Exam 4 Valvular Disease

Question 1

most common level of aortic stenosis

Answer 1

aortic valve - 75%, as opposed to sub or supravalvular

Question 2

age 30 - 65 aortic valve concerns

Answer 2

congenitally bicuspid aortic valve becomes calcified/stenotic. congenital

Question 3

Sx aortic stenosis

Answer 3

fatigue, exertional dyspnea

Question 4

late Sx aortic stenosis

Answer 4

dyspnea, angina, syncope, heart failure

Question 5

heart sound aortic stenosis

Answer 5

systolic ejection murmur, crescendo-decrescendo

Question 6

physical exam sign aortic stenosis

Answer 6

thrill in suprasternal notch or 2nd right ICS

Question 7

grade 1 murmur

Answer 7

barely audible

Question 8

grade 2 murmur

Answer 8

quiet but clearly audible

Question 9

grade 3 murmur

Answer 9

moderately loud

Question 10

grade 4 murmur

Answer 10

loud, with thrill

Question 11

grade 5 murmur

Answer 11

very loud, thrill, hear with steth partially off chest

Question 12

grade 6 murmur

Answer 12

very loud, thrill, hear with steth completely off chest

Question 13

lab finding aortic stenosis

Answer 13

left ventricular hypertrophy

Question 14

porcelain aorta

Answer 14

calcium deposits on aorta, can be seen in CXR

Question 15

Tx of symptomatic aortic stenosis

Answer 15

cardio referral, probably valve replacement

Question 16

symptomatic aortic stenosis

Answer 16

angina, syncope, dyspnea/CHf

Question 17

surface area a/w severe aortic stenosis

Answer 17

< 1.0 cm squared

Question 18

hypertrophic cardiomyopathy cause

Answer 18

inherited 60%

Question 19

hypertrophic cardiomyopathy murmur

Answer 19

same as aortic stenosis, louder when pt. stands, valsalva

Question 20

Tx hyptertophic cardiomyopathy

Answer 20

calcium channel blockers, beta blocker

Question 21

hypertrophic cardiomyopathy description

Answer 21

enlarged heart muscle without cause for secondary hypertrophy

Question 22

aortic regurg description

Answer 22

blood leaks back through aortic valve during diastole

Question 23

aortic regurg causes

Answer 23

aortic insufficiency

Question 24

physical exam signs aortic insufficiency/regurg

Answer 24

low diastolic, widened pulse pressure

Question 25

aortic insufficiency/regurg requiring surgical intervention

Answer 25

ejection fraction <55%, symptomatic, asymptomatic with LV dilation, end systol 55mm, end diastolic 70mm

Question 26

acute causes of aortic regurg

Answer 26

aortic dissection, surgical, endocarditis

Question 27

progression of chronic aortic regurg

Answer 27

LV overload, dilation, hypertrophy, CHF, then <2 year survival

Question 28

acute ar progression

Answer 28

pulmonary edema, doesn’t compensate for overload

Question 29

Tx aortic regurg

Answer 29

valve replacement

Question 30

heart sound aortic regurg

Answer 30

austin flint murmur - low pitched diast murmur at apex

Question 31

lab findings aortic regurg

Answer 31

left ventricular hypertrophy, sometimes CHF/pulmonary edema

Question 32

Tx aortic regurg

Answer 32

ace inhibitors, vasodilators, valve replacement if symptomatic

Question 33

mitral regurg definition

Answer 33

blood leaks from LV into LA

Question 34

mitral valve structures involved in mitral regurg

Answer 34

leaflets, chordae tendineae, papullary muscles, annulus

Question 35

causes of acute mitral regurg

Answer 35

papillary muscle necrosis, endocarditis

Question 36

causes chronic mitral regurg

Answer 36

endocarditis, inherited, marfan’s, rheumatic, etc

Question 37

barlow syndrome

Answer 37

cause of mitral regurg, valve degen, a/w grave’s disease, marfan’s muscular dystrophy

Question 38

a fib with mitral regurg

Answer 38

develops due to left atrial enlargement resulting from compensation

Question 39

Sx mitral regurg

Answer 39

gradual appearance, dyspnea, fatigue, arrhythmias

Question 40

heart sound mitral regurg

Answer 40

high pitched pansystolic murmur at apex

Question 41

physical exam late mitral regurg

Answer 41

JVD, hepatomegaly, edema

Question 42

lab findings mitral regurg

Answer 42

atrial enlargement, ventricular hypertrophies, a. fib.

Question 43

Tx mitral regurg

Answer 43

ace inhibitors, vasodilators, Na reduction, diuretics, digitalis, valve repair or replacement

Question 44

mitral valve prolapse description

Answer 44

during systole ballooning of mitral leaflets into left atrium

Question 45

Tx mitral proplapse

Answer 45

most require none, if palp or arrhythmia beta blockers, if a/w regurgitation, use mitral regurg Tx

Question 46

mitral stenosis description

Answer 46

narrowing mitral valve, increases LA pressure

Question 47

cause of mitral stenosis

Answer 47

rheumatic heart disease most common

Question 48

Sx mitral stenosis

Answer 48

dyspnea, pulmonary edema, pulmonary HTN, then right heart failure, a-fib, emboli

Question 49

heart sound mitral stenosis

Answer 49

S1 opening snap then mid diastolic rumbling murmur

Question 50

lab findings mitral stenosis

Answer 50

gigantic LA, smaller LV, right vent hypertrophy, a-fib, kerley B lines,

Question 51

Tx mitral stenosis

Answer 51

mild: diuretics, Na restriction, warfarin a-fib embolus prevention, valve surgery

Question 52

endocarditis description

Answer 52

vegetative growths on valve 2nd to bacterial infx

Question 53

class 1 endocarditis requiring surgery

Answer 53

heart failure, pulmonary HTN, resistant organisms, heart block

Question 54

class 2 endocarditis requiring surgery

Answer 54

recurrent emboli or vegetation in spite of abx

Question 55

tricuspid regurg cause

Answer 55

right valve dysfunction a/w endocarditis

Question 56

Tx endocarditis

Answer 56

abx