Valve Disease II

Question 1

Causes of Mitral Regurgitation?

Answer 1

Rheumatic
Dystrophic/Degenerative
Ischemic/MI
Infective Endocarditis
Connective Tissue Diseases
Prolapse
Myxomatous/Barlows Disease
Trauma

Question 2

Auscultory findings in mitral regurgitation

Answer 2

Loud pansystolic murmur transmitted to axilla

Question 3

Effects of Mitral Regurg on the body

Answer 3

Increase LA, Pulmonary vein pressure

Fatigue, Dyspnea, Decreased exercise tolerance, Palpitations

Question 4

Respiratory Symptom associated with acute MR

Answer 4

Flash edema from increase in the pressure without time to accomodate it

Question 5

Mitral regurgitation CXR findings?

Answer 5

Enlarged LA and eventually LV

Various degrees of pulmonary congestion

Question 6

Mitral regurgitation treatment?

Answer 6

Observe in mild cases, watch for thrombus
Medical treatment – diuresis, rhythm control/anticoag
Surgical - MV repair, replacement is you have to

Question 7

Drug mentioned to help control heart rhythm?

Answer 7

Amnioderone

Question 8

What heart structures are preserved in MV replacement?

Answer 8

Posterior leaflet chords (to preserve LV geometry and function)

Question 9

Causes of aortic stenosis

Answer 9

Degenerative/Calcific (Most common)
Congenital (Bicuspid most common, earlier age)
Rheumatic

Question 10

Concern with calcific aortic stenosis?

Answer 10

May affect the conduction system if Ca extends to the conduction system

Question 11

Pathology of Aortic Stenosis

Answer 11

Increased afterload with impaired LV emptying in systole
Concentric LV hypertrophy, diminishing compliance
Atrial systole becomes more and more important
LV hypertrophy can eventually cause LV failure
Hypertrophy increases blood requirements for ventricle

Question 12

Classic symptoms of aortic stenosis

Answer 12

Angina, Syncope, CHF

Question 13

Most common fatal valve lesion

Answer 13

AS

Question 14

Most untreated AS patients will die of…

Answer 14

CHF

Question 15

Physical findings of aortic stenosis?

Answer 15

Systolic ejection murmur in the 2nd ICS

Radiated to the carotids

Question 16

EKG findings with aortic stenosis

Answer 16

LVH

May have IVC delays like R and L BBB, AV nodal block, atrial fib

Question 17

CXR findings with aortic stenosis?

Answer 17

Calcification of the aortic valve/aorta
LVH
Post stenotic aorta enlargement

Question 18

Echo measurement done in aortia stenosis

Answer 18

measure AVA (0.8 or less is severe)

Question 19

Medical therapy for aortic stenosis?

Answer 19

Control hypertension (be careful with diuretics)
Control arrythmias

Question 20

What to do for a high risk patient who needs replacement but is too high risk

Answer 20

Transcatheter Aortic Valve Replacement

Question 21

Causes of aortic regurgitation?

Answer 21

Calcific AV disease, Congenital, Rheumatic
Endocarditis, aortic dissection,
Annuloaortic ectasia, RA, VSD, Myxoma

Question 22

What is annuloaortic ectasia?

Answer 22

abnormal dilation of the annulous and aortic root

Associated with Marfans

Question 23

Changes of the heart in aortic regurgitation?

Answer 23

Eccentric hypertrophy of the LV
(Increased chamber size AND increased wall thickness)
Can cause massive dilation of LV - Cor Bovinum

Question 24

Symptoms associated with aortic regurgitation?

Answer 24

Dyspnea, Orthopnea, PND, Angina

Rarely – Syncope

Question 25

Describe an aortic regurg murmur

Answer 25

Diastolic blowing murmur
Austin Flint Murmur – Regurgitant jet hits the anterior leaflet of MV, closes the anterior valve and moves murmur to apex

Question 26

Aortic Regurgitation CXR findings

Answer 26

LV enlargement
enlarged Ascending Aorta
Pulmonary Edema
Increased LA

Question 27

EKG findings in Aortic Regurgitation?

Answer 27

LVH

Question 28

Echo findings in Aortic Regurgitation?

Answer 28

Regurgitant jet

Question 29

Surgical procedure typically recommended for aortic regurg?

Answer 29

Valve replacement

May have to replace ascending aorta depending on etiology

Question 30

What should lead you to recommend a bioprosthetic valve?

Answer 30

Women of child bearing age
Non-compliant patients
Older patients
People who can’t take blood thinners

Question 31

When should you recommend a mechanical valve?

Answer 31

Younger patients