Clinica Valvular Heart Disease

Question 1

What is the predominant cause of mitral stenosis?

Answer 1

Rheumatic Fever

Question 2

What is mitral stenosis?

Answer 2

The thickened leaflets may be so adherent and rigid that they cannot open or shut, reducing or rarely even abolishing the first heart sound

Question 3

What changes in the heart occur as a result of MS?

Answer 3

LA dilation along with RV and RA dilation

Question 4

What is the main symptom of MS?

Answer 4

Dyspnea on exertion

Question 5

What is seen the echocardiogram of MS patients?

Answer 5

“Hockey Stick” abnormality

Question 6

What are the medical treatments of MS?

Answer 6

• Beta blockers may increase exercise capacity by reducing heart rate in patients with sinus rhythm, but especially in patients with atrial fibrillation.
• Digitalis glycosides for Right HF and atrial fibrillation
• Penicillin prophylaxis for beta-hemolytic streptococcal infections and prophylaxis for infective endocarditis

Question 7

What are the guidelines for surgical intervention in MS?

Answer 7

It should be carried out in symptomatic patients with moderate to severe MS

Question 8

What are the surgical treatments for MS?

Answer 8

• Valvuloplasty

- MV Replacement

Question 9

What are the causes of mitral regurgitation?

Answer 9

• Inflammatory –Rheumatic,SLE
• Degenerative - MVP, Marfans, MAC
• Infective Subacute Endocarditis
• Congenital

Question 10

Where is MR best heard?

Answer 10

In the axilla - it is holosystolic from S1 to S2

Question 11

What happens to the LV with volume overload?

Answer 11

It will enlarge with NO hypertrophy

Question 12

What happens to the LV with pressure overload?

Answer 12

It will be normal size with hypertrophy

Question 13

What is the best pre-op end systolic diameter of the MV?

Answer 13

50 mm or less

Question 14

What are the symptoms in chronic MR?

Answer 14

Symptoms usually do not develop in patients with chronic MR until the left ventricle fails. By the time that symptoms secondary to a reduced cardiac output and/or pulmonary congestion become apparent, serious and sometimes even irreversible left ventricular dysfunction may have developed.

Question 15

What is the medical treatment for MR?

Answer 15

Afterload reduction is of particular benefit in the management of MR—both the acute and the chronic forms. An angiotensin inhibitor or oral hydralazine are indicated.

Question 16

Does valvuloplasty work in aortic stenosis?

Answer 16

No. Usually the calcification with return.

Question 17

What is the treatment for aortic stenosis?

Answer 17

AV Replacement

Question 18

What is the cause of aortic regurgitation?

Answer 18

Aortic regurgitation (AR) may be caused by primary disease of either the aortic valve leaflets (rheumatic fever) or the wall of the aortic root or both.

Question 19

What is good medical treatment for AR?

Answer 19

Nifedipine

Question 20

What is the most common cause of tricuspid regurgitation?

Answer 20

The most common cause of tricuspid regurgitation (TR) is not intrinsic involvement of the valve itself but dilatation of the right ventricle and of the tricuspid annulus, which may be complications of right ventricular failure of any cause and which cause secondary, functional TR.

Question 21

Where is the murmur of the TR best hear?

Answer 21

Left lateral sternal border.