Cardiac Valve Disease (3.2) Flashcards
Mitral stenosis causes:
a. parallel replication of sarcomeres in the left ventricle
b. parallel replication of sarcomeres in the left atrium
c. serial replication of sarcomeres in the left ventricle d. serial replication of sarcomeres in the left atrium
b. parallel replication of sarcomeres in the left atrium
What is the most common cause of aortic stenosis?
a. infective endocarditis
b. bicuspid aortic valve
c. rheumatic fever
d. ruptured papillary muscles
b. bicuspid aortic valve
Which of the following is consistent with the most appropriate management for the patient with a pressure volume loop with increased height, decreased width, increased ESV, and increased EDV? (Select 2.)
a. PAOP = 12
b. SVR = 1500
c. HR = 45
d. CVP = 1
a. PAOP = 12
b. SVR = 1500
Which conditions promote myocardial remodeling through parallel replication of sarcomeres? (Select 2.)
a. pressure overload
b. chamber dilation
c. eccentric hypertrophy
d. stenosis
a. pressure overload
d. stenosis
Which part of the pressure-volume loop is altered by aortic insufficiency?
left vertical segment (isovolumetric relaxation is affected)
A patient presents with a history of angina, syncope, and dyspnea. What is the most likely diagnosis?
a. aortic stenosis
b. acute aortic insufficiency
c. chronic mitral regurgitation d. mitral stenosis
a. aortic stenosis
(SAD: syncope, angina, dyspnea = AS)
Following mitral valve repair, you observe systolic anterior motion of the anterior leaflet on the TEE. This patient most likely received: (Select 2.)
a. dobutamine
b. nitroprusside
c. 500 mL NaCl bolus
d. phenylephrine
a. dobutamine
b. nitroprusside
(fluid bolus and phenyl would improve SAM)
Select the best treatment for the hypotensive patient with mitral stenosis.
a. dobutamine
b. vasopressin
c. ephedrine
d. epinephrine
b. vasopressin
Which drug is most likely to increase the degree of prolapse in the patient mitral valve prolapse?
a. sevoflurane
b. etomidate
c. ketamine
d. phenylephrine
c. ketamine
Which of the following is the least likely to precipitate pulmonary edema with mitral stenosis?
a. judicious fluid administration
b. atrial fibrillation
c. trendelenburg position
d. uterine contraction
a. judicious fluid administration
Where is mitral regurgitation heard the best?
at the apex or left axilla
An increase in which hemodynamic variables support cardiovascular stability in the patient with aortic stenosis? (Select 2.)
a. heart rate
b. systemic vascular resistance
c. preload
d. pulmonary vascular resistance
b. systemic vascular resistance
c. preload
What cardiac changes are consistent with heart failure with reduced ejection fraction?
a. systolic anterior motion of the mitral valve
b. reduced pulmonary artery occlusion pressure
c. increased wall thickness
d. sarcomeres replicate in series
d. sarcomeres replicate in series
Which medications restore hemodynamic stability in the patient with symptomatic mitral insufficiency? (Select 2.)
a. phenylephrine
b. isoproterenol
c. sodium nitroprusside
d. esmolol
b. isoproterenol
c. sodium nitroprusside
Which intervention is most likely to promote hemodynamic instability in the patient with severe aortic insufficiency?
a. 5 mg metoprolol IV
b. 0.5 mcg/kg/min nitroprusside IV
c. 250 mL IV fluid challenge
d. 15 mL 0.5% bupivacaine via epidural
a. 5 mg metoprolol IV
A diastolic murmur is discovered at the apex of the heart on the midclavicular line. What comorbidities are commonly associated with this murmur? (Select 3.)
a. rheumatoid arthritis
b. endocarditis
c. systemic lupus erythematosus
d. incompetent aortic valve
e. papillary muscle dysfunction
f. ruptured chordae tendinae
a. rheumatoid arthritis
b. endocarditis
c. systemic lupus erythematosus
(mitral stenosis)
Match each heart valve with the location where it is best heard.
a. pulmonic valve
b. mitral valve
c. aortic valve
d. tricuspid valve
1. right of sternal border, 2nd ICS
2. left of sternal border, 2nd ICS
3. left midclavicular line, 5th ICS
4. left of sternal border, 4th ICS
1C
2A
3B
4D
Which valvular disease is associated with ankylosing spondylitis?
a. mitral insufficiency
b. aortic stenosis
c. mitral stenosis
d. aortic insufficiency
d. aortic insufficiency
What heart sounds are best heard using the bell of the stethoscope? (Select 2.)
a. S4
b. S2
c. S3
d. S1
a. S4
c. S3
Complications associated with a malpositioned valve during TAVR include: (Select 2.)
a. pulmonary edema
b. outflow tract obstruction
c. left ventricular dilation
d. decreased aperture
a. pulmonary edema
c. left ventricular dilation
The presence of an S1 murmur heard at the midclavicular line 5th intercostal space most likely suggests:
a. mitral stenosis
b. aortic insufficiency
c. mitral insufficiency
d. aortic stenosis
c. mitral insufficiency
