Cardio: Mitral Stenosis

Question 1

Most common cause of mitral stenosis

Answer 1

Rheumatic Fever

Question 2

mitral valve orifice area in normal adults

Answer 2

4-6 sq. cm

Question 3

Hemodynamic hallmark of MS

Answer 3

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

Question 4

MV orifice area in severe MS

Answer 4

<1.5 sq cm

Question 5

LA pressure required to maintain normal cardiac output in severe MS

Answer 5

25mmHg

Question 6

parameters measured to assess severity of obstruction

Answer 6

transvalvular pressure gradient

flow rate

Question 7

Effect of tachycardia on valvular pressure and LA pressure

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

Answer 7

A

Question 8

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

Answer 8

A

Question 9

Cardiac output in severe MS

Answer 9

normal at rest, subnormal rise on exertion

Question 10

Area of orifice in very severe MS

Answer 10

<1 sq cm

Question 11

Cardiac ouput in very severe MS

Answer 11

subnormal at rest, fail to rise on exertion

Question 12

_______ is measured to assess severity of obstruction in MS

Answer 12

Transvalvular gradient flow rate

Question 13

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

Answer 13

A

Question 14

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

Answer 14

a wave, y descent

Question 15

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

Answer 15

E

Question 16

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

Answer 16

E

Question 17

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

Answer 17

2 to 5 yrs

Question 18

What is the turning point of MS?

Answer 18

Atrial FIbrillation

Question 19

Symptoms of MS (6)

Answer 19

Dyspnea
Cough
Atrial Fibrillation
Hemoptysis
Recurrent pulmonary emboli
Pulmoonary infections

Question 20

In MS,
With exercise, pulmonary compliance \_\_\_\_\_\_\_ as pulmonary capillary pressure \_\_\_\_\_\_\_\_
a. Increase, Decrease
b. Decrease, Increase
c. Decrease, Decrease
d. Increase, Increase

Answer 20

B

Question 21

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.

Answer 21

B; 10-20%

Question 22

Physical findings for MS EXCEPT

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

Answer 22

D

Question 23

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

Answer 23

D. EXPIRATION

Question 24

Character of murmur in mS

Answer 24

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

Question 25

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

Answer 25

B. Presystolic

Question 26

Carvallo's sign

Answer 26

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

Question 27

High pitched diastolic decrescendo blowing murmur at left sternal border

Answer 27

Graham Steel Murmur

Question 28

ECG findings in MS

Answer 28

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

Question 29

ECG findings in MS with severe pulmonary hypertension

Answer 29

RA enlargement RA deviation RVH QRS usually normal

Question 30

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

Answer 30

Transesophageal Echocardiography

Question 31

CXR findings in MS (4)

Answer 31

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

Question 32

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

Answer 32

Austin Flint Murmur

Question 33

Indication of cardiac catheterization

Answer 33

Helpful in assessing associated lesions (AS, AR)

Question 34

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

Answer 34

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

Question 35

T/F | Direct oral anticoagulatns are not approved for use in patients with rheumatic MS

Answer 35

T

Question 36

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

Answer 36

50%

Question 37

Indication for mitral valve replacement

Answer 37

px with MS and significant associated MR

Question 38

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

Answer 38

E

Question 39

10 year survival of surgical survivors

Answer 39

70%

Question 40

perioperative mortality rates for mitral valve replacement

Answer 40

5%

Question 41

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

Answer 41

2x

Question 42

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

Answer 42

65