Cardio: Valvular Diseases - Mitral Regurgitation

Question 1

Papillary muscle involved in mitral regurgitation after Acute MI

Answer 1

posteromedial papillary muscle

Question 2

MR in which leaflets and chordae tendinae are primarily responsible

a. Primary
b. Secondary

Answer 2

A

Question 3

MR but leaflets and chordae tendinae are normal

a. Primary
b. Secondary

Answer 3

B

Question 4

MR due to LV remodeling with consequent annular enlargement, papillary muscle displacement, leaflet tethering

a. Primary
b. Secondary

Answer 4

B

Question 5

Effect of Rheumatic fever on mitral valve (6)

Answer 5

DR2. C2SF
Deformity
Rigidity
Retraction of cusps
Commissural fusion
Contraction Shortening Fusion of chordae tendinae

Question 6

Congenital anomalies with MR (2)

Answer 6

Endocardial cushion defects (AVSD)

ASD

Question 7

ASD associated with MR

Answer 7

Ostium primum

Question 8

Characteristic of valvular involvement after radiation

Answer 8

leaflet thickening, retraction, calcification, with annular and chordal involvement

Question 9

Chronic MR is frequently secondary to _____

Answer 9

Ischemia

Question 10

True of MR associated with HOCM except

a. Dynamic in nature
b. dependent on systolic motion of the posterior mitral valve leaflet into a narrowed LV outflow track
c. Both
d. Neither

Answer 10

B; posterior

Question 11

True of MR EXCEPT

a. MR begets MR
b. Initial compensation to MR is complete LV emptying
c. LV volume increase progressively with time
d. LV volume decrease as contractile function deteriorates

Answer 11

D

Question 12

True of MR except

a. LV size decrease during systole initially
b. Later, there is decrease in forward cardiac output
c. LV diastolic pressure increase early in the course of MR
d. Regurgitant volume varies directly with LV systolic pressure

Answer 12

C; late

Question 13

In MR, regurgitant orifice is influnced by extent of ____ and ___ dilation

Answer 13

LV, mitral annular

Question 14

Ejection fraction is _____ in severe MR

a. Increase
b. Decrease

Answer 14

A

Question 15

Decrease in EF (<60%) reflects

Answer 15

significant contractile dysfunction

Question 16

In Chronic severe MR,

regurgitant vol:

Answer 16

> =60ml/beat

Question 17

In Chronic severe MR,

regurgitant fraction:

Answer 17

> =50%

Question 18

enlarged LA

a. Acute severe MR
b. Chronic severe MR
c. Both

Answer 18

B; normal LA in acute severe MR

Question 19

marked increase in LA pressures for any increase in LA vol

a. Acute severe MR
b. Chronic severe MR
c. Both

Answer 19

A; in Chronic severe MR, increase in LA compliance with little if any increase in LA and pulmonary venous pressure

Question 20

v wave with LA pressure pulse usually prominent

a. Acute severe MR
b. Chronic severe MR
c. Both

Answer 20

A; in chronic severe, it is less prominent

Question 21

In acute severe MR, there is rapid rise in LA pressures during ______

Answer 21

ventricular systole

Question 22

Characteristic of acute MR murmur

Answer 22

early
decrescendo
end before s2

Question 23

Characteristic of chronic severe MR murmur

Answer 23

holosystolic mumur with plateau

Question 24

Symptoms of chronic mild to moderate isolated MR

Answer 24

asymptomatic

Question 25

Symptoms of patient with chronic severe MR

Answer 25

Fatigue Exertional Dyspnea Orthopnea

Question 26

Palpitations may signify

Answer 26

AF

Question 27

MR with associated pulmonary vascular disease and pulmonary hypertension is characterized by

Answer 27

``` R sided heart failure with painful hepatic congestion ankle edema distended neck veins ascites secondar tricuspid regurgitation ```

Question 28

Arterial pressure is usually normal, carotid arterial pulse may show sharp, low volume upstroke a. Acute severe MR b. Chronic severe MR

Answer 28

B; Arterial pressure may be reduced with narrow pulse pressure for acute severe MR

Question 29

Systolic thrill often palpable at cardiac apex a. Acute severe MR b. Chronic severe MR

Answer 29

B

Question 30

JVP and wave forms may be normal or increased and exaggerated a. Acute severe MR b. Chronic severe MR

Answer 30

A

Question 31

Apical impulse not displaced a. Acute severe MR b. Chronic severe MR

Answer 31

A

Question 32

LV is hyperdynamic with brisk systolic impulse and palpable rapid-filling wave (s3) a. Acute severe MR b. Chronic severe MR

Answer 32

B

Question 33

Signs of pulmonary congestion prominent a. Acute severe MR b. Chronic severe MR

Answer 33

A

Question 34

Apex beat displaced laterally a. Acute severe MR b. Chronic severe MR

Answer 34

B

Question 35

Characteristic of S1 in MR

Answer 35

generally absent, soft or burried in the holosystolic murmur of chronic severe MR

Question 36

Characteristic of S2 in MR

Answer 36

wide but physiologic splitting

Question 37

Wide but physiologic splitting of s2 in MR is due to

Answer 37

premature aortic valve closure

Question 38

S3 in MR is at __ s, __ s after aortic valve closure sound

Answer 38

0.12, 0.17s

Question 39

Characteristic of S3 in MR

Answer 39

low pitched

Question 40

MR auscultatory sound due to sudden tensing of papillary muscles, chordae tendinae, valve leaflets, precedes short rumbling mid diastolic murmur even in the absence of actual MS

Answer 40

S3

Question 41

T/F | MR can have s4 sound

Answer 41

present in acute, severe MR in sinus rhythm

Question 42

Characterisitc auscultatory finding in chronic severe MR

Answer 42

HoloSystolic, decrescendo murmur at least grade III/BI

Question 43

The murmur in chronic mr usually most prominent at ____ and radiates to ______

Answer 43

apex, axilla

Question 44

When will systolic murmur radiate to the base of the heart in the context of MR?

Answer 44

When chordae tendinae ruptures with primary invlolvement of posterior mitral leaflet prolapse/flail

Question 45

Characteristic description of systolic murmur of MR when chordae tendinae ruptures

Answer 45

"seagull" cooing quality

Question 46

Characteristic description of systolic murmur of MR when there's prolapse/flail

Answer 46

Musical quality

Question 47

The murmur of MR is increased by a. isometric exercise b. strain phase c. handgrip d. valsalva

Answer 47

A and C; for B and C, murmur is decreased

Question 48

ECG findings if sinus rhythm a. LA enlargement b. LA hypertrophy c. LV enlargement d. LV hypertrophy

Answer 48

A

Question 49

When will RA enlargement be observed in MR

Answer 49

when pulmonary hypertension is significant and affects RV function and size

Question 50

Purpose of transthoracic Echocardiography in MR

Answer 50

Assess mechanisms of MR | Assess hemodynamic severity

Question 51

LV function can be assessed from (3)

Answer 51

LV end-diastolic end-systolic volumes ejection fraction

Question 52

CXR findings in MR

Answer 52

LA and LV dominant chambers

Question 53

T/F Patients with MR should isometric forms of exercise

Answer 53

T

Question 54

Management for post MI papillary muscle rupture or other forms of acute severe MR

Answer 54

``` Diuretics IV vasodilators (sodium nitroprusside) Mechanical support ```

Question 55

Indication for surgical repair of MR

Answer 55

Symptomatic Asymptomatic with <60% EF or LV end diastolic dimension >40mm

Question 56

Early consideration of mitral valve repair

Answer 56

1. recent onset AF (duration 3 mos.) 2. pulmonary hypertension: systolic PA pressure >= 50mmHg 3. Progressive decrease in LVEF or increase in LV ESD on serial imaging