AV valve Disease

Question 1

Main cause of mitral stenosis.

Answer 1

Rheumatic Fever

Question 2

What is Ortner Syndrome?

Answer 2

Hoarseness caused by mitral stenosis. The enlargement of the LA compresses the left recurrent laryngeal nerve. (The pulmonary arteries can also compress the nerve)

Question 3

What is the reason for the opening snap and loud S1 heard in mitral stenosis?

Answer 3

Opening Snap: occurs because of the higher than normal LA pressure overcoming LV pressure allowing the valve to rapidly open.

Loud S1: even though the valve is stenotic, the high LA pressure keeps the valve open wider than a normal valve would be at the end of diastole. This wider opening creates a louder sound in the beginning of systole when it closes.

Question 4

What is the use of cardiac catheterization in any valve problems?

Answer 4

Define coronary vasculature before surgery.

Question 5

What is the diagnostic modality of choice for mitral valve stenosis?

Answer 5

Echo

Question 6

What are the 3 medical treatment regimens for mitral stenosis?

Answer 6

1. Diuretics: to relieve pulmonary HTN
2. Anti-chronotropes (BB, CCB): improve diastolic filling time
3. Anticoagulants: if A fib starts

Question 7

When is Balloon Mitral Valvuloplasty best indicated?

Answer 7

For stenosis due to Rheumatic Fever that is not heavily calcified

Question 8

When is surgery indicated for Mitral Stenosis?

Answer 8

Severe symptomatic pts in non-candidates for BMV
Open mitral commissurotomy
Mitral valve replacement

Question 9

What are 4 differences between acute and chronic mitral regurgitation?

Answer 9

1. Acute: normal LA size
   Chronic: large LA
2. Acute: High LA pressure
   Chronic: normal LA pressure
3. Acute: Increased pulmonary veonus pressre
   Chronic: Normal PVP
4. Acute: pulmonary congestion and edema
   Chronic: low forward Cardiac Output

Question 10

How does acute mitral regurgitation sound on auscultation vs. chronic?

Answer 10

Acute: early systolic decrescendo murmur
Chronic: pansystolic, not louder during inspiration and maybe radiating to axilla.

Question 11

What is medical and surgical treatment for mitral regurgitation?

Answer 11

Acute:
Meds: IV diuretics, IV vasodilators
Surgery: repair ruptured papillary muscle, valve, or chordae tendinae

Chronic:
Meds: IV vasodilators only for edema or HTN
Surgery: repair valve is preferred to replacement

Question 12

What is Barlow Syndrome?

Answer 12

Mitral Valve Prolapse

Question 13

What congenital conditions are associated with MVP?

Answer 13

Marfan, Ehlers

Question 14

Diagnostic modality of choice for MVP.

Answer 14

Echo

Question 15

What is heard on auscultation in MVP?

Answer 15

Systolic click w/ systolic murmur.

• click heard later with squatting and murmur is shorter.
• opposite with standing

Question 16

What are the medical and surgical treatments for MVP?

Answer 16

Meds: only to relieve chest discomfort (beta blockers)

Surgery: valve replacement only if it leads to severe regurgitation.

Question 17

What are tricuspid valve regurgitation symptoms?

Answer 17

Right-heart failure symptoms:

• Peripheral edema
• Abdominal fullness/ discomfort
• Fatigue/ weakness

Question 18

What is the triad of sever Tricuspid Regurgitation?

Answer 18

1. Carvallo Sign
2. Pulsating Liver
3. Pulsating JVD