Aortic Valvular Disease - Regurgitation Flashcards
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
1 - closing of the tricuspid and mitral valves
- also called the atrioventricular valves, as these 2 valves relate to the atrium
Does the S1 heart sound occur at the start of diastole or systole?
- systole
- mitral and tricuspid valves close to stop blood moving back into the atrium
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
4 - closing of aortic and pulmonary valves
Does the S2 heart sound occur at the start of diastole or systole?
- diastole
- aortic and pulmonary valves close to allow atria to pump blood into ventricles
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
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
How many leaflets does the aortic valve have?
1 - 4
2 - 3
3 - 2
4 - 1
2 - 3
- however, some patients can have a bicuspid valve due to genetics
Does the aortic valve open during systole or diastole?
- systole
- pumps blood around the body
Does the aortic valve close during systole or diastole?
- diastole
- allows left ventricle to be filled
What os the most common cause aortic regurgitation?
1 - idiopathic/degenerative
2 - rheumatic
3 - congenital
4 - endocarditis
1 - idiopathic/degenerative
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
2 - hypertension
- can cause aortic regurgitation, but this is due to aortic disease
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
1 - rheumatic fever
- syphilis leads to inflammation and damage of the aortic valve
- endocarditis is inflammation of the inner layer of the cardiac tissue.
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
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
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.
1 - Group A Streptococcus
- commonly referred to as strep throat
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
2 - type 2 hypersensitivity
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
2 - >65 y/o
In a patient with aortic regurgitation, blood leaks back into the LV and increases SV. Does this increase of decrease SBP?
- increases SBP
- more pressure needed to pump the larger volume of blood
- increases pulse pressure
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?
- decreases DBP
- increases pulse pressure
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
3 - LV hypertrophy
- eccentric hypertrophy
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
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
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
4 - pericardial effusions
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
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)
2 - peripheral oedema
- may occur in chronic conditions as this can also cause HF
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
3 - capillary pulsation in finger nails
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
1 - prescribe ACE-I
- addresses large pulse pressure difference
3 - echocardiogram every 6-12 months
- monitors valvular changes
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
3 - surgery to replace the aortic valve
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
3 - transcatheter aortic valve replacement
- TAVI
Complete the table below using the labels below using systole or diastole of when you would hear the murmurs:
