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Cardiology USMLE Step 3 > Section 6: Valvular Heart Disease > Flashcards

Section 6: Valvular Heart Disease Flashcards

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1
Q

Differential diagnosis of valvular heart disease in young patients

A
  • Mitral valve prolapse
  • Hypertrophic obstructive cardiomyopathy
  • Mitral stenosis
  • Bicuspid aortic valves.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2143-2144). . Kindle Edition.

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2
Q

Clue to diagnosis in valvular heart disease:

  1. Young female, general population
  2. Healthy young athlete
  3. Immigrant, pregnant
  4. Turner’s syndrome, coarctation of aorta
  5. Palpitations, atypical chest pain not with exertion

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2155-2158). . Kindle Edition.

A
  1. Mitral valve prolapse
  2. Hypertrophic obstructive cardiomyopathy (HOCM)
  3. Mitral stenosis
  4. Bicuspid aortic valve
  5. Mitral valve prolapse
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3
Q

List the physical findings in a patient with vascular heart disease

A

Most common:

  • Murmurs
  • Rales on lung exam

Less common:

  • Peripheral edema
  • Carotid pulse findings
  • Gallops
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4
Q

Causes of systolic murmurs

A
  • Aortic stenosis
  • Mitral regurgitation
  • Mitral valve prolapse
  • Hypertrophic obstructive cardiomyopathy (HOCM).

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2167-2168). . Kindle Edition.

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5
Q

Cause of diastolic murmurs

A
  • Aortic regurgitation
  • Mitral stenosis.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 2169). . Kindle Edition.

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6
Q
  1. List the right sided murmurs
  2. What is their relationship with respiration
A
  1. Right-sided murmurs:
  • Pulmonic stenosis
  • Pulmonic regurgitation
  • Tricuspid stenosis
  • Tricuspid regurgitation

2.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2177-2178). . Kindle Edition.

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7
Q
  1. List the left sided murmurs
  2. What is their relationship with respiration
A

Mitral stenosis

MVP

Mitral regurgitation

Aortic regurgitation

Aortic stenosis

They increase with exhalation

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8
Q

Squatting and lifting the legs in the air —— (1) —— venous return to the heart.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2186-2187). . Kindle Edition.

A
  1. Increases
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9
Q

Valsalva maneuver and standing up suddenly — (1) — venous return to the heart.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2187-2188). . Kindle Edition.

A

Decrease

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10
Q

Explain Valsalva maneuver

A

Valsalva maneuver is exhaling against a closed glottis, like bearing down during a bowel movement or blowing against a thumb stuck in the mouth. This increases intrathoracic pressure, which decreases blood return to the heart.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2189-2191). . Kindle Edition.

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11
Q

What is the effect of sudden squating or lifting the leg on blood flow to the heart?

A

When you suddenly squat, you are squeezing the veins of the legs, which are rather large. This essentially squeezes blood up into the heart like squeezing on a tube of toothpaste. For those too weak to squat suddenly, the physician can lift up the legs. This has the same effect as squatting, which is to drain blood into the chest from the lower extremities.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2192-2195). . Kindle Edition.

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12
Q

The majority of murmurs increase in intensity with squatting and leg raise. List them.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2196-2197). . Kindle Edition.

A
  • Aortic stenosis (AS)
  • Aortic regurgitation (AR)
  • Mitral stenosis (MS)
  • Mitral regurgitation (MR)
  • Pulmonic stenosis
  • Pulmonic regurgitation
  • Tricuspid stenosis
  • Tricuspid regurgitation

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2196-2197). . Kindle Edition.

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13
Q

List the only two murmurs that become softer with squatting and leg raising

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2198-2199). . Kindle Edition.

A
  • Mitral valve prolapse (MVP)
  • Hypertrophic obstructive cardiomyopathy (HOCM).

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2198-2199). . Kindle Edition.

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14
Q

What is the effect of squatting or leg raising on the following lesions:

  1. Aortic stenosis (AS)
  2. Aortic regurgitation (AR)
  3. Mitral stenosis (MS)
  4. Mitral regurgitation (MR)
  5. Ventricular septal defect (VSD)
  6. Hypertrophic obstructive cardiomyopathy (HOCM)
  7. Mitral valve prolapse (MVP)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2223-2227). . Kindle Edition.

A
  1. Increase
  2. Increase
  3. Increase
  4. Increase
  5. Increase
  6. Decrease
  7. Decrease
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15
Q

What is the effect of standing/Valsalva maneuver on the following lesions:

  1. Aortic stenosis (AS)
  2. Aortic regurgitation (AR)
  3. Mitral stenosis (MS)
  4. Mitral regurgitation (MR)
  5. Ventricular septal defect (VSD)
  6. Hypertrophic obstructive cardiomyopathy (HOCM)
  7. Mitral valve prolapse (MVP)Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2223-2227). . Kindle Edition.
A
  1. Decreased
  2. Decreased
  3. Decreased
  4. Decreased
  5. Decreased
  6. Increased
  7. Increased
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16
Q

What murmures are worsened by handgrip?

A
  • Aortic regurgitation
  • Mitral regurgitation
  • VSD

Handgrip will make these murmurs louder

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17
Q

Handgrip is a maneuver that — (1) — — (2) — by compressing the arteries of the arm through contraction of the muscles of the arm.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2232-2233). . Kindle Edition.

A
  1. Increases
  2. Afterload
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18
Q

Why are ACE inhibitors useed in the Rx of AR and MR?

A

Because they reduce afterload and so increase the forward flow of blood into the aorta

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19
Q

What other medication acts similar to ACE inhibitors?

A

Amyl nitrate

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20
Q
  1. What class of drug is amyl nitrate?
  2. How does decrease afterload?
A
  1. Vasodilator
  2. By dilating peripheral arteries
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21
Q

Amyl nitrate has the — 1 — effect of handgrip. Giving amyl nitrate is like giving an ACE inhibitor or ARB. If handgrip worsens AR and MR, then amyl nitrate improves AR and MR.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2242-2243). . Kindle Edition.

A
  1. Opposite
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22
Q
  1. List murmurs handgrip improves or lessen
  2. Explain the physiology behind 1
A
  1. The murmurs handgrip improves are:
  • Hypertrophic obstructive cardiomyopathy (HOCM)
  • Mitral valve prolapse (MVP)
  • Aortic stenosis
  1. The murmurs of MVP and HOCM lessen when the left ventricular chamber is larger or more full. What happens to the size of the left ventricular (LV) chamber if there is increased afterload? The LV chamber will not empty and, therefore, the LV will be larger. A larger LV chamber relieves or lessens the obstruction in HOCM.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2245-2247). . Kindle Edition.

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23
Q

What is the effect of handgrip on the following murmurs?

  1. Aortic stenosis (AS)
  2. Aortic regurgitation (AR)
  3. Mitral stenosis (MS)
  4. Mitral regurgitation (MR)
  5. Ventricular septal defect (VSD)
  6. Hypertrophic obstructive cardiomyopathy (HOCM)
  7. Mitral valve prolapse (MVP)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2268-2287). . Kindle Edition.

A
  1. Decrease
  2. Increase
  3. Negligible effect
  4. Increase
  5. Increase
  6. Decrease
  7. Decrease
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24
Q

What is the effect of amyl nitrate on the following murmurs?

  1. Aortic stenosis (AS)
  2. Aortic regurgitation (AR)
  3. Mitral stenosis (MS)
  4. Mitral regurgitation (MR)
  5. Ventricular septal defect (VSD)
  6. Hypertrophic obstructive cardiomyopathy (HOCM)
  7. Mitral valve prolapse (MVP)Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2268-2287). . Kindle Edition.
A
  1. Increase
  2. Decrease
  3. Negligible effect
  4. Decrease
  5. Decrease
  6. Increase
  7. Increase
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25
Q

Where is the location and radiation of the following murmurs?

  1. Aortic stenosis
  2. Pulmonic valve murmurs
  3. Aortic regurgitation, tricuspid murmurs and VSD murmurs
  4. Mitral regurgitation
A
  1. Aortic stenosis is heard best at the second right intercostal space and radiates to the carotid arteries. It is classically described as a crescendo-decrescendo murmur.
  2. Pulmonic valve murmurs are heard at the second left intercostal space.
  3. Aortic regurgitation and tricuspid murmurs, as well as VSD murmurs, are heard at the lower left sternal border.
  4. Mitral regurgitation (MR) is heard at the apex and radiates into the axilla. The apex is at the level of the 5th intercostal space, below the left nipple.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2300-2303). . Kindle Edition.

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26
Q

Grade murmurs by intensity

A
  1. I/ VI: Only heard with special maneuvers (e.g., Valsalva, handgrip)
  2. II/ VI and III/ VI: Majority of murmurs; no objective difference between them
  3. IV/ VI: Thrill present (a thrill is a palpable vibration you can feel from a severe valve lesion)
  4. V/ VI: Can be heard with stethoscope partially off the chest
  5. VI/ VI: Stethoscope not needed to hear it

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2305-2307). . Kindle Edition.

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27
Q

Diagnostic tests for valvular heart disease

  1. Best initial test
  2. Most accurate test
  3. Other important tests on CCS
A
  1. Echocardiogram
  2. Left heart catherization
  3. EKG and chest X-ray
28
Q

Rx for regurgitant lesions

A

Vasodilators

  1. ACE inhibitors
  2. ARBs
  3. Nifedipine

Surgical replacement if medical therapy fails

29
Q

Rx for stenotic lesions

A

Anatomic repair

  • Mitral stenosis should undergo balloon valvuloplasty, even if the patient is pregnant.
  • Aortic stenosis that is severe must be surgically replaced.
  • Aortic valve replacement is well tolerated even in the very old.
  • Diuretics can decrease pulmonary vascular congestion with stenotic lesions, but they are not as effective or important as anatomic repair.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2321-2323). . Kindle Edition.

30
Q

— 1 — medication is indicated if Valsalva improves murmur

— 2 — medication is indicated if amyl nitrate improves murmur

A
  1. Diuretics
  2. ACE inhibitor
31
Q

What is the effect on the the following murmurs by Standing/Valsalva maneuver and Is there a place for diuretic Rx?

  1. Aortic stenosis (AS)
  2. Aortic regurgitation (AR)
  3. Mitral stenosis (MS)
  4. Mitral regurgitation (MR)
  5. Ventricular septal defect (VSD)
  6. Hypertrophic obstructive cardiomyopathy (HOCM)
  7. Mitral valve prolapse (MVP)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2341-2351). . Kindle Edition.

A
  1. Decrease; yes (surgical replacement best)
  2. Decrease; yes
  3. Decrease; yes (ballon best)
  4. Decrease; yes
  5. Decrease; yes
  6. Increase; no
  7. Increase; no
32
Q

What is the effect of amyl nitrate on the following murmurs and indicate if ACE inhibitors have a place in their management?

  1. Aortic stenosis (AS)
  2. Aortic regurgitation (AR)
  3. Mitral stenosis (MS)
  4. Mitral regurgitation (MR)
  5. Ventricular septal defect (VSD)
  6. Hypertrophic obstructive cardiomyopathy (HOCM)
  7. Mitral valve prolapse (MVP)Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2341-2351). . Kindle Edition.
A
  1. Increase; no
  2. Decrease; yes
  3. Negligible effect; no
  4. Decrease; yes
  5. Decrease; yes
  6. Increase; no
  7. Increase; no
33
Q

Most common causes of regurgitant diseases

A
  • HTN
  • Ischemic heart disease
34
Q

Clinical presentations in aortic stenosis

A
  • Chest pain (most common presentation)
  • Syncope
  • CHF
  • Older patients
  • Hx of HTN
35
Q

What is the prognosis of aortic stenosis if the patient presents with the following complications?

  1. Coronary disease
  2. Syncope
  3. CHF
A
  1. 3 to 5 years average survival
  2. 2 to 3 years average survival
  3. 1.5 to 2 years average survival
36
Q

Describe the murmur of aortic stenosis

A
  • AS gives a crescendo-decrescendo systolic murmur
  • The murmur will be heard best at the second right intercostal space and radiate to the carotid arteries.
  • The murmur will increase in intensity with leg raising, squatting, and amyl nitrate.
  • The murmur will decrease with Valsalva, standing, and handgrip.
  • The case may describe delayed carotid upstroke as well.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2389-2392). . Kindle Edition.

37
Q

Aortic Stenosis

  • Best initial test
  • Most accurate test
A
  • Transthoracic echocardiogram (TTE) is the best initial diagnostic test. A transesophageal echocardiogram (TEE) is more accurate.
  • Left heart catheterization is the most accurate diagnostic test and allows the most accurate method of assessing the pressure gradient across the valve.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2396-2399). . Kindle Edition.

38
Q

What is the normal gradient across the aortic valve?

A
  • The normal gradient is < 30 mm Hg.
  • Moderate disease is indicated by 30– 70 mm Hg, and severe disease is indicated by a gradient > 70 mm Hg.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2399-2400). . Kindle Edition.

39
Q

Rx for aortic stenosis

A

Diurectics (judicoius use)

Definitive rx of choice: valve replacement

  • Bioprosthetic valves (porcine, bovine) will last 10 years on average, but do not require anticoagulation with warfarin
  • Mechanical valves do not have to be replaced but must be also treated with warfarin to an INR of 2– 3
  • Valve replacement is well tolerated, even in the elderly
  • Balloon dilate AS only if the patient is too sick to undergo surgery

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2406-2410). . Kindle Edition.

40
Q

Causes of aortic regurgitation

A
  • Hypertension
  • Rheumatic heart disease
  • Endocarditis
  • Cystic medial necrosis

Rarer causes include:

  • Marfan’s syndrome
  • Ankylosing spondylitis
  • Syphilis
  • Reactive Arthritis

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 2413). . Kindle Edition.

41
Q

Reactive arthritis:

What is this?

What is another name for reactive arthritis?

A
  • Reactive arthritis is an inflammatory arthritis of large joints, inflammation of the eyes (conjunctivitis and uveitis), and urethritis
  • Reiter’s syndrome.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2413-2414). . Kindle Edition.

42
Q

Most common presentation of aortic regurgitation

A

Shortness of breath

Fatigue

43
Q

Describe the murmur of aortic regurgitation

A
  • The murmur of AR is a diastolic decrescendo murmur heard best at the left sternal border.
  • The murmur will increase in intensity with leg raising, squatting, and handgrip.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2418-2420). . Kindle Edition.

44
Q

Arterial or capillary pulsations in the fingernails

High bounding pulses (also known as a “water-hammer pulse”)

Head bobbing up and down with each pulse

Murmur heard over the femoral artery

Blood pressure gradient much higher in the lower extremities

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2420-2425). . Kindle Edition.

A
  • Quincke pulse
  • Corrigan’s pulse
  • Musset’s sign
  • Duroziez’s sign
  • Hill sign
45
Q

Aortic Regurgitation:

  1. Best initial test
  2. Most accurate test
  3. Findings on EKC and CXR
A
  1. TTE. TEE more accurate
  2. Left heart catheterization
  3. EKG and a chest x-ray, which will show left ventricular hypertrophy.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 2428). . Kindle Edition.

46
Q

Rx for Aortic regurgitation

A

ACE inhibitors, ARBs, and nifedipine are the best initial therapy.

For CCS add loop diuretics: Furosemide

Surgery is the answer when the ejection fraction drops below 55 percent or the left ventricular end systolic diameter goes above 55 mm; surgery should be done in patients with these criteria even if they are asymptomatic.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2432-2433). . Kindle Edition.

47
Q

Most common cause of Mitral stenosis

A

Rheumatic fever

48
Q

Special features or presentations in mitral stenosis

A
  1. Dysphagia: Large left atrium pressing on the esophagus
  2. Hoarseness: Pressure on recurrent laryngeal nerve
  3. Atrial fibrillation leading to stroke

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2438-2440). . Kindle Edition.

49
Q

Describe the murmur of mitral stenosis

A

The murmur of MS is a diastolic rumble after an opening snap, which can be described as an “extra sound” in diastole.

The S1 is louder. As the mitral stenosis worsens, the opening snap moves closer to S2.

The murmur will increase in intensity with leg raising, squatting, and expiration.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2443-2445). . Kindle Edition.

50
Q

Mitral Stenosis

  1. Best initial test
  2. Most accurate test
  3. Findings on EKG and CXR
A

On chest x-ray, there is straightening of the left heart border and elevation of the left mainstem bronchus.

There may also be a description of a double density in the cardiac silhouette (from left atrial enlargement).

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2449-2451). . Kindle Edition.

51
Q

Rx for Mitral Stenosis

A

Diuretics are the best initial therapy. They do not alter progression.

Balloon valvuloplasty is the most effective therapy.

Pregnant women can and should be readily treated with balloon valvuloplasty. Pregnancy is not a contraindication to valvuloplasty.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 2455). . Kindle Edition.

52
Q

Causes of mitral regurgitation

A

Hypertension

Ischemic heart disease

Any other condition that leads to dilation of the heart.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2457-2458). . Kindle Edition.

53
Q

Most common clinical presentation of mitral regurgitation

A

Dyspnea on exertion is the most common complaint.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 2459). . Kindle Edition.

54
Q

Describe the murmur of mitral regurgitation

A
  • The murmur of MR is holosystolic and obscures both S1 and S2.
  • MR is heard best at the apex and radiates to the axilla.
  • The murmur increases in intensity with leg raising, squatting, and handgrip.
  • Standing, Valsalva, and amyl nitrate decrease the intensity. S3 gallop is often present.

S3 gallop is associated with fluid overload states, such as congestive heart failure or mitral regurgitation. An S3 can be normal in patients under the age of 30.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2464-2467). . Kindle Edition.

55
Q

Mitral Regurgitation:

  • Best initial test
  • Most accurate test
A
  • TTE. TEE more accurate
  • ?Left heart catheterization
56
Q

Rx of mitral regurgitation

A
  • ACE inhibitors, ARBs, and nifedipine are the best initial therapy and the medications most likely to decrease the rate of progression of the disease.
  • Surgery is the answer when the left ventricular ejection fraction drops below 60 percent or the left ventricular end systolic diameter goes above 40 mm. Surgery should be done in patients with these criteria even if they are asymptomatic.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2474-2475). . Kindle Edition.

57
Q

List the operative criteria for regurgitant lesions (aortic and mitral regurgitations)

A

Aortic Regurgitation

  • Ejection fraction < 55%
  • Left ventricular end systolic diameter > 55 mm

Mitral Regurgitation

  • Ejection fraction < 60%
  • Left ventricular end systolic diameter > 40 mm

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2479-2487). . Kindle Edition.

58
Q

Clinical presentation of Ventricular Septal Defect (VSD)

A
  • Asymptomatic patients may present with only a holosystolic murmur at the lower left sternal border.
  • Larger defects leads to shortness of breath.
  • The murmur worsens with exhalation, squatting, and leg raise.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2489-2491). . Kindle Edition.

59
Q

Diagnostic tests for VSD

A

Echocardiography is the diagnostic test to use first, but catheterization is used to determine the degree of left-to-right shunting most precisely.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2492-2494). . Kindle Edition.

60
Q

Rx for VSD

A

Mild defects can be left without mechanical closure.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2495-2496). . Kindle Edition.

61
Q

Clinical presentation of Atrial Septal Defect

A
  • Small ASDs are asymptomatic.
  • Larger ones may lead to shortness of breath or signs of right ventricular failure, such as shortness of breath and a parasternal heave.
  • The most frequently tested knowledge is that ASD is associated with fixed splitting of S2.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2498-2500). . Kindle Edition.

62
Q

Diagnostic test for ASD

A

Echocardiogram

63
Q

Rx of ASD

A

Percutaneous or catheter devices are the best therapy. Repair is most often indicated when the shunt ratio exceeds 1.5 to 1.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2504-2505). . Kindle Edition.

64
Q

List causes of wide splitting of S2 with delayed P2

A
  • Right bundle branch block
  • Pulmonic stenosis
  • Right ventricular hypertrophy
  • Pulmonary hypertension

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2511-2519). . Kindle Edition.

65
Q

List the causes of Paradoxical splitting of S2 with delayed A2

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 2509). . Kindle Edition.

A
  • Left bundle branch block
  • Aortic stenosis
  • Left ventricular hypertrophy
  • Hypertension

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 2516-2519). . Kindle Edition.

66
Q

List cause of fixed splitting of S2

A

ASD

Cardiology USMLE Step 3 (12 decks)

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