Lecture 22 + 23 - Valvular Heart Disease

Question 1

Aortic and mitral valve area measures < ____cm^2 in severe stenosis. The mean compensatory pressure gradient is > ____ mmHg for severe Aortic valve stenosis and > ____ mmHg for Mitral valve stenosis.

Answer 1

< 1 cm^2

> 40mmHg - Aortic

> 10mmHg - Mitral

Question 2

Heart valve stenosis is only treated if it is _______, while regurg is only treated if it is _______. Mitral stenosis is treated with medications that ______ (increase or decrease?) diastolic filling time, while Aortic stenosis requires surgery. Mitral regurg requires surgery, while Aortic regurg can be partially treated with _______ to prolong the need for surgery.

Answer 2

Symptomatic

Severe

Increase

Vasodilators

Question 3

Remember that Aortic stenosis typically occurs in older patients (70+) if it is not congenital. Congenital bicuspid Aortic stenosis is the most common cause of Aortic stenosis in _____ aged individuals (50-70).

Answer 3

Middle aged

Question 4

For severe Aortic stenosis, you’ll hear a ______-______ murmur, possibly with an absent ____ heart sound (which tells you it’s really severe).

Answer 4

Crescendo-Decrescendo murmur

S2

Question 5

Aortic regurg patients can present with many classical clinical findings.

Look for widened _____ pressure, Waterhammer pulse, Corrigan’s sign (visible arterial pulsation in the _____), de Musset’s sign (bobbing of the _____ in time with the heartbeat), Quincke’s sign ( capillary pulsation visible in the ____ ____), Traube’s sign (a pistol shot heard over the ____ artery), and Muler’s sign (pulsation of the _____).

Answer 5

Pulse

Neck

bobbing of the Head

Nail beds

Femoral artery

Uvula

Question 6

Aortic regurg may result in an Austin Flint murmur, which is the sound made by turbulent flow passed the _____ valve. This is caused by the regurg jet of blood coming back through the Aorta, into the LV, and hitting the anterior leaflet of the _____ valve, preventing it from opening all the way.

Answer 6

Mitral valve

Mitral valve

Question 7

Mitral stenosis can result in enlargement of the Left _____, which can be detected with a ______ swallow that indicates mid esophageal narrowing. Remember that Mitral stenosis is commonly caused by ________ Heart Disease secondary to Strep A pharyngitis –> is this common in the US population? Who is it common among?

Answer 7

Left Atrium

Barium swallow

Rheumatic Heart disease

This is NOT common among US citizens, unless they are recent immigrants. This is common among those in non-industrialized nations.

Question 8

Are patients with valvular or non-valvular A-fib at higher risk for clot formation? Think about blood flow when the valve is involved vs when it’s not.

Answer 8

Valvular A-fib

Question 9

Physical exam of patients with Mitral STENOSIS will reveal a loud ____ heart sound with an early opening ____ and diastolic rumble.

Answer 9

loud S1

opening Snap

Question 10

Which lasts longer, a bioprosthetic valve or a mechanical valve, and which requires lifelong antithrobotics?

Answer 10

Mechanical lasts longer and needs antithrombosis treatment for life.

Question 11

What pressure wave finding is indicative of Mitral valve regurg?

Answer 11

Giant V-wave, which corresponds to systole and indicates a large increase in Left Atrial pressure.

Question 12

What’s the difference in S1 sound between Mitral Regurg and mitral Stenosis?

Answer 12

S1 is SOFT in Mitral Regurg, and it is LOUD in Mitral Stenosis.

Question 13

What is the difference in Left Ventricle and Left Atrial size in Acute vs Chronic Mitral Regurg?

Answer 13

Both are enlarged in CHRONIC. Keep in mind Chronic Mitral Regurg is asymptomatic for many years/decades until Left Ventricle dysfunction develops (Acute can be fatal if not treated promptly).