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M3 > Cardio: Valvular Diseases - Mitral Regurgitation > Flashcards

Cardio: Valvular Diseases - Mitral Regurgitation Flashcards

1
Q

Papillary muscle involved in mitral regurgitation after Acute MI

A

posteromedial papillary muscle

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2
Q

MR in which leaflets and chordae tendinae are primarily responsible

a. Primary
b. Secondary

A

A

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3
Q

MR but leaflets and chordae tendinae are normal

a. Primary
b. Secondary

A

B

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4
Q

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

a. Primary
b. Secondary

A

B

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5
Q

Effect of Rheumatic fever on mitral valve (6)

A 
DR2. C2SF
Deformity
Rigidity
Retraction of cusps
Commissural fusion
Contraction Shortening Fusion of chordae tendinae
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6
Q

Congenital anomalies with MR (2)

A

Endocardial cushion defects (AVSD)

ASD

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7
Q

ASD associated with MR

A

Ostium primum

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8
Q

Characteristic of valvular involvement after radiation

A

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

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9
Q

Chronic MR is frequently secondary to _____

A

Ischemia

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10
Q

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

A

B; posterior

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11
Q

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

A

D

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12
Q

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

A

C; late

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13
Q

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

A

LV, mitral annular

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14
Q

Ejection fraction is _____ in severe MR

a. Increase
b. Decrease

A

A

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15
Q

Decrease in EF (<60%) reflects

A

significant contractile dysfunction

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16
Q

In Chronic severe MR,

regurgitant vol:

A

> =60ml/beat

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17
Q

In Chronic severe MR,

regurgitant fraction:

A

> =50%

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18
Q

enlarged LA

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

A

B; normal LA in acute severe MR

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19
Q

marked increase in LA pressures for any increase in LA vol

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

A

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

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20
Q

v wave with LA pressure pulse usually prominent

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

A

A; in chronic severe, it is less prominent

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21
Q

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

A

ventricular systole

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22
Q

Characteristic of acute MR murmur

A

early
decrescendo
end before s2

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23
Q

Characteristic of chronic severe MR murmur

A

holosystolic mumur with plateau

24
Q

Symptoms of chronic mild to moderate isolated MR

A

asymptomatic

25
Q

Symptoms of patient with chronic severe MR

A

Fatigue
Exertional Dyspnea
Orthopnea

26
Q

Palpitations may signify

A

AF

27
Q

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

A 
R sided heart failure with painful hepatic congestion
ankle edema
distended neck veins
ascites
secondar tricuspid regurgitation
28
Q

Arterial pressure is usually normal, carotid arterial pulse may show sharp, low volume upstroke

a. Acute severe MR
b. Chronic severe MR

A

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

29
Q

Systolic thrill often palpable at cardiac apex

a. Acute severe MR
b. Chronic severe MR

A

B

30
Q

JVP and wave forms may be normal or increased and exaggerated

a. Acute severe MR
b. Chronic severe MR

A

A

31
Q

Apical impulse not displaced

a. Acute severe MR
b. Chronic severe MR

A

A

32
Q

LV is hyperdynamic with brisk systolic impulse and palpable rapid-filling wave (s3)

a. Acute severe MR
b. Chronic severe MR

A

B

33
Q

Signs of pulmonary congestion prominent

a. Acute severe MR
b. Chronic severe MR

A

A

34
Q

Apex beat displaced laterally

a. Acute severe MR
b. Chronic severe MR

A

B

35
Q

Characteristic of S1 in MR

A

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

36
Q

Characteristic of S2 in MR

A

wide but physiologic splitting

37
Q

Wide but physiologic splitting of s2 in MR is due to

A

premature aortic valve closure

38
Q

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

A

0.12, 0.17s

39
Q

Characteristic of S3 in MR

A

low pitched

40
Q

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

A

S3

41
Q

T/F

MR can have s4 sound

A

present in acute, severe MR in sinus rhythm

42
Q

Characterisitc auscultatory finding in chronic severe MR

A

HoloSystolic, decrescendo murmur at least grade III/BI

43
Q

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

A

apex, axilla

44
Q

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

A

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

45
Q

Characteristic description of systolic murmur of MR when chordae tendinae ruptures

A

“seagull” cooing quality

46
Q

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

A

Musical quality

47
Q

The murmur of MR is increased by

a. isometric exercise
b. strain phase
c. handgrip
d. valsalva

A

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

48
Q

ECG findings if sinus rhythm

a. LA enlargement
b. LA hypertrophy
c. LV enlargement
d. LV hypertrophy

A

A

49
Q

When will RA enlargement be observed in MR

A

when pulmonary hypertension is significant and affects RV function and size

50
Q

Purpose of transthoracic Echocardiography in MR

A

Assess mechanisms of MR

Assess hemodynamic severity

51
Q

LV function can be assessed from (3)

A

LV end-diastolic
end-systolic volumes
ejection fraction

52
Q

CXR findings in MR

A

LA and LV dominant chambers

53
Q

T/F Patients with MR should isometric forms of exercise

A

T

54
Q

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

A 
Diuretics
IV vasodilators (sodium nitroprusside)
Mechanical support
55
Q

Indication for surgical repair of MR

A

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

56
Q

Early consideration of mitral valve repair

A
  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

M3 (66 decks)

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