Exam 2- Valvular Heart Disease

Question 1

Which cardiac valcular lesions require a slow heart rate to prolong the duration of diastole and improve left ventricular filling and coronary blood flow?

Answer 1

Stenotic Valvular Lesions, (aortic and mitral stenosis).

Question 2

Which valvular lesions require afterload reduction and a somewhat faster heart rate to shorten diastolic time to reduce backflow?

Answer 2

Regurgitant valvular lesions (aortic and mitral insufficiency)

Question 3

On an EKG, what findings would suggest the presence of left atrial enlargement typical of mitral valve disease?

Answer 3

Broad and notched P waves (P mitrale).

Question 4

What common EKG changes would suggest left or right ventricular hypertrophy?

Answer 4

Presence of left or right axis deviation, and high voltage.

Question 5

What type of valvular lesion is portrayed by narrowing of the valvular orifice, which restricts flow when open, causes increased resistance to flow, and increases the turbulence of blood as it passes through the orifice.

Answer 5

Stenosis

Question 6

Regurgitation is also known as:

Answer 6

Insufficiency

Question 7

Which type of valvular lesion is identified as a diseased valve that has incomplete/partial closure?

Answer 7

Regurgitation or Insufficiency

Question 8

What type of valvular lesion has a combination of stenotic and regurgitent effects, and is named based on the dominance of severity?

Answer 8

Mixed. Stenosis with insufficiency (Stenosis is dominant), Insufficiency with stenosis (Insufficiency is dominant).

Question 9

On a posteroanterior chest radiograph, cardiomegaly can be established if the heart size exceeds ____% of the internal width of the thoracic cage.

Answer 9

50%

Question 10

Utility of echocardiography in evaluation of valvular heart disease. AKA- What can an echo tell us about valvle issues?

Answer 10

1. Determine significance of cardiac murmurs
2. Identify hemodynamic abnormalities associated with physical findings.
3. Determine valve area
4. Determine transvalvular pressure gradient.
5. Determine ventricular ejection fraction (EF)
6. Diagnose valvular regurgitation
7. Evaluate prosthetic valve function.

Question 11

Mitral Stenosis is considered to be severe when transvalvular pressure gradients are greater than ____mmHg.

Answer 11

> 10 mmHg

Question 12

Aortic stenosis is considered to be severe when transvalvular pressure gradients are greater than _____ mmHg.

Answer 12

> 50 mmHg

Question 13

Which type of prosthetic valve is very durable, lasting at least 20-30 years but require long-term anticoagulation?

Answer 13

Mechanical. Usually preferred in patients who are young, have life expectancy of > 10-15 years, or require long-term anticoagulation therapy for another reason, like a-fib.

Question 14

Which type of prosthetic valve lasts about 10-15 years and do not usually require long-term anticoagulation?

Answer 14

Bioprosthetic- (hererografs from porcine or bovine tissues, or homografts, which are preserved human aortic valves)- preferred in elderly patients and in those who cannot tolerate anticoagulation.