Valvular Heart Disease

Question 1

What is the best initial test for all valvular heart disease?

Answer 1

TEE

Question 2

What is the most accurate test for all valvular heart disease?

Answer 2

Catheterization

Question 3

How are stenotic lesions generally treated?

Answer 3

Correct the anatomy
-MS: dilation with a balloon
-AS: TAVR

Question 4

How are regurgitant lesions generally treated?

Answer 4

Vasodilators initially: ACEI/ARB, Nifedipine, Hydralazine

Surgery before the heart dilates too much

Question 5

What is the most common cause of Mitral Stenosis (MS)?

Answer 5

Rheumatic Fever

Question 6

What is defined as critical narrowing in Mitral Stenosis?

Answer 6

<1cm^2

Question 7

What are some unique symptoms to Mitral Stenosis?

Answer 7

Dysphagia: LA pressing on esophagus
Hoarseness: LA pressing on Laryngeal Nerve
A-Fib and stroke from enormous LA
Hemoptysis

Question 8

How would you describe the Murmur in Mitral Stenosis?

Answer 8

Diastolic just after an opening snap

Question 9

What maneuvers Increase the intensity of murmur in Mitral Stenosis?

Answer 9

Squatting and Leg raising: they increase venous return to the heart

Question 10

What treatments are used in Mitral Stenosis?

Answer 10

Diuretics/Na restriction to control fluid overload

Balloon valvuloplasty with a catheter

Valve replacement

Warfarin for A-Fib to INR of 2-3

Rate control for A-Fib: Digoxin, BB or Diltiazem/Verapamil

Question 11

What are the common causes of Aortic Stenosis (AS)?

Answer 11

congenital bicuspid valve

Increasing calcification due to age

Question 12

What is the most common symptom of Aortic Stenosis?

Answer 12

Angina

Question 13

What symptom has the worst prognosis in Aortic Stenosis?

Answer 13

CHF

Question 14

How would you describe the Murmur in Aortic Stenosis?

Answer 14

Systolic Crescendo-Decrescendo murmur
-heard best at 2nd R ICS and radiates to the carotids

Question 15

What maneuvers decrease the intensity of murmur in Aortic Stenosis?

Answer 15

Valsalva and standing due to decreasing venous return to the heart

Handgrip due to decreased ejection of blood

Question 16

What treatment is superior for Aortic Stenosis?

Answer 16

TAVR

Question 17

What is Mitral Regurgitation (MR)?

Answer 17

Backward flow of blood through a mitral valve that does not close together

Question 18

How would you describe the murmur in Mitral Regurgitation?

Answer 18

Holosystolic that radiates to the axilla

Question 19

What maneuvers worsen Mitral Regurgitation?

Answer 19

Handgrip: forces more blood backward through the valve

Squatting and leg-raise: increase venous return

Increases with Expiration (left-sided murmur)

Question 20

What causes Aortic Regurgitation?

Answer 20

Anything that makes the heart or aorta dilate
-MI
-HTN
-Endocarditis
-Marfan Syndrome/Cystic Medial Necrosis
-Inflammatory Disorders
-Syphillis

Question 21

What are some of the specific clinical findings seen in Aortic Regurgitation?

Answer 21

WIde Pulse Pressure
Water-hammer (wide, bounding) Pulse
Quinche Pulse (pulsations in nail bed)
Hill Sign (BP in legs up to 40mmHg greater than arms)
Head Bobbing

Question 22

How would you describe the murmur of Aortic Regurgitation?

Answer 22

Diastolic Crescendo Murmur
-best at lower left sternal border

Question 23

What maneuvers worsen the murmur in Aortic Regurgitation?

Answer 23

Handgrip: compresses the arteries increasing afterload

Question 24

What maneuvers make the murmur in Aortic Regurgiation better?

Answer 24

Valsalva and standing

Question 25

What murmur is associated with Mitral valve Prolapse (MVP)?

Answer 25

Midsystolic click: if severe is associate with a murmur just after the click from MR

Question 26

What Maneuvers worsen MVP?

Answer 26

Valsava and standing: decrease venous return to the heart

Question 27

What maneuvers improve MVP?

Answer 27

Anything that increases the LV chamber size: squatting or handgrip

Question 28

What is Hypertrophic Obstructive Cardiomyopathy?

Answer 28

Genetic Disorder where an abnormally shaped septum blocks the outflow of blood from the Left Ventricle (LV)

Question 29

What are common symptoms of Hypertrophic Obstructive Cardiomyopathy (HOCM)?

Answer 29

Systolic Anterior Motion (SAM) of the Mitral valve: contributes to obstruction Dyspnea Chest Pain Syncope and lightheadedness Sudden Cardiac Death: particularly in healthy athletes

Question 30

What worsens the symptoms in HOCM?

Answer 30

Anything that increases the Heart Rate -Exercise -Dehydration -Diuretics Anything that decreases LV chamber size -ACEI, ARB, Digoxin, Hydralazine, Valsalva, Sudden standing

Question 31

What is the best initial treatment for HOCM?

Answer 31

Beta-Blockers