Pathophysiology and Clinical Approach to Valvular Heart Disease

Question 1

What is an Austin Flint sound?

Answer 1

A psuedo mitral stenosis sound found in aortic regurgitation due to blood hitting the mitral valve

Question 2

This valvular disorder is clinically not relevant, but may progress to mitral regurgitation.

Answer 2

Mitral valve prolapse (Barlow’s Syndrome)

Question 3

What drugs are used to manage symptoms of chronic mitral regurgitation?

Answer 3

Diuretics

Question 4

Describe the pathophysiology of mitral stenosis.

Answer 4

The LA takes longer to empty into the LV due to stenosis. This increases LA pressure and causes backup into the pulmonary vein. The result is congestive heart failure.

Question 5

What findings are present in a heart exam of a patient with aortic stenosis?

Answer 5

A crescendo-decrescendo systolic ejection murmur, diminished S2

Question 6

What is the effect of mitral regurgitation on ejection fraction during LV compensation?

Answer 6

Ejection fraction will be above normal (>65%) due to increased end diastolic and volume

Question 7

True/False. Diastolic murmurs are always pathologic.

Answer 7

True

Question 8

What infectious cause is highly associated with mitral stenosis?

Answer 8

Rheumatic fever

Question 9

Describe the pathophysiology of mitral regurgitation on the heart.

Answer 9

As blood regurgitates back into the LA during systole, the LA becomes dilated over time. Dilation of the LA increases LA pressure and cause a backup of flow from the pulmonary vein resulting in shortness of breath

Question 10

An opening snap is most associated with what valvular disorder?

Answer 10

Mitral stenosis

Question 11

True/False. Surgery is indicated in mitral regurgitation patients with EF < 30%. Valvular repair has better outcomes than valve replacement.

Answer 11

True

Question 12

True/False. Aortic stenosis is a volume problem.

Answer 12

False. It is a pressure problem. The aortic valve does not open fully and the LV must pump harder to eject blood.

Question 13

What is the most common cause of mitral regurgitation?

Answer 13

Myxomatous (degenerative)

Question 14

What is the hallmark of mitral regurgitation on a physical exam?

Answer 14

Holosystolic murmur

Question 15

What heart exam findings are present in a patient with aortic regurgitation?

Answer 15

Diastolic murmur immediately after S2, S4+, Austin flint

Question 16

What is the clinical presentation of a patient with aortic stenosis?

Answer 16

Syncope, angina, dyspnea (SAD)

Question 17

How can aortic stenosis be differentiated from mitral regurgitation?

Answer 17

Presence of a diminished S2

Question 18

What is the medical management for mitral stenosis?

Answer 18

Heart rate control and anti-coagulation

Question 19

The most common cause of aortic stenosis is myxamotous. What is the second most common cause?

Answer 19

Bicuspid aortic stenosis - only 2 leaflets leading to turbulent flow, fibrosis, and calcification

Question 20

Percutaneous balloon angioplasty may be used to treat mitral stenosis. What complications may arise?

Answer 20

Relapse of mitral stenosis, mitral regurgitation

Question 21

As the LV decompensated from mitral regurgitation what changes will be seen?

Answer 21

LA dilation, decrease in CO and EF, increased end systolic and diastolic volumes