Valvular Heart Disease Flashcards Preview

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Flashcards in Valvular Heart Disease Deck (108):
1

Optimal results with balloon valvulotomy is achieved in patients who have mitral score of ...

7 +/- 1.

1

TEE is indicated to differentiate between... (bug) bacteremia and infective endocarditis (positive for in 25% of cases).

S. aureus

2

CHF is the major indication for ... (intervention) of infective endocarditis.

surgical management

3

Infective endocarditis mortality rate with strep infection is... .

10%

4

Infective endocarditis mortality rate with S. aureus infection is... .

35%

5

Early infective endocarditis (at less than 2 months after prosthetic valve surgery) is often caused by CN staphylococci and is treated by... (intervention).

replacement

6

Lambl’s excrescences are normal valvular strands confused with findings of... .

endocarditis

7

... can be used in staphylococcal endocarditis in patients who are mildly allergic to penicillin.

Cefazolin (First generation)

8

Because it effectively treats staphylococci on foreign-body prosthetic material, ... should also be given.

rifampin at 300 mg PO TID

9

The ... bacteria group are fastidious G- rods that cause large vegetations in infective endocarditis.

HACEK

10

... (bacterium) is a frequent cause of infective endocarditis in homeless patients with chronic alcoholism (probably transmited by body lice).

Bartonella quintana

11

Vasodilator Therapy for Chronic Aortic Regurgitation is indicated as long-term therapy in asymptomatic patients with severe regurgitation who have LV dilatation but... I

normal systolic function.

12

The functional murmur (Still) is better heard in ... position.

supine

13

If only the peak pressure gradient is elevated in a patient with prosthetic mitral valve and the mean gradient and T ½ are normal, this likely indicates significant ...

"occult MR," meaning that there is significant MR that is shadowed by the prosthesis.

14

The medical therapy in acute MR in normotensive patients consists of potent vasodilators like...

nitroprusside.

15

Valvular thickening by echo, present in a patient with a prior history of mediastinal radiation characterizes...

radiation-associated valvular heart disease.

16

Patients with cardiomyopathy and mitral regurgitation have better long-term prognosis after undergoing...

mitral reconstruction via an annuloplasty ring.

17

The management of patients with moderate risk MVP consists of...

reevaluation in 2-3 years.

18

... is a valvular complication of end-stage cardiomyopathy that is associated with poor prognosis.

Secondary mitral regurgitation

19

The therapy in patients with low risk MVP consists of...

reassurance and reevaluation in 5 years.

20

The apical mid-diastolic murmur occurring in rheumatic fever carditis is called...

Carey-Coombs murmur.

21

The valve repair or replacement in MR should occur before LVEF falls below...

60%.

22

The apical impulse is displaced downward and to the left in chronic... (valvulopathy).

severe MR

23

The murmur in... is a short apical systolic murmur.

acute severe MR

24

The only situation in cardiology where the pathology leads to improved, rather than abnormal, LV diastolic function is...

MR.

25

... is used with warfarin to decrease thrombosis in patients after heart valve replacement.

Dipyridamole

26

... from mitral stenosis is a high-pitched and snapping sound best heard following S2 between left lateral sternal border and apex with the diaphragm.

The opening snap

27

The interval between the S2 and the opening snap... (characteristic change) with progression of mitral stenosis.

shortens

28

Balloon valvotomy for MS is usually performed in the... trimester of the pregnancy with excellent results in symptomatic patients refractory to meds.

late second

29

The valve repair or replacement in MR should occur when... occur.

symptoms

30

The medical therapy in acute MR in HYPOtensive patients consists of...

IABP.

31

In cases of MR severe enough to need vasodilators or IABP, surgical correction should follow... (when) after the medical stabilization has been accomplished.

soon

32

... can be diagnosed by a characteristic midsystolic click and late systolic murmur.

MVP

33

Subjects with MVP without a mitral regurgitant murmur or Doppler regurgitation have a... level of risk.

low

34

The medical therapy for a pregnant woman with tight MS consists of...

diuretics, salt-restriction and beta blockers.

35

A pulsatile liver is consistent with...

severe TR.

36

Some degree of... (valvulopathy) is extremely common in CAD patients.

MR

37

Patients with bicuspid aortic valve have a risk of... than patients with normal valve to develop acute aortic dissection.

9 times higher

38

Regurgitant jets within the left atrium that are..., cause predictable underestimation of the severity of mitral regurgitation.

peripheral or impinging on a wall, rather than central

39

By determining the peak velocity of a tricuspid regurgitation jet, one can then calculate the... pressure gradient.

right ventricular-to-right atrial

40

In cases of moderate and severe..., flow in the pulmonary veins may reverse direction in systole.

mitral regurgitation

41

The earliest effect of rheumatic disease on the mitral valve is the result of inflammation and thickening of leaflet tips that restricts the motion of the tips while allowing free motion of the body of the leaflets, resulting in a characteristic... motion

"doming"

42

Stenotic and regurgitant velocities exceeding the Nyquist limit, lead to a spectral display paradoxically recorded as a velocity in the opposite direction of the moving target, phenomenon known as...

"aliasing".

43

The... (quality) of the regurgitant jet within the left atrium on echo is directly proportional to the severity of mitral regurgitation.

size

44

Secondary effects of mitral stenosis include left atrial dilation with subsequent blood stasis and thrombus formation and secondary...

pulmonary hypertension.

45

The pressure half-time can be related to an anatomical valve area by the following formula: valve area = P1/2 t ÷... msec.

220

46

A jet impinging on a wall underestimates the regurgitant volume by approximately...

40 percent.

47

Irrespective of the cause of a flail leaflet, the resultant jet is often highly eccentric and its flow is directed on the... side of the leaflet bearing the pathological lesion

opposite

48

When a patient with mitral stenosis has class III or IV CHF,... is indicated unless there is complicating morbidity.

balloon valvuloplasty or surgery

49

... is suggested by the triad of narcotic addiction, fever and multiple lung lesions (septic emboli).

Tricuspid endocarditis

50

Surgery should be performed in aortic regurgitation before... (symptom/morphological change).

signs of irreversible LVF damage occur.

51

When a patient with mitral stenosis has a pliable MV with little calcification and no or only mild MR he is an ideal case for...

balloon valvuloplasty.

52

A hemodynamically significant mitral stenosis is present when the mean transmitral pressure gradient rises above 15mmHg and pulmonary artery systolic pressure exceeds...

60mmHg.

53

The most common cause for acquired pulmonary stenosis is...

carcinoid disease.

54

The most frequent location of a leaflet vegetation in endocarditis is on the... valve.

mitral

55

The SECONDARY most common causes of aortic stenosis are...

rheumatic heart disease and degenerative aortic stenosis.

56

In a patient with normal ventricular function and a low peak aortic valve gradient (20–25 mm Hg), the likelihood of significant aortic stenosis is...

negligible.

57

Two-dimensional echocardiography often reveals an indentation of the anterior mitral valve leaflet during diastole due to the impinging regurgitant jet of... that distorts the symmetrical opening pattern of the mitral leaflet.

aortic regurgitation

58

Rheumatic aortic stenosis is seen almost exclusively in the presence of...

rheumatic mitral stenosis.

59

The distal secondary effect of aortic stenosis is...

poststenotic dilation of the aorta.

60

If left ventricular function augments with a dobutamine infusion and the aortic valve gradient increases to clinically pertinent levels, the diagnosis is most likely...

severe aortic stenosis with secondary left ventricular dysfunction.

61

Aortic leaflet thickening along the commissural edges is seen typically in...

rheumatic aortic stenosis.

62

The proximal secondary effect of aortic stenosis is...

LVH.

63

In cases of clinically significant aortic stenosis, the gradient is likely to exceed... mm Hg.

50

64

In cases of clinically significant aortic stenosis, the flow Doppler velocity is likely to exceed... m/sec, which is out of the range for accurate quantitation using pulsed-wave Doppler.

3.5

65

In a patient with 25-35% left ventricular function and a low peak aortic valve gradient (20–25 mm Hg), dobutamine infusion while monitoring left ventricular function and transvalvular gradients, can be a useful means to determine the presence of...

unrelated left ventricular dysfunction.

66

If left ventricular function augments with a dobutamine infusion and the aortic valve gradient does not change, the diagnosis is most likely...

left ventricular dysfunction not secondary to severe aortic stenosis.

67

The proximal secondary effect of aortic regurgitation is...

left ventricular dilation.

68

The distal secondary effect of aortic regurgitation is...

proximal aorta dilation.

69

... is a congenital malformation that is characterized by abnormalities of the tricuspid valve and right ventricle leading to a small functional RV.

Ebstein's anomaly

70

AR without ... is usually well tolerated during pregnancy, probably secondary to a marked fall in systemic vascular resistance and possibly due to the physiological increase in heart rate which may shorten diastole and thus reduce the degree of regurgitat

left ventricular dysfunction

71

The normal mitral valve area is ... cm2.

4 to 6

72

Prophylactic antibiotic treatment for labor is given routinely in patients with... heart disease in many institutions.

valvular

73

Most patients with... , especially those with valve area >1.0 cm2, tolerate pregnancy well, provided early diagnosis and close follow-up.

AS

74

... is the most commonly encountered valvular lesion in pregnancy.

Mitral stenosis

75

... is contraindicated in patients with moderate or severe aortic regurgitation, aortic dissection, aortic aneurysm, patent ductus arteriosus, severe peripheral vascular disease, bleeding disorders, or sepsis.

IABP insertion

76

The normal aortic valve area is ... in adults.

2.6 to 3.5 cm2

77

Severe mitral stenosis is present with valve areas less than ...

1.3 cm2.

78

In low-output states, the Gorlin formula may systematically predict ... valve areas than are actually present.

smaller

79

Patients contemplating pregnancy who are found to have severe MS (mitral valve area [MVA] <1.0 cm2) should be offered ... before pregnancy.

percutaneous mitral balloon valvuloplasty (PMBV)

80

Optimal management of the already pregnant patient with MS should aim at reducing the heart rate and left atrial pressure by administering...

beta-blockers (metoprolol may be preferred).

81

It seems reasonable to limit ... during pregnancy to symptomatic patients with severe mitral stenosis who do not respond to medical therapy or who cannot be provided a close and expert follow-up during pregnancy, labor and delivery.

percutaneous mitral balloon valvuloplasty

82

In both restrictive cardiomyopathy and constrictive pericarditis, the E/A ratio is elevated, but in cases of ... there is a greater than usual respiratory variation in inflow velocities.

constriction

83

Echocardiographic mitral valve prolapse may be seen in normal individuals after ...

volume depletion or a decrease in intravascular volume.

84

Symptoms in patients with mitral valve prolapse may be directly related to the severity of regurgitation; certain patients with mitral valve prolapse, however, may have symptoms related to ...

autonomic dysfunction (mitral valve prolapse syndrome).

85

The medical treatment in symptomatic patients with aortic stenosis during gestation is limited to ...

diuretics.

86

... murmur (name) is a presystolic rumble, heard along the left sternal border in the 3rd and 4th interspaces and at the apex as well; inhalation of amyl nitrite reduces the murmur.

Austin Flint in pure aortic regurgitation.

87

It has been noted that young patients tolerate ... valvectomy without valve replacement quite well, provided that there is no associated pulmonary hypertension.

tricuspid

88

Systolic anterior motion of the mitral valve that remains in contact with the septum for 40 percent of the systolic cycle is more likely to be associated with significant hemodynamic obstruction in ...

hypertrophic cardiomyopathy.

89

Vegetations due to ... (bug) are more likely to result in abscess formation and less likely to be sterilized with antibiotics.

Staphylococcus aureus

90

A traditional echocardiographic finding that represents indication for surgery in aortic regurgitation is dilation of the left ventricle beyond... mm in DIASTOLE in association with fractional shortening or ejection fraction below the normal range.

75

91

A traditional echocardiographic finding that represents indication for surgery in aortic regurgitation is a serial decline in left ventricular ejection fraction or progressive dilation of the left ventricle of 1.0 cm or more over... duration.

12-month

92

Most studies have suggested that when a high-quality, entirely normal transthoracic echocardiogram has been obtained in which there is no evidence of valvular mass or thickening and no evidence of pathological regurgitation, the yield in proceeding to TEE

relatively low.

93

The most common congenital tricuspid valve anomaly to escape detection to adulthood is ...

Ebstein anomaly.

94

... is the most appropriate therapy in virtually all patients with symptomatic aortic regurgitation.

Aortic valve replacement

95

A traditional echocardiographic finding that represents indication for surgery in aortic regurgitation is dilation of the left ventricle beyond... mm in SYSTOLE in association with fractional shortening or ejection fraction below the normal range.

55

96

The most common form of tricuspid valve disease is annular dilation due to... , resulting in abnormal leaflet coaptation and tricuspid regurgitation.

right-sided overload

97

Performing a full echocardiographic and Doppler examination at the time of the first follow-up visit after ... is indicated to obtain an early baseline pressure gradient.

a mechanical prosthesis or a stented bioprosthesis implantation

98

The most common form of restrictive cardiomyopathy is the ... most often seen in the elderly.

idiopathic

99

Patients with... have a predictable rate of hemodynamic progression with an average annual increase in gradient of 7 mmHg and decrease in valve area of 0.1 cm2.

aortic stenosis

100

... is the procedure of choice for relief of mitral stenosis.

Percutaneous mitral valvuloplasty

101

... is indicated to exclude left atrial thrombus before percutaneous mitral valvuloplasty.

Transesophageal echocardiography (TEE)

102

Both S3 and S4 are not uncommon in..., especially in the supine position, and are considered normal.

athletes

103

Cutaneous flushing, venous telangiectasia, diarrhea, bronchospasm, and cardiac valvular lesions are a number of manifestations associated with...

carcinoid tumors.

104

... is the most common and serious cardiac feature of relapsing polychondritis.

Aortic insufficiency

105

Mild mitral stenosis is best treated initially with... (class meds).

diuretics

106

Patients with AI and dilated LV should be started on afterload reduction with... (class or drug).

ACEI or nifedipine

107

... should be performed in any patient suspected with severe AS and older then 45 before surgical therapy.

Left heart catheterization – to assess gradient and coronaries for possible simultaneous CABG