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MSRS 6310 > Aortic Valve Disease > Flashcards

Aortic Valve Disease Flashcards

1
Q

Which of the following symptoms is commonly associated with aortic stenosis?
a) Cough
b) Angina
c) Nausea
d) Headache

A

b) Angina

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2
Q

What physical examination finding is characteristic of aortic stenosis?
a) Continuous diastolic murmur
b) Early systolic murmur
c) Harsh crescendo–decrescendo systolic murmur
d) Soft ejection murmur

A

c) Harsh crescendo–decrescendo systolic murmur

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3
Q

and quantifying the severity of aortic stenosis?
a) Chest X-ray
b) ECG
c) Blood test
d) Echocardiography

A

d) Echocardiography

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4
Q

What is the only effective therapy for severe aortic stenosis?
a) Medication
b) Physical therapy
c) Aortic valve replacement
d) Lifestyle changes

A

c) Aortic valve replacement

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5
Q

Aortic regurgitation can be caused by which of the following?
a) Pulmonary stenosis
b) Left ventricular hypertrophy
c) Abnormality of the valve or dilatation of the aortic root
d) Mitral valve stenosis

A

c) Abnormality of the valve or dilatation of the aortic root

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6
Q

In the setting of endocarditis, aortic regurgitation typically presents:
a) Slowly and progressively
b) Acutely
c) With no symptoms
d) Only in elderly patients

A

b) Acutely

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7
Q

What is the definitive treatment for both acute and chronic severe aortic regurgitation?
a) Medication
b) Lifestyle modification
c) Aortic valve replacement
d) Observation

A

c) Aortic valve replacement

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8
Q

How many cusps does the normal aortic valve have?
a) Two
b) Three
c) Four
d) Five

A

b) Three

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9
Q

What is the primary function of the aortic valve during systole?
a) To close and prevent blood flow into the aorta
b) To open and allow ejection of blood from the left ventricle
c) To close and prevent regurgitation into the left atrium
d) To assist in ventricular contraction

A

b) To open and allow ejection of blood from the left ventricle

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10
Q

What does the aortic valve prevent during diastole?
a) Forward flow of blood into the right ventricle
b) Retrograde flow of blood from the aorta into the left ventricle
c) Blood flow from the left atrium to the left ventricle
d) Blood flow into the pulmonary artery

A

b) Retrograde flow of blood from the aorta into the left ventricle

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11
Q

Which of the following is a consequence of aortic valve dysfunction?
a) Increased forward cardiac output
b) Reduction in effective forward cardiac output
c) Prevention of blood ejection from the right ventricle
d) Enhanced blood flow into the pulmonary circulation

A

b) Reduction in effective forward cardiac output

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12
Q

Aortic valve regurgitation is caused by:
a) Complete closure of the valve during systole
b) Incomplete closure of the valve during diastole
c) Reduced contraction of the left ventricle
d) Blocked coronary arteries

A

b) Incomplete closure of the valve during diastole

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13
Q

What is the most common cause of left ventricular (LV) outflow obstruction?
a) Hypertrophic obstructive cardiomyopathy (HOCM)
b) Valvular aortic stenosis (AS)
c) Atrial septal defect
d) Non-calcific tricuspid valve degeneration

A

b) Valvular aortic stenosis (AS)

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14
Q

outcomes?
a) It is defined by a fixed threshold value
b) It is a continuous and independent relationship
c) It only correlates with immediate outcomes
d) It is inconsistent and varies by patient

A

c) It only correlates with immediate outcomes

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15
Q

What limitation do FFR and iFR have regarding microvasculature function?
a) They only measure microvasculature function in patients with acute coronary syndromes
b) They provide detailed analysis of microvascular flow
c) They do not measure microvasculature function, which can contribute to myocardial ischemia
d) They require advanced imaging to assess microvasculature

A

c) They do not measure microvasculature function, which can contribute to myocardial ischemia

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16
Q

What type of approach can negatively affect patient care when using FFR or iFR for clinical decisions?
a) A holistic approach
b) A dichotomous approach
c) An individualized approach
d) A probabilistic approach

A

b) A dichotomous approach

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17
Q

Studies have shown a gradient in major adverse outcomes for patients with which FFR value?
a) Exactly 0.80
b) Less than 0.75
c) Greater than 0.80
d) Exactly 1.00

A

c) Greater than 0.80

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18
Q

Which condition has been reported in patients with previous MI and CAD risk factors that FFR and iFR do not measure?
a) Coronary artery stenosis
b) Microvasculature dysfunction
c) Left ventricular hypertrophy
d) Hypertension

A

b) Microvasculature dysfunction

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19
Q

What type of variable are iFR and FFR considered to be?
a) A categorical variable
b) A fixed variable
c) A continuous biological variable
d) A binary variable

A

c) A continuous biological variable

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20
Q

What effect does the dichotomous use of a continuous biological variable, such as FFR, have on patient care?
a) It allows for more accurate diagnostics
b) It can introduce unnecessary rigidity
c) It minimizes patient risk
d) It increases treatment flexibility

A

b) It can introduce unnecessary rigidity

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21
Q

What combination of conditions is typical with rheumatic involvement of the aortic valve in the U.S.?
a) Stenosis and hypertrophy
b) Stenosis and regurgitation
c) Regurgitation and hypertrophy
d) Calcification and stenosis

A

b) Stenosis and regurgitation

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22
Q

How is calcification different in rheumatic AS compared to degenerative AS?
a) Rheumatic AS has calcification from the base to the leaflets
b) Degenerative AS has commissural fusion
c) Rheumatic AS has calcification with commissural fusion
d) Degenerative AS has a lack of leaflet involvement

A

c) Rheumatic AS has calcification with commissural fusion

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23
Q

At what age does rheumatic AS generally present?
a) Between 30 and 50 years
b) Between 20 and 40 years
c) After age 60
d) During childhood

A

a) Between 30 and 50 years

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24
Q

What is the approximate prevalence of bicuspid aortic valve disease in the general population?
a) 0.5%
b) 1.3%
c) 5%
d) 10%

A

b) 1.3%

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25
Q

bicuspid aortic valve should be referred to a specialized surgical center?
a) >3.5 cm
b) >4.0 cm
c) >4.5 cm
d) >5.0 cm

A

c) >4.5 cm

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26
Q

What imaging recommendation is made for patients with a bicuspid aortic valve due to the risk of aortic dilatation?
a) Imaging of the heart chambers
b) Imaging of the pulmonary arteries
c) Imaging of the aorta
d) Imaging of the coronary arteries

A

c) Imaging of the aorta

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27
Q

Which systemic disease is mentioned as a less common cause of aortic stenosis?
a) Paget disease
b) Marfan syndrome
c) Addison’s disease
d) Hashimoto’s thyroiditis

A

a) Paget disease

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28
Q

What factors are believed to contribute to the development of aortopathy in patients with bicuspid aortic valve disease?
a) Environmental and lifestyle factors
b) Genetic and hemodynamic factors
c) Inflammatory and autoimmune factors
d) Viral and bacterial factors

A

b) Genetic and hemodynamic factors

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29
Q

What is the average survival without valve replacement for patients with AS who present with angina?
a) 1 year
b) 3 years
c) 5 years
d) 7 years

A

c) 5 years

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30
Q

What compensatory adaptation occurs in response to the pressure overload from aortic stenosis (AS)?
a) Ventricular dilation
b) Concentric left ventricular hypertrophy (LVH)
c) Left atrial enlargement
d) Right ventricular hypertrophy

A

b) Concentric left ventricular hypertrophy (LVH)

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31
Q

Which of the following is a classic symptom of aortic stenosis (AS)?
a) Chest pain
b) Angina
c) Syncope
d) All of the above

A

d) All of the above

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32
Q

What is the most concerning presentation of AS, as it is associated with the worst survival without valve replacement?
a) Syncope
b) Angina
c) Congestive heart failure (CHF)
d) Dyspnea

A

c) Congestive heart failure (CHF)

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33
Q

Angina in AS patients is primarily caused by which factor in the absence of significant coronary artery disease (CAD)?
a) Increased myocardial oxygen demand
b) Subendocardial ischemia
c) Impaired coronary artery perfusion
d) Systemic hypertension

A

b) Subendocardial ischemia

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34
Q

What mechanism contributes to syncope in patients with aortic stenosis during physical exertion?
a) Increased cardiac output
b) Decreased cardiac output due to fixed valvular obstruction
c) Severe arrhythmias
d) Increased systemic vascular resistance

A

b) Decreased cardiac output due to fixed valvular obstruction

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35
Q

What is the initial cause of heart failure symptoms in patients with AS?
a) Systolic dysfunction
b) Diastolic dysfunction
c) Coronary artery disease
d) Left atrial enlargement

A

b) Diastolic dysfunction

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36
Q

Which condition is associated with gastrointestinal bleeding in patients with aortic stenosis (AS)?
a) Angiodysplasia (Heyde syndrome)
b) Ulcerative colitis
c) Gastroesophageal reflux disease (GERD)
d) Peptic ulcer disease

A

a) Angiodysplasia (Heyde syndrome)

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37
Q

What complication of AS can lead to embolic events, such as stroke?
a) Atrial fibrillation
b) Small calcium deposits detachment
c) Pulmonary congestion
d) Increased left atrial pressure

A

b) Small calcium deposits detachment

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38
Q

What condition in AS patients can lead to pulmonary edema, especially with physical activity or atrial fibrillation?
a) Increased LV end-diastolic pressure
b) Loss of atrial function
c) Elevated pulmonary venous pressures
d) All of the above

A

d) All of the above

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39
Q

What is the key physical exam finding in the carotid artery that suggests severe aortic stenosis (AS)?
a) Increased pulsation
b) Pulsus parvus et tardus
c) Decreased carotid pulsation with rapid upstroke
d) Normal pulsation

A

b) Pulsus parvus et tardus

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40
Q

What is the typical auscultatory finding of the second heart sound in severe AS?
a) Increased aortic closure sound
b) Split second heart sound with a delay in the pulmonic closure sound
c) Decreased S1 intensity
d) Single second heart sound

A

b) Split second heart sound with a delay in the pulmonic closure sound

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41
Q

Which feature is associated with the murmur of aortic stenosis (AS)?
a) Crescendo-decrescendo pattern
b) Holosystolic pattern
c) High-pitched sound
d) Early diastolic murmur

A

a) Crescendo-decrescendo pattern

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42
Q

The “Gallavardin phenomenon” in AS refers to:
a) Transmission of the murmur into the carotids
b) A high-frequency resonation heard at the apex
c) A late systolic murmur
d) A soft S3 heart sound

A

b) A high-frequency resonation heard at the apex

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43
Q

What heart sound reflects reduced left ventricular compliance during atrial contraction in AS?
a) Third heart sound (S3)
b) Fourth heart sound (S4)
c) Split second heart sound
d) Ejection click

A

b) Fourth heart sound (S4)

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44
Q

When is the jugular venous pressure elevated in a patient with AS?
a) In the absence of left ventricular dysfunction
b) In the presence of congestive heart failure (CHF)
c) Only in the presence of right ventricular failure
d) Early in the disease process

A

b) In the presence of congestive heart failure (CHF)

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45
Q

Which heart sound is commonly heard if left ventricular dysfunction has developed in AS?
a) First heart sound (S1)
b) Third heart sound (S3)
c) Fifth heart sound (S5)
d) Sixth heart sound (S6)

A

b) Third heart sound (S3)

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46
Q

What finding is commonly observed in severe AS as the stenosis progresses?
a) The left ventricular apical impulse is displaced inferiorly and laterally
b) The right ventricular impulse becomes prominent
c) A prominent “a” wave in the jugular venous pressure
d) A soft, high-pitched murmur at the apex

A

a) The left ventricular apical impulse is displaced inferiorly and laterally

47
Q

What is a characteristic feature of aortic sclerosis?
a) Early peaking murmur with normal carotid pulsations
b) Crescendo-decrescendo murmur with transmission into the carotids
c) Late peaking murmur with a palpable S4
d) Severe aortic valve calcification with stenosis

A

a) Early peaking murmur with normal carotid pulsations

48
Q

What condition is associated with a significantly higher prevalence of coronary artery disease (CAD) and cardiovascular mortality, even though it does not cause significant stenosis?
a) Aortic sclerosis
b) Severe aortic stenosis
c) Mitral valve prolapse
d) Hypertrophic cardiomyopathy

A

a) Aortic sclerosis

49
Q

How can the murmur of mitral regurgitation (MR) be differentiated from that of aortic stenosis (AS)?
a) The MR murmur is holosystolic with a more musical quality and constant intensity.
b) The AS murmur is holosystolic and has a musical quality.
c) The MR murmur is accentuated after pauses, such as after a premature ventricular contraction.
d) The AS murmur is more prominent with decreasing preload.

A

a) The MR murmur is holosystolic with a more musical quality and constant intensity.

50
Q

Which of the following is a key difference between the murmurs of HOCM (Hypertrophic Obstructive Cardiomyopathy) and valvular aortic stenosis (AS)?
a) The HOCM murmur is accentuated after pauses, such as after a premature ventricular contraction.
b) The HOCM murmur becomes more prominent with increasing preload.
c) The AS murmur increases in intensity with decreasing preload.
d) The HOCM murmur becomes more prominent with decreasing preload, such as during the Valsalva maneuver

A

d) The HOCM murmur becomes more prominent with decreasing preload, such as during the Valsalva maneuver

51
Q

What is a characteristic feature of the carotid upstroke in Hypertrophic Obstructive Cardiomyopathy (HOCM)?
a) A rapid carotid upstroke with a bisferious (double peak) quality.
b) A slow carotid upstroke with delayed peak.
c) A biphasic carotid upstroke with a gradual increase in intensity.
d) A normal carotid upstroke without any notable changes

A

a) A rapid carotid upstroke with a bisferious (double peak) quality.

52
Q

What is the most common and useful test for evaluating suspected aortic stenosis (AS)?
a) CT angiography
b) Two-dimensional echocardiography with Doppler
c) Cardiac magnetic resonance imaging
d) Exercise stress testing

A

b) Two-dimensional echocardiography with Doppler

53
Q

Which of the following conditions can affect the transvalvular pressure gradient in patients with aortic stenosis?
a) Exercise
b) Anxiety
c) Anemia
d) All of the above

A

d) All of the above

54
Q

What is the threshold for a peak transvalvular gradient that is consistent with severe aortic stenosis?
a) >30 mm Hg
b) >40 mm Hg
c) >50 mm Hg
d) >64 mm Hg

A

d) >64 mm Hg

55
Q

Which of the following measurements is generally believed to be more reliable than the pressure gradient alone in determining the severity of aortic stenosis?
a) Left ventricular ejection fraction
b) Aortic valve area (AVA)
c) Left atrial size
d) Systolic blood pressure

A

b) Aortic valve area (AVA)

56
Q

What is a potential pitfall when relying solely on Doppler-derived aortic valve area (AVA) to assess the severity of aortic stenosis?
a) Failure to account for exercise-induced changes
b) Not visualizing the valve for calcification and altered mobility
c) Misinterpretation due to atrial fibrillation
d) Inadequate assessment of left ventricular hypertrophy

A

b) Not visualizing the valve for calcification and altered mobility

57
Q

What is a potential pitfall when relying solely on Doppler-derived aortic valve area (AVA) to assess the severity of aortic stenosis?
a) Failure to account for exercise-induced changes
b) Not visualizing the valve for calcification and altered mobility
c) Misinterpretation due to atrial fibrillation
d) Inadequate assessment of left ventricular hypertrophy

A

b) Not visualizing the valve for calcification and altered mobility

58
Q

How can a low mean transvalvular pressure gradient in patients with low cardiac output affect the assessment of aortic stenosis severity?
a) It may suggest severe aortic stenosis despite low pressure gradients.
b) It may cause the AVA to appear normal despite severe stenosis.
c) It may confuse the diagnosis with aortic regurgitation.
d) It may lead to an inaccurate diagnosis of heart failure.

A

a) It may suggest severe aortic stenosis despite low pressure gradients.

59
Q

In cases of low-flow, low-gradient aortic stenosis, what
is commonly observed when a dobutamine infusion is used?
a) A significant increase in cardiac output with no change in the transvalvular gradient
b) No change in cardiac output despite an increase in AVA
c) A reduction in the AVA index
d) An increase in left ventricular ejection fraction

A

a) A significant increase in cardiac output with no change in the transvalvular gradient

60
Q

What imaging method is particularly helpful for confirming the diagnosis of low-flow, low-gradient aortic stenosis in cases without LV systolic dysfunction?
a) Transthoracic echocardiography
b) Cardiac CT to assess aortic valve calcification
c) Magnetic resonance imaging of the heart
d) Left ventricular angiography

A

b) Cardiac CT to assess aortic valve calcification

61
Q

What is the most common ECG finding in patients with aortic stenosis (AS)?
a) Sinus rhythm
b) Atrial fibrillation
c) LVH (Left Ventricular Hypertrophy)
d) ST-segment elevation

A

c) LVH (Left Ventricular Hypertrophy)

62
Q

What is the most common ECG finding in patients with aortic stenosis (AS)?
a) Sinus rhythm
b) Atrial fibrillation
c) LVH (Left Ventricular Hypertrophy)
d) ST-segment elevation

A

c) LVH (Left Ventricular Hypertrophy)

63
Q

Which of the following findings is commonly observed in the chest x-ray of a patient with aortic stenosis?
a) Grossly dilated heart
b) Pulmonary venous congestion
c) Aortic root enlargement
d) Cardiomegaly due to right heart failure

A

b) Pulmonary venous congestion

64
Q

At what age should coronary angiography be performed in patients with aortic stenosis who require aortic valve replacement (AVR) or have two or more risk factors for coronary artery disease (CAD)?
a) 25 years
b) 30 years
c) 35 years
d) 40 years

A

c) 35 years

65
Q

When is invasive hemodynamic measurement indicated for patients with aortic stenosis?
a) When echocardiogram findings are inconclusive or discordant
b) In all patients with severe AS
c) Only when symptoms are present
d) In patients with normal LV function

A

a) When echocardiogram findings are inconclusive or discordant

66
Q

What alternative diagnostic tests may be used if echocardiography is nondiagnostic for assessing aortic stenosis severity?
a) Electrocardiogram (ECG)
b) Cardiac CT or MRI
c) Cardiac catheterization
d) Chest x-ray

A

b) Cardiac CT or MRI

67
Q

Which measurement of the aortic root diameter generally warrants aortic root replacement in patients with aortic stenosis?
a) >3.0 cm
b) >4.0 cm
c) >5.1 to 5.5 cm
d) >6.0 cm

A

c) >5.1 to 5.5 cm

68
Q

What is a key benefit of MRI in patients with aortic stenosis?
a) It is helpful for assessing LV volume, function, and mass.
b) It is the most reliable method for assessing aortic valve calcification.
c) It is the first-line method for diagnosing coronary artery disease.
d) It helps in evaluating myocardial infarction risk.

A

a) It is helpful for assessing LV volume, function, and mass.

69
Q

Which of the following ECG findings is less common in patients with aortic stenosis?
a) LVH
b) LA hypertrophy
c) ST-segment depression in leads V4-V6
d) Conduction system disease

A

c) ST-segment depression in leads V4-V6

70
Q

What is the primary indication for aortic valve replacement (AVR) in patients with aortic stenosis (AS)?
a) Severe and asymptomatic AS
b) Severe and symptomatic AS
c) Mild AS with no symptoms
d) Moderate AS with normal ejection fraction

A

b) Severe and symptomatic AS

71
Q

Which of the following is a common treatment for heart failure from LV systolic dysfunction in AS patients?
a) Valve replacement
b) Anticoagulation therapy
c) Treatment of complications according to standard heart failure guidelines
d) Diuretics and vasodilators

A

c) Treatment of complications according to standard heart failure guidelines

72
Q

What is the recommended approach to treating atrial fibrillation (AF) in patients with AS?
a) Electrical cardioversion only if asymptomatic
b) Anticoagulation therapy alone
c) Maintenance of sinus rhythm and anticoagulation based on stroke risk
d) Surgical intervention and valve replacement

A

c) Maintenance of sinus rhythm and anticoagulation based on stroke risk

73
Q

Why should volume depletion be avoided in patients with AS?
a) It causes severe bradycardia
b) It reduces LV filling pressures and may cause severe hypotension
c) It accelerates the progression of aortic valve calcification
d) It increases the risk of atrial fibrillation

A

b) It reduces LV filling pressures and may cause severe hypotension

74
Q

In patients with AS, which of the following can lead to volume depletion?
a) Aggressive diuresis and noncardiac surgery
b) Aortic valve replacement surgery
c) Increased fluid intake
d) Calcium channel blockers

A

a) Aggressive diuresis and noncardiac surgery

75
Q

When is infective endocarditis prophylaxis recommended for patients with native AS?
a) Always, regardless of risk factors
b) Only in patients with congenital valvular abnormalities
c) Only if other risk factors for infective endocarditis are present
d) It is not recommended for any patients with AS

A

c) Only if other risk factors for infective endocarditis are present

76
Q

patients with moderate to severe outflow tract obstruction in AS?
a) Vigorous exercise with no restrictions
b) Mild exercise with close supervision
c) No vigorous, unsupervised exercise
d) Regular cardiovascular exercise

A

c) No vigorous, unsupervised exercise

77
Q

What is the prognosis for asymptomatic patients with severe AS?
a) They have a high risk of sudden death (>10% per year)
b) They have an acceptable course and prognosis with a low rate of sudden death
c) They require immediate AVR
d) They will develop symptoms within one year

A

b) They have an acceptable course and prognosis with a low rate of sudden death

78
Q

What is the primary distinction between acute and chronic aortic regurgitation (AR)?
a) The location of the valve defect
b) The associated diseases, prognosis, and treatment options
c) The severity of symptoms
d) The presence of aortic dissection

A

b) The associated diseases, prognosis, and treatment options

79
Q

Which of the following is a common cause of acute aortic regurgitation (AR)?
a) Rheumatic heart disease
b) Ascending aortic dissection
c) Aortic sclerosis
d) Systemic hypertension

A

b) Ascending aortic dissection

80
Q

Which of the following conditions is most frequently responsible for infective endocarditis causing aortic regurgitation?
a) Bicuspid aortic valve
b) Degenerative valve disease
c) Perivalvular leak
d) Traumatic valve disruption

A

c) Perivalvular leak

81
Q

Which condition is a common cause of aortic root disease leading to aortic regurgitation?
a) Systemic hypertension
b) Aortic valve calcification
c) Marfan syndrome
d) Rheumatic heart disease

A

c) Marfan syndrome

82
Q

How does systemic hypertension contribute to the development of aortic regurgitation?
a) By weakening the valve cusps directly
b) By causing dilatation of the ascending aorta
c) By causing valve leaflet calcification
d) By leading to infective endocarditis

A

b) By causing dilatation of the ascending aorta

83
Q

Which of the following is NOT a common cause of aortic root disease leading to aortic regurgitation?
a) Marfan syndrome
b) Loeys-Dietz syndrome
c) Syphilitic aortitis
d) Ventricular septal defect with prolapse

A

d) Ventricular septal defect with prolapse

84
Q

What is the primary consequence of acute aortic regurgitation (AR) on the heart?
a) Impaired cardiac output and volume overload of the left ventricle (LV)
b) Increased heart rate and reduced stroke volume
c) Pressure overload of the right ventricle
d) Reduced ejection fraction without volume overload

A

a) Impaired cardiac output and volume overload of the left ventricle (LV)

85
Q

What role does connective tissue disorder play in the development of aortic regurgitation?
a) Causes calcification of the aortic valve
b) Leads to annuloaortic ectasia and distortion of the aortic valve structure
c) Increases the likelihood of infective endocarditis
d) Directly damages the valve leaflets

A

b) Leads to annuloaortic ectasia and distortion of the aortic valve structure

86
Q

What is the prognosis for patients with chronic severe aortic regurgitation (AR) who have symptoms such as angina or heart failure?
a) Low mortality, similar to asymptomatic patients
b) High mortality, similar to severe aortic stenosis (AS)
c) No change in prognosis after symptoms develop
d) Mortality of less than 5% per year

A

b) High mortality, similar to severe aortic stenosis (AS)

87
Q

In asymptomatic patients with chronic severe AR and normal left ventricular (LV) function, what is the annual rate of developing symptoms of LV dysfunction?
a) 10%
b) 4%
c) 25%
d) 0.2%

A

b) 4%

88
Q

What percentage of patients with chronic severe AR who die or progress to LV dysfunction do so before manifesting symptoms?
a) 50%
b) 25%
c) 75%
d) 10%

A

b) 25%

89
Q

What is a characteristic feature of the natural history of acute AR?
a) Asymptomatic progression without significant morbidity
b) Severe complications like pulmonary edema and cardiogenic shock
c) Slow and progressive onset of symptoms over several years
d) High rates of sudden death from arrhythmias

A

b) Severe complications like pulmonary edema and cardiogenic shock

90
Q

What is a characteristic feature of the natural history of acute AR?
a) Asymptomatic progression without significant morbidity
b) Severe complications like pulmonary edema and cardiogenic shock
c) Slow and progressive onset of symptoms over several years
d) High rates of sudden death from arrhythmias

A

b) Severe complications like pulmonary edema and cardiogenic shock

91
Q

What is the primary cause of symptoms in acute aortic regurgitation?
a) Rapid compensatory LV dilatation
b) Severe impairment of LV systolic function and increased LV diastolic pressure
c) Normal LV function with sudden regurgitation
d) Increased systemic vascular resistance

A

b) Severe impairment of LV systolic function and increased LV diastolic pressure

92
Q

In acute AR, how does the left ventricle (LV) typically respond to sudden volume overload?
a) The LV undergoes rapid compensatory dilation
b) The LV maintains normal compliance and function
c) The LV develops chronic hypertrophy
d) The LV experiences reduced compliance, leading to impaired systolic function

A

d) The LV experiences reduced compliance, leading to impaired systolic function

93
Q

Which of the following signs is typically absent in patients with acute AR, but commonly seen in chronic regurgitation?
a) Pulmonary edema
b) Tachycardia
c) Hypotension
d) Classic signs of chronic volume overload, such as a displaced apical impulse

A

d) Classic signs of chronic volume overload, such as a displaced apical impulse

94
Q

In patients with acute AR, what compensatory mechanism is commonly observed in an attempt to increase cardiac output?
a) Bradycardia
b) Peripheral vasodilation
c) Sinus tachycardia
d) Decreased LV preload

A

c) Sinus tachycardia

95
Q

What are the common complaints in patients with chronic aortic regurgitation (AR) when symptoms develop? a) Fatigue and dizziness
b) Exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea, angina, and palpitations
c) Severe chest pain and syncope
d) Severe dizziness and fainting

A

b) Exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea, angina, and palpitations

96
Q

What happens to the left ventricle (LV) as chronic AR progresses? a) The LV decreases in size and function
b) The LV undergoes hypertrophy and dilates
c) The LV becomes stiff and rigid
d) The LV increases in size but remains unaffected functionally

A

b) The LV undergoes hypertrophy and dilates

97
Q

How does the increased stroke volume in chronic AR maintain forward cardiac output in the early stages? a) By decreasing heart rate
b) By increasing heart rate substantially
c) Without substantial increases in heart rate despite regurgitation
d) By decreasing diastolic pressure

A

c) Without substantial increases in heart rate despite regurgitation

98
Q

What physiological effect results in a wide pulse pressure in chronic AR? a) Increased aortic systolic pressure and low aortic diastolic pressure
b) Decreased stroke volume and high aortic diastolic pressure
c) Increased heart rate and normal systolic pressure
d) Decreased stroke volume and low diastolic pressure

A

a) Increased aortic systolic pressure and low aortic diastolic pressure

99
Q

During exercise, how does the body compensate in chronic AR to improve forward cardiac output? a) By increasing LV end-diastolic pressure
b) By reducing systemic vascular resistance and shortening the diastolic filling period
c) By reducing stroke volume
d) By increasing regurgitation per beat

A

b) By reducing systemic vascular resistance and shortening the diastolic filling period

100
Q

In which situation does left ventricular (LV) systolic failure occur in chronic AR? a) When the LV compensates well for the volume overload
b) When the LV’s ability to compensate is exceeded, leading to LV dysfunction
c) When stroke volume is insufficient
d) When there is no increase in LV size

A

b) When the LV’s ability to compensate is exceeded, leading to LV dysfunction

101
Q

What happens when the left ventricle ejection fraction (LVEF) decreases in chronic AR? a) The LV becomes hypertrophied and stiffens
b) The LV dilates further, worsening symptoms
c) The LV function improves temporarily
d) The LV contracts more efficiently

A

b) The LV dilates further, worsening symptoms

102
Q

What type of heart murmur is characteristic of acute aortic regurgitation (AR)? a) A loud, prolonged diastolic murmur
b) A short, soft diastolic murmur
c) A high-pitched systolic murmur
d) A continuous murmur with a loud systolic phase

A

b) A short, soft diastolic murmur

103
Q

In acute AR, what is typically absent or soft on auscultation?
a) The first heart sound
b) The third heart sound
c) The second heart sound
d) The diastolic murmur

A

a) The first heart sound

104
Q

What causes the soft second heart sound in acute AR?
a) Early diastolic filling of the left ventricle
b) Premature closure of the mitral valve
c) Increased aortic pressure
d) Decreased left atrial pressure

A

b) Premature closure of the mitral valve

105
Q

In chronic AR, which finding is characteristic of peripheral pulses? a) Weak, thready pulses
b) Bounding pulses with a wide pulse pressure
c) Absent peripheral pulses
d) Irregular pulses

A

b) Bounding pulses with a wide pulse pressure

106
Q

What is the location where the diastolic murmur of chronic AR is best heard?
a) Left upper sternal border
b) Base of the heart along the left sternal edge or second right intercostal space
c) Cardiac apex
d) Midline of the sternum

A

b) Base of the heart along the left sternal edge or second right intercostal space

107
Q

What murmur can occur in severe chronic AR and be confused with mitral stenosis?
a) Austin Flint murmur
b) Aortic systolic murmur
c) Continuous murmur
d) Pulmonic regurgitation murmur

A

a) Austin Flint murmur

108
Q

What condition can mimic AR and presents with a continuous murmur? a) Coronary arteriovenous fistula
b) Pulmonic regurgitation
c) Patent ductus arteriosus
d) Aortic dissection

A

c) Patent ductus arteriosus

109
Q

Which diagnostic tool is primarily used for the initial assessment of acute and chronic AR?
a) Electrocardiogram (ECG)
b) Chest radiography
c) Echocardiography
d) Cardiac catheterization

A

c) Echocardiography

110
Q

What findings on the ECG are typical for chronic AR?
a) Right-axis deviation and right ventricular hypertrophy
b) Left-axis deviation and LV hypertrophy
c) Acute ST-segment changes
d) P-wave abnormalities

A

b) Left-axis deviation and LV hypertrophy

111
Q

In patients with chronic AR, what does chest radiography typically show? a) Massive right-sided heart enlargement
b) Massive left ventricular dilatation (cor bovinum)
c) No changes in cardiac size
d) Pulmonary artery dilatation only

A

b) Massive left ventricular dilatation (cor bovinum)

112
Q

What is the primary treatment for acute severe AR?
a) Medical management alone
b) Surgical repair or valve replacement
c) Vasodilators
d) Diuretics and beta-blockers

A

b) Surgical repair or valve replacement

113
Q

In the management of chronic AR, which medication class is recommended for treating hypertension? a) Beta-blockers only
b) Dihydropyridine calcium channel blockers, ACE inhibitors, or angiotensin receptor blockers
c) Diuretics
d) Non-steroidal anti-inflammatory drugs

A

b) Dihydropyridine calcium channel blockers, ACE inhibitors, or angiotensin receptor blockers

114
Q

When should surgical intervention be considered for patients with severe asymptomatic AR? a) Only when LV ejection fraction drops below 30%
b) When there is significant aortic root dilation
c) When the patient experiences no symptoms at all
d) In patients with normal LV function but an abnormal ECG

A

b) When there is significant aortic root dilation

MSRS 6310 (11 decks)

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