Valvular Heart Diseases

Question 1

Hemodynamic hallmark of mitral stenosis (MS)

Answer 1

blood can flow from LA to LV only if propelled by an abnormally elevated left atrioventricular pressure gradient (d.t. reduction in mitral orifice area < 2 cm)

Question 2

The leading cause of mitral stenosis

Answer 2

RHD

Question 3

narrowed mitral orifice <4cm2 with obstruction blood flow from LA to LV

Answer 3

MITRAL STENOSIS

Question 4

MC presenting symptoms of MS

Answer 4

dyspnea
fatigue
decreased exercise tolerance

Question 5

important cause of morbidity and mortality late in the course of MS

Answer 5

recurrent pulmonary emboli

Question 6

Characteristic murmur of MS

Answer 6

DIASTOLIC RUMBLING MURMUR PRECEDED BY OPENING SNAP (OS) AT THE APEX

Question 7

Murmur is usually LOUDER during INSPIRATION and diminishes during forced expiration

Answer 7

Carvallo’s sign

Question 8

High-pitched, diastolic, decrescendo blowing murmur along the left sternal border

Answer 8

Graham Steell murmur

Question 9

SIGNS OF CHF:

Answer 9

jugular venous distention
dullness on chest percussion → pleural effusion
fine rales
hepatomegaly and ascites
pedal or sacral edema

Question 10

ECG findings in MS

Answer 10

• atrial fibrillation
• LA hypertrophy
• RV hypertrophy
• RA hypertrophy

Question 11

Chest x-ray in MS

Answer 11

• left atrial enlargement
• prominent PA
• dilation of the upper lobe pulmonary veins
• posterior displacement of the esophagus by an enlarged LA

• Kerley B lines
-result from distention of interlobular septae and lymphatics with edema when resting mean LA pressure exceeds ~20 mmHg

• pleural effusion and alveolar infiltrates
• pulmonary edema

Question 12

Important for at risk patients with rheumatic MS

Answer 12

Penicillin prophylaxis

Question 13

Useful in slowing the ventricular rate of patients w/ AF

Answer 13

beta blockers
nonhydropyridine calcium channel blockers
digitalis glycosides

Question 14

Should be administered indefinitely to patients w/ MS who have AF or a history of thromboembolism

Answer 14

warfarin therapy

targeted to an international normalized ratio (INR) of 2-3

Question 15

Indicated in symptomatic (New York Heart Association [NYHA] Functional Class II–IV) patients with isolated severe MS, whose effective orifice (valve area) is < ~1 cm2/m2 body surface area, or <1.5 cm2 in normal sized adults

Answer 15

mitral valvotomy

Question 16

May be d.t. ACS w/ papillary muscle rupture, chest trauma, endocarditis

Answer 16

Acute MR

Question 17

May be d.t. RHD, MVP, cardiomyopathies

Answer 17

Chronic MR

Question 18

Most prominent symptoms in CHRONIC SEVERE MR

Answer 18

fatigue
exertional dyspnea
orthopnea

Question 19

Characteristic murmur of MR

Answer 19

apical holosystolic murmur of at least grade III

Question 20

Chest X-Ray findings in MR

Answer 20

LAE

LVH

Question 21

ECG findings in MR

Answer 21

LAE
LVH
atrial fibrillation

Question 22

Frequent finding in heritable CT disease

Answer 22

MVP (Floppy syndrome, Barlow’s syndrome)

more common in women 15-30 y/o
more severe in men and > 50 years old

Question 23

Characteristic murmur of MVP

Answer 23

apical mid- or late non-ejection systolic murmur preceded by a click

ACCENTUATED BY - standing and strain phase of Valsalva maneuver
DIMINISHED BY - squatting and isometric exercises

Question 24

narrowing of the aortic valve orifice – causes

obstruction to the flow of blood from LV to aorta

Answer 24

AORTIC STENOSIS

Question 25

CONGENITAL AORTIC VALVE DISEASE

Answer 25

Bicuspid aortic valve (BAV) - MC aortic heart defect - AD - NOTCH1 gene - abnormalities in nitric oxide synthase and NKX2.5

Question 26

CALCIFIC AORTIC VALVE DISEASE

Answer 26

degenerative MC cause of AS in adults

Question 27

3 CARDINAL SYMPTOMS of AS

Answer 27

* exertional dyspnea * angina pectoris * syncope (exertional)

Question 28

Characteristic murmur of AS

Answer 28

thrill and harsh CRESCENDO-DECRESCENDO SYSTOLIC murmur at the 2nd R ICS ↓ in valsalva maneuver

Question 29

pulsus parvus et tardus

Answer 29

* carotid arterial pulse rises slowly to a delayed peak | * weak and late-peaking/delayed pulse

Question 30

Gallavardin effect (AS)

Answer 30

murmur may transmitted to apex resembling murmur of MR

Question 31

ECG findings in AS

Answer 31

* LV hypertrophy | * ST segment depression and T wave inversion

Question 32

Gold standard for AS diagnosis

Answer 32

Cardiac Catheterization * determine the status of coronary artery disease * coronary angiography is indicated to detect or * exclude CAD in patients >45 years old with severe AS who are being considered for operative treatment

Question 33

percutaneous aortic balloon valvuloplasty (PABV)

Answer 33

preferable to operation in many children and young adults with congenital, noncalcific AS NOT commonly used as definitive therapy in adults with severe calcific AS because of a very high restenosis rate

Question 34

transcatheter aortic valve replacement

Answer 34

performed with increasing frequency in prohibitive-, high-, and intermediate surgical-risk adult patients worldwide using one of two available systems, a balloon expandable valve and a self-expanding valve, both of which incorporate a pericardial prosthesis

Question 35

Can be caused by primary aortic valve disease or primary aortic root disease

Answer 35

AORTIC REGURGITATION

Question 36

Primary Valve Disease

Answer 36

RHD congenital bicuspid aortic valve endocarditis

Question 37

Primary Aortic Root Disease

Answer 37

aortic annular dilation | Marfan's syndrome

Question 38

Characteristic murmur of AR

Answer 38

high pitched blowing DECRESCENDO DIASTOLIC murmur in 3rd ICS left PSB

Question 39

ECG findings in AR

Answer 39

LVH w/ ST depression and T wave inversion in I, avL, V5-V6 (lateral leads)

Question 40

Chest x-ray findings in AR

Answer 40

apex displaced DOWNWARD and to the LEFT

Question 41

Management of AR

Answer 41

diuretics, ACE-I and vasodilators for CHF Aortic Valve Replacement

Question 42

valve area is < 4cm2 which causes an ↑ in RA pressures with progressive dilatation

Answer 42

TRICUSPID STENOSIS

Question 43

Does NOT occur as an isolated lesion and usually associated with MS almost always accompanied by severe TR

Answer 43

TRICUSPID STENOSIS

Question 44

MC cause of TS

Answer 44

RHD

Question 45

Carcinoid Syndrome

Answer 45

production of substance that stimulates collagen production – fibrosis of the tricuspid valve

Question 46

Symptoms in TS

Answer 46

ascites | edema

Question 47

Signs in TS

Answer 47

ascites, edema, hepatosplenomegaly - signs or R sided CHF

Question 48

Characteristic murmur of TS

Answer 48

DIASTOLIC murmur at lower left PSB AUGMENTED - inspiration REDUCED - expiration and Valsalva (strain phase)