Aortic Valvular Disease - Regurgitation

Question 1

When we listen to the heart we should be able to hear 2 separate sounds, S1 and S2. What does S1 relate to?

1 - closing of the tricuspid and mitral valves
2 - closing of tricuspid and aortic valves
3 - closing of mitral and aortic valves
4 - closing of aortic and pulmonary valves

Answer 1

1 - closing of the tricuspid and mitral valves
- also called the atrioventricular valves, as these 2 valves relate to the atrium

Question 2

Does the S1 heart sound occur at the start of diastole or systole?

Answer 2

• systole
• mitral and tricuspid valves close to stop blood moving back into the atrium

Question 3

When we listen to the heart we should be able to hear 2 separate sounds, S1 and S2. What does S2 relate to?

1 - closing of the tricuspid and mitral valves
2 - closing of tricuspid and aortic valves
3 - closing of mitral and aortic valves
4 - closing of aortic and pulmonary valves

Answer 3

4 - closing of aortic and pulmonary valves

Question 4

Does the S2 heart sound occur at the start of diastole or systole?

Answer 4

• diastole
• aortic and pulmonary valves close to allow atria to pump blood into ventricles

Question 5

In some patients a 3rd heart sound can be heard, S3, which occurs just after S2. What causes this 3rd heart sound?

1 - mitral regurgitation
2 - ventricular septal defect
3 - chordae tendineae pulling
4 - aortic regurgitation

Answer 5

3 - chordae tendineae pulling
- papillary muscles contract and pull chordae tendineae which attach to mitral valves

• sound is because they pull so hard to fully expand the left ventricle
• can be heard in some younger patients, BUT can signify HR in older patients

Question 6

How many leaflets does the aortic valve have?

1 - 4
2 - 3
3 - 2
4 - 1

Answer 6

2 - 3
- however, some patients can have a bicuspid valve due to genetics

Question 7

Does the aortic valve open during systole or diastole?

Answer 7

• systole
• pumps blood around the body

Question 8

Does the aortic valve close during systole or diastole?

Answer 8

• diastole
• allows left ventricle to be filled

Question 9

What os the most common cause aortic regurgitation?

1 - idiopathic/degenerative
2 - rheumatic
3 - congenital
4 - endocarditis

Answer 9

1 - idiopathic/degenerative

Question 10

Aortic regurgitation refers to when the aortic valve is unable to close properly and blood moves back into the left ventricle. All of the following are causes of aortic regurgitation, due to valvular dysfunction, EXCEPT which one?

1 - rheumatic fever
2 - hypertension
3 - infective endocarditis
4 - bicuspid valve

Answer 10

2 - hypertension
- can cause aortic regurgitation, but this is due to aortic disease

Question 11

Aortic regurgitation refers to when the aortic valve is unable to close properly and blood moves back into the left ventricle. All of the following are causes of aortic regurgitation, due to aortic disease, EXCEPT which one?

1 - rheumatic fever
2 - hypertension
3 - aortic dissection
4 - connective tissue disorders (ehlers danlos and Marfans syndrome)
5 - syphilis

Answer 11

1 - rheumatic fever

• syphilis leads to inflammation and damage of the aortic valve
• endocarditis is inflammation of the inner layer of the cardiac tissue.

Question 12

Rheumatic fever can cause aortic regurgitation and commissural fusion of the leaflets. How does rheumatic fever do this?

1 - increases inflammation that can damage valves
2 - Group A Streptococcus release M protein that resembles self MHC-1 in cardiac and valve tissue
3 - Group A Streptococcus directly infect aortic valve
4 - all of the above

Answer 12

2 - Group A Streptococcus release M protein that resembles self MHC-1 in cardiac and valve tissue

• called molecular mimicry, essentially antibodies target the aortic valve thinking it is Group A Streptococcus

Question 13

Which bacteria is associated with rheumatic fever that can lead to aortic regurgitation?

1 - Group A Streptococcus
2 - Corynebacterium diphtheriae
3 - Arcanobacterium haemolyticum
4 - Mycoplasma pneumoniae.

Answer 13

1 - Group A Streptococcus
- commonly referred to as strep throat

Question 14

What type of hypersensitivity is aortic regurgitation caused by the release of M protein found in Group A Streptococcus?

1 - type 1 hypersensitivity
2 - type 2 hypersensitivity
3 - type 3 hypersensitivity
4 - type 4 hypersensitivity

Answer 14

2 - type 2 hypersensitivity

Question 15

Although aortic regurgitation due to rheumatic fever is rare, it can happen. Which of the following patients is LEAST likely to develop this?

1 - <5 y/o
2 - >65 y/o
3 - low social economic background
4 - overcrowding home

Answer 15

2 - >65 y/o

Question 16

In a patient with aortic regurgitation, blood leaks back into the LV and increases SV. Does this increase of decrease SBP?

Answer 16

• increases SBP
• more pressure needed to pump the larger volume of blood
• increases pulse pressure

Question 17

In a patient with aortic regurgitation, blood leaks back into the LV and increases SV. This also means that there is less blood volume in the aorta. What effect does this have on DBP?

Answer 17

• decreases DBP
• increases pulse pressure

Question 18

What is the main affect that aortic regurgitation have on the heart that can be seen on an ECG?

1 - RV hypertrophy
2 - RA hypertrophy
3 - LV hypertrophy
4 - LA hypertrophy

Answer 18

3 - LV hypertrophy
- eccentric hypertrophy

Question 19

Aortic regurgitation, whatever the cause can cause a murmur due to turbulent flow of blood. When would we typically expect to hear this murmur?

1 - after S2
2 - after S1
3 - after S3

Answer 19

1 - after S2
- S2 is closing of aortic and pulmonary valves
- murmur is due to blood leaking back into the heart during diastole
- occurs just at the end of S2
- called pansystolic murmur or crescendo-decrescendo murmur

Question 20

In addition to a early diastolic murmur, all of the following can be observed in patients with aortic regurgitation, EXCEPT which one?

1 - collapsing pulse (Corrigans pulse)
2 - heart failure
3 - austin flint murmur (blood flows over the mitral valve)
4 - pericardial effusions

Answer 20

4 - pericardial effusions

Question 21

All of the following are tests to diagnose a patient with suspected aortic regurgitation, but which generally provides a definitive diagnosis and is regularly used?

1 - Echocardiogram
2 - ECG
3 - CXR
4 - cardiac catheterisation

Question 22

Patients typically describe the following symptoms associated with aortic regurgitation, EXCEPT which one?

1 - paroxysmal nocturnal dyspnea
2 - peripheral oedema
3 - exertional dyspnoea
4 - orthopnea (breathlessness when sitting)

Answer 22

2 - peripheral oedema
- may occur in chronic conditions as this can also cause HF

Question 23

What is Quinckes sign?

1 - bobbing of the head with each heart beat
2 - carotid pulsations
3 - capillary pulsation in finger nails
4 - murmur over mitral valve

Answer 23

3 - capillary pulsation in finger nails

Question 24

If a patient has aortic regurgitation, but has no symptoms, which 2 of the following are conducted?

1 - prescribe ACE-I
2 - ECG every 12 weeks
3 - echocardiogram every 6-12 months
4 - renal function every 4 weeks

Answer 24

1 - prescribe ACE-I
- addresses large pulse pressure difference

3 - echocardiogram every 6-12 months
- monitors valvular changes

Question 25

If a patient has symptoms with aortic regurgitation, what should they have?

1 - medications and 24h BP monitoring
2 - monitored in hospital
3 - surgery to replace the aortic valve
4 - anti-hypertensive medication

Answer 25

3 - surgery to replace the aortic valve

Question 26

If a patient is not fit for surgery but is symptomatic with aortic regurgitation, what is the next treatment option?

1 - medications and 24h BP monitoring
2 - monitored in hospital
3 - transcatheter aortic valve replacement
4 - anti-hypertensive medication

Answer 26

3 - transcatheter aortic valve replacement
- TAVI

Question 27

Complete the table below using the labels below using systole or diastole of when you would hear the murmurs:

Answer 27