Valvular Heart Disease EXTRAS

Question 1

What is the most sensitive indicator of left ventricular myocardial ischemia?
A) Wall motion abnormalities on echo
B) Appearance of V waves on the PCW tracing
C) ST segment changes in V5
D) Decrease in cardiac output

Answer 1

A) Wall motion abnormalities on echo

Question 2

Cardiac Tamponade is associated with?
A) pulsus alternans
B) Pulsus tardus
C) pulsus parvus
D) pulsus paradoxus

Answer 2

D) pulsus paradoxus

Question 3

The MAP in a patient with a blood pressure of 180/60 mmHg is?
A) 90
B)110
C)100
D)120

Answer 3

C) 100

Question 4

Which of the following would be the best intraoperative TEE view to monitor for myocardial ischemia?
A) Midesophageal 4 chamber view
B) Midesophageal long axis view
C) Transgastric mid-papillary left ventricular short axis view
D) Midesophageal two chamber view

Answer 4

C) Transgastric mid-papillary left ventricular short axis view

Question 5

Which of the following medications blocks angiotensin at the receptor?
A) losartan
B) lisinopril
C) terazosin
D) spironolactone

Answer 5

A) losartan

Question 6

Sildenafil belongs to the same class of drug as which of the following?
A) yohimbine
B) hydralazine
C) milrinone
D) enalapril

Answer 6

C) milrinone

Question 7

What is the minimum amount of time after angioplasty with a drug eluting stent that DAPT is continued before elective surgery?
A) 3 months
B) 1 year
C) 6 months
D) 18 months

Answer 7

B) 1 year

Question 8

The effects of clopidogrel can be reversed with?
A) FFP
B) Aprotinin
C) Factor VIII
D) None of the above

Answer 8

D) None of the above

Question 9

You made an infusion of dopamine with 200 mg dopamine in 250 mL 800mcg/mL. What is the rate for 5 mcg/kg/min in a 70 kg patient?
A) 10 mL/hr
B) 20 mL/hr
C) 16 mL/hr
D) 26 mL/hr

Answer 9

D) 26 mL/hr

Question 10

Severe aortic stenosis is associated with a valve area of less than how many cm^2?
A) 1
B) 4
C) 1.5
D) 40

Answer 10

A) 1

Question 11

_____ regurgitation d/t ischemic heart disease increases mortality.

Answer 11

Mitral

Question 12

A compensatory increase in sympathetic nervous system activity may manifest as _____, __________, and resting ________.

Answer 12

anxiety, diaphoresis, tachycardia

Question 13

What is a physiologic murmur?

Answer 13

A murmur that is primarily d/t physiologic conditions outside the heart, as opposed to the heart itself.

Question 14

What is the only murmur that can be considered physiologic or functional?

Answer 14

midsystolic

Question 15

What will you do if you auscultate anyone with a systolic murmur?

Answer 15

STOP. It’s valid to delay the case for a cardiac workup

Question 16

What type of murmur radiates to the carotids? What pathology is it associated with?

Answer 16

midsystolic murmur. Aortic Stenosis

Question 17

What type of murmur radiates to the axilla? What pathology is it associated with?

Answer 17

holosystolic murmur. Mitral regurgitation

Question 18

When referring to murmurs…. what does crescendo mean?

Answer 18

gradually getting louder

Question 19

When referring to murmurs… what does decrescendo mean?

Answer 19

gradually getting softer

Question 20

What murmurs will increase with standing or valsalva maneuvers?
What murmur decreases with standing or valsalva meneuvers?

Answer 20

Mitral prolapse, hypertrophic cardiomyopathy.
Aortic stenosis

Question 21

What murmur increases with tachycardia?

Answer 21

Mitral stenosis

Question 22

What murmur increases with inspiration?

Answer 22

tricuspid regurgitation

Question 23

What murmur is associated with a midsystolic click?

Answer 23

Mitral valve prolapse

Question 24

What murmur is associated with an ejection click? A midsystolic click?

Answer 24

Ejection click = aortic stenosis
Midsystolic click = mitral stenosis

Question 25

Is warfarin still discontinued in mechanical heart valve patients before minor surgery? Major surgery?

Answer 25

Minor surgery = no, as long as bleeding risk is minimal Major surgery= yes, transition w/unfractionated heparin until the day before or day of surgery. Resume heparin post-operatively and transition back to warfarin

Question 26

When referring to the left atrium/left ventricle, what is the sub-valvular apparatus?

Answer 26

LV free wall, two papillary muscles, and chordae tendineae. The sub-valvular apparatus prevents mitral valve prolapse during systole.

Question 27

What type of MI can cause ischemia and infarction of the papillary muscles?

Answer 27

Inferior MI

Question 28

With severe mitral stenosis, any additional stress such as fever or sepsis may precipitate what?

Answer 28

Pulmonary edema

Question 29

What pressor agents are the agents of choice in maintaining SVR and BP in patients with mitral stenosis?

Answer 29

Phenylephrine and vasopressin

Question 30

Why is pancuronium avoided in many valvular diseases?

Answer 30

Histamine release

Question 31

What is a common cause of acute mitral regurgitation?

Answer 31

Myocardial ischemia/infarction which causes papillary muscle dysfunction/rupture

Question 32

Is afterload reduction for treating mitral regurgitation appropriate?

Answer 32

Absolutely

Question 33

What are some risks associated with bicuspid aortic valve?

Answer 33

-aortic stenosis -aortic aneurysms -aortic dissection

Question 34

Is ROSC likely in a coding patient with aortic stenosis?

Answer 34

No