 37

Why does strenuous handgrip intensify the AR murmur?

Answer 37

It increases systemic resistance, augmenting regurgitant volume.

Question 38

What is the most common congenital cause of AS?

Answer 38

Bicuspid aortic valve.

Question 39

What is the main histologic feature of rheumatic heart disease?

Answer 39

Aschoff bodies (perivascular mononuclear infiltrates).

Question 40

What is the most important clinical indicator of MS severity?

Answer 40

The interval between S2 and the opening snap (shorter = more severe).

Question 41

What imaging modality is best for diagnosing valvular abnormalities?

Answer 41

Echocardiography.

Question 42

What is the treatment for symptomatic severe AS?

Answer 42

Aortic valve replacement.

Question 43

What are the indications for surgery in AR?

Answer 43

Severe AR with symptoms, LV dysfunction, or progressive dilation.

Question 44

What is the definitive treatment for severe MS?

Answer 44

Percutaneous balloon mitral valvuloplasty or valve replacement.

Question 45

What is the most common valvular abnormality in rheumatic heart disease?

Answer 45

Mitral stenosis.

Question 46

Why does pulmonary hypertension develop in MS?

Answer 46

Left atrial pressure increases, leading to pulmonary venous congestion.

Question 47

What does a loud S1 in MS indicate?

Answer 47

Increased forceful closure of the mitral valve.

Question 48

What does an opening snap in MS indicate?

Answer 48

Sudden tensing of the mitral valve leaflets.

Question 49

What is the gold standard for assessing valvular abnormalities?

Answer 49

Doppler echocardiography.