Heart disease

Question 1

Lub

Dub

Answer 1

S1-closure of mitral/tricuspid valve

S2-closure of aortic/pulmonic valve

Question 2

Systolic murmurs

Answer 2

AS
MR (I)
TR (I)

Question 3

Diastolic murmurs

Answer 3

AI

MS

Question 4

Systolic murmur grades

Answer 4

I/VI: faint
II/VI: obvious
III/VI: loud
IV/VI: thrill (pulsation)
V/VI: Very Loud
VI/VI: heard “across the room”

Question 5

Holosystolic
Mid Systolic
Late Systolic

Answer 5

hear throughout from beginning to end
hear centrally
later in S1 closer to S2

Question 6

MCC mitral stenosis

Answer 6

rheumatic heart disease

Valve is getting tighter and tighter causing reduced blood lfow

Question 7

clinical presentation of MS

Answer 7

asymptomatic till repair is needed

LV failure then causes Dyspnea on exertion, Orthopnea

If RV becomes effected, you will see Fatigue, pulmonary edema, and ascites

Question 8

stethoscope findings for MS

Answer 8

Opening snap of valve itself,
early to mid diastolic rumble at the apex
Heard best lying on left lateral decubitus position

Question 9

how to test for MS?

Answer 9

• echo is gold standard

- CXR shows Kerley B-lines (indicates congestion)

Question 10

catheter findings for MS?

Answer 10

Normal >2.0
Mild: > 1.5 cm2 (Valve Area)
Moderate: 1.1-1.5 cm2
Severe: < 1.0 cm2

Question 11

how to treat MS?

Answer 11

• prophylactic antibiotics (prosthetic valves or h/o endocarditis)
• anticoag

Question 12

mechanical valves require

Answer 12

lifelong anticoag

Question 13

mitral regurg

Answer 13

Valve opens and doesn’t close completely

seen in >80% of healthy adults

Question 14

chronic mitral regurg can result in EF of

Answer 14

<50%

Question 15

stethoscope mitral regurg

Answer 15

soft S1 and a Holosystolic (throughout S1/S2) murmur at the APEX, no snap

Question 16

EKG findings for MR

Answer 16

: LA enlargement, Atrial Fibrillation, LV hypertrophy

Question 17

MCC aortic stenosis

Answer 17

Degenerative/Calcification

Question 18

presentation of AS

Answer 18

syncope, angina

Question 19

Pulsus Tardus:

Pulsus Parvus:

Answer 19

slow rising carotid pulse

decrease pulse amplitude

Question 20

stethoscope findings for AS

Answer 20

Systolic Ejection Murmur: Cresendo-Decrescendo, the PEAK is later as the Severity of the stenosis increases, soft and split second heart sound

Question 21

echo measurements for AS

Answer 21

MILD	
Aortic Valve Area >1.5cm2	
Mean Gradient: < 25mmHg
MODERATE	
AVA 1.0-1.5cm2	
Mean Gradient: 25-50mmHg
SEVERE	
AVA < 1.0cm2	
Mean Gradient: >50mmHg

Question 22

how to treat AS?

Answer 22

surgery (only one you can do w/o opening the chest), do not use vasodilators

Question 23

PE findings for aortic regurg

Answer 23

wide pulse pressures
diastolic murmur at LSB
Austin Flint Murmur (Apex)
Mid to late diastolic “Rumble” at the Apex

Question 24

aortic regurg presentation?

Answer 24

Asymptomatic: usually until 4th or 5th decade

• dyspnea
• nocturnal angina
• palpitations

Question 25

tricuspid stenosis presents as

Answer 25

• JVD
• Right sided heart failure
• holosystolic murmur
• common in IV drug users