Cardiology Core Conditions

Question 1

What is aortic stenosis?

Answer 1

Obstruction of blood flow across the aortic valve usually caused by senile calcification

Question 2

What is the Mx aortic stenosis?

Answer 2

Valve replacement

Percutaneous aortic balloon valvuloplasty

Question 3

How is mitral regurgitation treated?

Answer 3

Depends on severity

Prophylaxis against endocarditis

Mitral valve repair or replacement

ACE Inhibitors, diuretics and possibly anticoagulants if surgery not possible

Question 4

What are the classic signs and symptoms of aortic stenosis?

Answer 4

Chest pain: angina on exertion that is relieved by rest

Heart failure: with symptoms including paroxysmal nocturnal dyspnea, orthopnea, dyspnea on exertion, and shortness of breath

Syncope: Often on exertion due to peripheral, arterial vasodilation leading to a drop in systemic BP due to having a fixed SV

Others: pulsus alternans, soft S2,

Question 4

What are symptoms of mitral regurgitation?

Answer 4

(can be asymptomatic for years despite cardiac dimensions increasing)

Increases SV sensed as palpitation

Dyspnoea and orthopnoea

Fatigue and lethargy (due to reduced SV)

Question 5

What Ix findings are present in mitral regurgitation?

Answer 5

CXR: LA and LV enlargement

ECG: Features of LA delay (bifid P waves)

Features of LV hypertrophy - tall R waves in left lat leads (leads 1 and V6) and deep S waves in the R-sided precordial leads (V1 and V2)

Possible AF

Echo: Dilated LA and LV

Severity of regurg can be assessed with doppler

Question 7

What is the epidemiology of aortic stenosis?

Answer 7

Between 2-9% in elderly patients

Question 7

What are the main causes of aortic stenosis?

Answer 7

Congenital unicuspid or bicuspid valves

Age related calcification

Question 9

What are the signs of mitral regurgitation?

Answer 9

Pan-systolic murmur, mid-systolic click (due to prolapse of valve during systole)

Soft S1

Laterally displaced, forceful, diffuse apex beat and systolic thrill

Prominent third heart sound

Question 10

What does degenerative (myxomatous) disease of the mitral valve commonly cause?

Answer 10

Mitral Regurgitation

Question 11

What are the Ix finding for aortic stenosis?

Answer 11

Measure aortic valve area on 2D echocardiogram

Measure transvalvular pressure gradient with a doppler echo

Aortic calcification is seen on CXR in patients with haemodymanically significant AS