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M3 > Cardio: Mitral Stenosis > Flashcards

Cardio: Mitral Stenosis Flashcards

1
Q

Most common cause of mitral stenosis

A

Rheumatic Fever

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2
Q

mitral valve orifice area in normal adults

A

4-6 sq. cm

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3
Q

Hemodynamic hallmark of MS

A

blood flow from LA to LV through an orifice <2 sq cm only if propelled by an abnormally elevated L AV pressure gradient,

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4
Q

MV orifice area in severe MS

A

<1.5 sq cm

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5
Q

LA pressure required to maintain normal cardiac output in severe MS

A

25mmHg

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6
Q

parameters measured to assess severity of obstruction

A

transvalvular pressure gradient

flow rate

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7
Q

Effect of tachycardia on valvular pressure and LA pressure

a. Both elevated
b. Both depressed
c. Elevated, depressed
d. Depressed, elevated

A

A

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8
Q

In isolated mitral stenosis, LV diastolic pressure and EF are

a. Both normal
b. Both elevated
c. Both depressed
d. Elevated, depressed
e. Depressed, elevated

A

A

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9
Q

Cardiac output in severe MS

A

normal at rest, subnormal rise on exertion

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10
Q

Area of orifice in very severe MS

A

<1 sq cm

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11
Q

Cardiac ouput in very severe MS

A

subnormal at rest, fail to rise on exertion

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12
Q

_______ is measured to assess severity of obstruction in MS

A

Transvalvular gradient flow rate

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13
Q

LV diastolic pressure and ejection fraction in isolated mitral stenosis
A. Normal
B. Elevated
C. Depressed

A

A

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14
Q

In mitral stenosis in sinus rhythm, LA and PA wedge pressure suggest prominent ___ wave and ___ descent

A

a wave, y descent

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15
Q

TRUE of MS EXCEPT

a. Severe MS: <1.5 cm2 orifice
b. Severe MS: CO is normal at rest and rises subnormally on exertion
c. Very Severe MS: <1cm2 orifice
d. Very Severe MS: CO subnormal at rest and fail to rise on exertion
e. NOTA

A

E

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16
Q

True of MS EXCEPT

a. Pulmonary hypertension results from pulmonary arteriolar constriction
b. In MS, passive backward transmission of elevated LA pressure cause pulmonary hypertension
c. MS results to LV enlargement
d. Pulmonary hypertension results to Secondary tricuspid regurgitation
e. NOTA

A

E

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17
Q

Without valvotomy, patients with MS will die in _ to _ yrs

A

2 to 5 yrs

18
Q

What is the turning point of MS?

A

Atrial FIbrillation

19
Q

Symptoms of MS (6)

A 
Dyspnea
Cough
Atrial Fibrillation
Hemoptysis
Recurrent pulmonary emboli
Pulmoonary infections
20
Q 
In MS,
With exercise, pulmonary compliance \_\_\_\_\_\_\_ as pulmonary capillary pressure \_\_\_\_\_\_\_\_
a. Increase, Decrease
b. Decrease, Increase
c. Decrease, Decrease
d. Increase, Increase
A

B

21
Q

True of Thrombi and Emboli in MS EXCEPT

a. May be the only presenting feature
b. Incidence is 30%
c. Occurs most frequently in atrial fibrillation
d. Occurs in patients > 65 y.o.

A

B; 10-20%

22
Q

Physical findings for MS EXCEPT

a. Malar flush, pinched blue facies
b. JVP prominent a waves
c. Parasternal lift
d. Systolic thrill

A

D

23
Q

Auscultation iin MS EXCEPT

a. S1 is accentuated in early stages
b. P2 often accentuated in increased PAPs
c. S2 splitting
d. Opening snap of mitral valve most readily audible in INSPIRATION

A

D. EXPIRATION

24
Q

Character of murmur in mS

A

low pitched
rumbling
diastolic at apex
heard best with px in left lateral recumbent

25
Q

True of murmur in MS

a. Duration of murmur is correlated with degree of stenosis in patients with preserved cardiac output
b. MS in sinus rhythm: systolic accentuation of murmur
c. Mixed mitral valve with regurgitation: soft gr I-II systolic murmur at or medial to apex
d. RV failure

A

B. Presystolic

26
Q

Carvallo’s sign

A

Pansystolic murmur produced by functional tricuspid regurgitation louder during inspiration and diminishes during forced expiration

27
Q

High pitched diastolic decrescendo blowing murmur at left sternal border

A

Graham Steel Murmur

28
Q

ECG findings in MS

A

LA enlargement tall
peaked p waves in lead II
upright p in v1
QRS usually normal

29
Q

ECG findings in MS with severe pulmonary hypertension

A

RA enlargement
RA deviation
RVH
QRS usually normal

30
Q

Diagnostic test to exclude presence of thrombus prior to percutaneous mitral balloon valvuloplasty

A

Transesophageal Echocardiography

31
Q

CXR findings in MS (4)

A

straightening of upper L border of cardiac sillhoutte
prominence of MPA
dilation of upper lobe pulmonary veins
posterior displacement of esophagus

32
Q

Apical mid diastolic murmur of atrial regurgitation; not intensified in presystolic; becomes softer with administration of amyl nitrite or other arterial vasodilators

A

Austin Flint Murmur

33
Q

Indication of cardiac catheterization

A

Helpful in assessing associated lesions (AS, AR)

34
Q

True about MS diagnostics

a. recommended for px with <65 y.o. with or without MR findings
b. Men >50 y.o. Coronary angiography is advisable preoperatively
c. Women >45 y.o. Coronary angiography is advisable preoperatively
d. AOTA

A

C.
recommended with typical findings of severe initial obstruction on PE and TTE
>40 y.o. for men

35
Q

T/F

Direct oral anticoagulatns are not approved for use in patients with rheumatic MS

A

T

36
Q

Successful Valvotomy: ___% decrease in the mean mitral valve gradient and a doubling of mitral valve area

A

50%

37
Q

Indication for mitral valve replacement

A

px with MS and significant associated MR

38
Q

Valvotomy is not recommended in the following

a. Patients who are entirely asymptomatic
b. patients with mild or moderate stenosis
c. systemic embolization
d. severe pulmonary hypertension has occured
e. AOTA

A

E

39
Q

10 year survival of surgical survivors

A

70%

40
Q

perioperative mortality rates for mitral valve replacement

A

5%

41
Q

perioperative mortality rates for mitral valve replacement vary with age, __ as high if >65 y.o.

A

2x

42
Q

Long-term prognosis is worse in px __y.o.

A

65

M3 (66 decks)

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