Valvular Heart Disease

Question 1

Most common cause of aortic stenosis

Answer 1

Degenerative/senile/sclerocalcific AS

Question 2

Moat common congenital heart valve defect with male predominance

Answer 2

Bicuspid aortic valve disease

Question 3

Severe LV obstruction is defined as

Answer 3

Mean systolic pressure gradient >40mmhg with normal CO

effective aortic orifice area < 1cm2 or < 0.6cm2/m2 BSA

Question 4

In the early course of severe AS - indicates reduced compliance of the hypertrophied LV

Answer 4

Elevated LV EDP + preserved EF

Question 5

In late AS deterioration of contractile function is due to

Answer 5

Excess afterload: dec CO and LV- aortic pressure gradient, inc in the mean LA, PA, and RV pressure

Question 6

Increased oxygen demand due to hypertophied LV in AS causes

Answer 6

Angina

Question 7

Cardinal symptoms in AS

Answer 7

Angina, syncope, dyspnea (AS-D)

Question 8

Symptoms of LV failure

Answer 8

Orthopnea, PND, pulmo edema

Question 9

Slow rise of peripheral arterial pulse to a delayed sustained peak in AS

Answer 9

Pulsus parvus et tardus

Question 10

Synchronous or paradoxically split s2 in AS

Answer 10

Delayed closure of aortic valve as the LV systole becomes prolonged

Question 11

Murmur in AS

Answer 11

Midsystolic ejection murmur loudest at the base of the heart most commonly in 2nd right ics

Question 12

AS Severity in 2D echo

Answer 12

Severe:< Icm
moderate:1-1-5cm2
M i I d:1.5-2 cm2

Question 13

In Aortic Stenosis average time Of death after onset Of Symptoms( in the absence of surgical treatment)

Answer 13

Angina:3 years
Syncope:3 years
Dyspnea:2 years
C H F :1.5-2 years

Question 14

most common cause Of death in AS

Answer 14

CHF

Question 15

major hemodynamic compensation in Aortic regung

Answer 15

increased LV End Diastolic Volume(preload)

Question 16

Laplace’s law in Aortic Regurg:

Answer 16

Left vent dilation increases left vent systolic tension required to develop any given level of systolic pressure

Question 17

rapidly rising ‘water hammer’ pulse which collapses suddenly as arterial pressure falls during late systole and diastole in AR

Answer 17

Corrigan’s pulse

Question 18

capillary pulsations with alternate Flushing and paling Of the skin at the root of the nail in AR

Answer 18

Quincke’s pulse

Question 19

Booming pistol shot pulse over the Femoral arteries

Answer 19

Traube’s sign

Question 20

To and fro murmur audible with light compression of the steth over the femoral artery

Answer 20

Duroziez’s sign

Question 21

Aortic Regurgitation murmur

Answer 21

high pitched blowing de crescendo diastolic murmur heard best over the 3rd ICS left sternal border

Question 22

soft rumbling middiastolic bruit in AR

Answer 22

Austin Flint murmur

Question 23

Optimal Time of Surgery in AR

Answer 23

After Onset of LV dysfunction but BEFORE the onset of severe symptoms

Question 24

Leading cause of mitral stenosis

Answer 24

Rheumatic Fever

Question 25

Low pitched diastolic murmur following the OS

Answer 25

mitral stenosis

Question 26

Pansystolic murmur produced by Functional T R at the left Sternal border accentuated by inspiration and diminished by Forced expiration or valsalva

Answer 26

Carvallo ‘s sign

Question 27

Carvallo ‘s sian in mitral Stenosis indicates?

Answer 27

Severe Pulmonary Hypertension

Question 28

High- pitched diastolic de crescendo blowing murmur along the left Sternal border resulting from dilatation of the pulmonary value ring and occurs in patients with mitral valve disease and Severe pulmonary hypertension

Answer 28

Graham Steel murmur

Question 29

most sensitive and specific non invasive method in diagnosis mitral Stenosis

Answer 29

2 D echo

Question 30

Malar Telangiectasia

Answer 30

Severe mitral Stenosis

Question 31

Anacrotic pulse

Answer 31

AS

Question 32

Bifid/ Bisferiens pulse

Answer 32

Hypertrophic Cardiomyopathy, AR

Question 33

Pulsus bigeminus

Answer 33

pvc’s

Question 34

Pulsus alternans

Answer 34

Severe HF

Question 35

Normal B P difference between arms

Answer 35

< 10 mmHg

Question 36

conditions causing delay in mv closure causes

Answer 36

reversed Split S2
severe ms
LA myxoma
LBBB

Question 37

Diastolic sound

Answer 37

Opening Snap
pericardial knock
Tumor plop
S4

Question 38

most common Valvular involvement in carcinoid syndrome

Answer 38

Pulmonic Valve