chapter 11 - adult valvular heart disease

Question 1

describe the murmur grading scale

Answer 1

I (one) - softer than can be heard with a stethoscope
II - just loud enough to be heard when stethoscope is just placed on the chest.
III- louder than grade II
IV - very loud murmur
V - can be heard when the stethoscope is a few millimeters off the chest wall
IV- murmurs that can be heard with the naked ear

Question 2

what is an organic systolic murmur and which grade of murmur is usually organic

Answer 2

it is indicative of disease. grade II systolic murmur can be either normal (innocent) or abnormal (organic). grade III systolic murmur is always organic

Question 3

what is a thrill

Answer 3

palpable vibration that can accompany a murmur

Question 4

In HCM, a short _______ can sometimes be heard that is ____ when the patient stands

Answer 4

short grade III systolic murmur, louder when standing

Question 5

when should an UWer be concerned about a grade II murmur that the physician is not aware of or is not concerned (has not investigated)

Answer 5

when there is a family history of hypertrophic cardiomyopathy (HCM)

Question 6

what condition can cause childhood murmur and usually requires aortic valve replacement by age 50

Answer 6

bicuspid aortic valve

Question 7

what is the clinical clue (Symptom) to diagnosing a bicuspid aortic valve

Answer 7

systolic ejection click

Question 8

do grade I or II diastolic murmurs indicate disease

Answer 8

yes, can indicate significant disease

Question 9

where is a murmur of aortic stenosis usually heard

Answer 9

systolic- upper sternum radiating to carotid

Question 10

where is a murmur of aortic regurgitation usually heard

Answer 10

diastolic - left sternal edge, high pitch, decrescendo

Question 11

where is the murmur of mitral stenosis usually heard

Answer 11

diastolic - rumbling, apex, with opening snap

Question 12

where is the murmur of mitral regurgitation usually heard

Answer 12

systolic- blowing, apex, radiating to axilla

Question 13

where is the murmur of VSD usually heard

Answer 13

systolic - 3rd and 4th intercostal space next to sternum

Question 14

where is the murmur of MVP usually heard

Answer 14

late systolic - click, apex, not left sternal border

Question 15

what are the characteristics of innocent/normal murmurs

Answer 15

left sternal edge location, grade I or II (III in children only), loudest supine but reduced or absent sitting, systolic/short/mid-systolic, may increase the same as organic murmurs, no abnormal heart sounds or clicks, nil TTE

Question 16

is an EKG any help in deciding whether a murmur is normal or not

Answer 16

no

Question 17

when is TEE preferred over TTE

Answer 17

when patient has barrel chest, extreme obesity, emphysema, intra cardiac factors, or aortic root disease - TEE would provide better visualization

Question 18

what is a normal LVEF

Answer 18

55-65%

Question 19

how much does the EF increase with exercise

Answer 19

usually 5%

Question 20

what is mild, moderate, severe LV impairment (percentages)

Answer 20

mild 45-55%.
moderate 35-34%.
severe <35%.

Question 21

if the echo report indicates mild regurg in all 3 valves, the valves are likely _______

Answer 21

normal

Question 22

aortic sclerosis is associated with an increased risk of _______

Answer 22

CAD and stroke

Question 23

50% of individuals with aortic sclerosis have ________

Answer 23

bicuspid aortic valve

Question 24

what are the most common causes of valvular aortic stenosis

Answer 24

1. congenital abnormal valve, either bicuspid or unicuspid, with calcification. 2. normal tri-leaflet (tricuspid) valve with degenerative changes, eventual calcification, and fibrosis. 3. rheumatic valve disease

Question 25

symptoms of aortic stenosis can include: (4)

Answer 25

dyspnea, decreased exercise tolerance, syncope/dizziness, angina

Question 26

what re 5 unfavorable features with aortic stenosis

Answer 26

presence of symptoms (angina, syncope), elev BP, abnml heart rhythm (e.g. afib, LBBB), very low fitness level and arrhythmias on exercise EKG, echo showingLV wall >16mm or EF <50% or mitral disease

Question 27

what are 2 main general causes of aortic regurgitation

Answer 27

aortic valve leaflet (cusp) disease and deformityy of the aortic root and aorta

Question 28

what re the most common specific causes of aortic regurg

Answer 28

congenital bicuspid valve, bacterial endocarditis, aortic root dilatation, marfan, ehlers-danlos.

Question 29

what are other causes of aortic regurg

Answer 29

other congenital heart diseases (AV prolapse with VSD), RF, ankylosing spondylitis, RA, SLE, diet pill disease

Question 30

what are poss symptoms of aortic regurg

Answer 30

fatigue, dyspnea, angina, palps

Question 31

what is mitral stenosis

Answer 31

obstruction of blood flow from the left atrium to the LV caused by narrowing of the MV and creating a pressure gradient across the valve in diastole

Question 32

what are causes of mitral stenosis

Answer 32

rheumatic fever, infective myocarditis, severe mitral annular calcification. rare: left atrial myxoma, congenital stenosis, carcinoid syndrome, SLE, RA, end-myocardial fibrosis

Question 33

what are symptoms of mitral stenosis

Answer 33

dyspnea, decreased exercise tolerance, palms, cough, chest pain. also can occur: Afib, stroke, pulmonary edema, pulmonary hemorrhage

Question 34

what is mitral regurg

Answer 34

blood flow from the LV to lt atrium during systole

Question 35

what are causes of MR

Answer 35

abnormalities of mitral valve apparatus, MVP, myxomatous degeneration, rheumatic heart disease infective endocarditis, mitral annual calc, ruptured chord, degeneration with age, congenital cleft valve, other cardiac dsieases, Marfan, Ehlers-danlos

Question 36

what are symptoms of MR

Answer 36

dyspnea, fatigue, decreased exercise tolerance, palms, blowing, high0putched holosytolic murmur best heard at apex

Question 37

what are favorable features of MVP

Answer 37

female, apical click no murmur, degree of prolapse on echo <2.5, valve thickening <4, valve regurgitation 2+ or less, no change in 5 yrs of f/u, normal body build and habitus

Question 38

what are unfavorable features of MVP (likely progression within next 5-10 yrs)

Answer 38

mitral regurgitation on echo grade II-III, major degree of prolapse and myxomatous change, valve thickening, progression on echos and clinical findings, enlarging LV and LAE, any symptoms, afib, progression of murmur to pansystolic, flail leaflet on echo

Question 39

is MVP an important cause of cardiac morbidity and nortality

Answer 39

yes

Question 40

what is the average age for mitral surgery for prolapse/myxomatous degeneration

Answer 40

57 years

Question 41

one of the 2 most important measure of severity of aortic stenosis is the:

1. grade of the murmur
2. degree of sclerosis
3. hypertrophy of the LV
4. gradient across the valve

Answer 41

4. gradient across the valve

Question 42

what are the 2 most important measures on echo to evaluate severest of aortic stenosis

Answer 42

LV-aortic gradient and valve area

Question 43

causes of death after heart valve surgery include which of the following
A. blood clots on the valve
B. ventricular arrhythmais
C. brain embolism

Answer 43

A B and C are correct

Question 44

common causes of aortic stenosis include all of the following EXCEPT:

1. congenital abnormalities
2. aortic root dilatation
3. valvular calcification
4. rheumatic valve disease

Answer 44

2. aortic root dilatation

Question 45

what is TAVR

Answer 45

transcatheter aortic valve replacement

Question 46

name 2 conditions TAVR can’t be used for

Answer 46

bicuspid or non calcified valve

Question 47

Can nitrates be used to treat heart valve disease

Answer 47

Yes

Question 48

Recent trends in the treatment of valve disease include all of the following except:
A. Nitrates 
B. Beta blockers
C. Anticardiolipin antibodies 
D. Calcium channel blockers

Answer 48

C anticardiolipin antibodies