E1 : Valvular Heart Disease & Pericarditis

Question 1

diastolic murmurs

Answer 1

1. aortic regurgitation / insufficiency

2. mitral stenosis

Question 2

systolic murmurs

Answer 2

1. mitral regurgitation / insufficiency
2. aortic stenosis
3. asymmetric septal hypertrophy (ASH) / idiopathic hypertrophic sub aortic stenosis (IHSS)

Question 3

etiology of mitral stenosis

Answer 3

rheumatic fever

Question 4

symptoms associated w/mitral stenosis

Answer 4

• dyspnea
• orthopnea
• pulmonary edema (due to dilated LEFT ATRIUM)

Question 5

when does complete incapacity occur w/mitral stenosis?

Answer 5

~ 7 years

Question 6

how long is the onset of symptoms delayed w/mitral stenosis?

Answer 6

15-20 years

Question 7

etiology of mitral regurgitation / insufficiency

Answer 7

• rheumatic fever
• papillary muscle dysfunction secondary to MI
• endocarditis
• mitral valve prolapse
• Redux (diet drug that causes pure right heart failure)

Question 8

acute mitral regurgitation =

Answer 8

pulmonary edema

Question 9

chronic mitral regurgitation =

Answer 9

slow onset symptom of CHF

Question 10

etiology of aortic stenosis

Answer 10

• rheumatic fever

- congenital bicuspid valve

Question 11

triad of symptoms associated w/aortic stenosis

Answer 11

• syncope
• angina
• left ventricular failure

SURVIVAL < 5 YEARS

Question 12

drugs used to treat aortic stenosis

Answer 12

• digoxin
• diuretics
• no salt

Question 13

indications for surgery to treat aortic stenosis

Answer 13

• active and still have excellent QOL

- gradient across valve > 50 mm

Question 14

etiologies of aortic regurgitation / insufficiency

Answer 14

• rheumatic fever
• syphilitic aortitis
• ankylosing spondylitis
• marfans

Question 15

symptoms of aortic regurgitation / insufficiency

Answer 15

volume overload (LV failure)

Question 16

CXR indications for surgical treatment of aortic regurgitation / insufficiency

Answer 16

• MOD LV failure
• LV hypertrophy w/strain on EKG = SVI + RV5 > 35 mm
• pulse pressure > 100

Question 17

etiology of ASH / IHSS

Answer 17

genetic

Question 18

symptoms of ASH / IHSS

Answer 18

• syncope
• angina
• difficult on exertion
• sudden death

Question 19

drugs used to treat ASH / IHSS

Answer 19

• beta blocker
• CCB
• (avoid digoxin)

Question 20

symptoms of pericarditis

Answer 20

• sharp chest pain
• rub
• diffuse EKG changes (ST concavity)

Question 21

etiologies of acute pericarditis

Answer 21

• idiopathic
• trauma (blunt to chest)
• CVD (rheumatic fever, SLE)
• infection (bacterial, TB, fungal, VIRAL)
• cancer w/metastases (lung, breast, bad prognosis)
• radiation through chest
• uremia
• post thoracotomy

Question 22

etiologies of chronic pericarditis

Answer 22

• idiopathic
• infection
• CVD
• tumor/metastases
• radiation
• uremia