Valve Disorders

Question 1

X

Answer 1

C

Question 2

X

Answer 2

X

Question 3

X

Answer 3

C

Question 4

X

Answer 4

C

Question 5

X

Answer 5

C

Question 6

X

Answer 6

C

Question 7

What are the clinical features of aortic valve regurgitation

Answer 7

Corigan pulse in the carotid due to the wide pulse pressure - high systolic low diastolic
In capillaries - de quicken sign
De musset sign - head nodding with the pulse

Question 8

What are the heart sounds heart in aortic regurgitation ?

Answer 8

Early diastolic decrescendo murmur - worsens with hand grip and squatting as more blood goes back through the valve
S3

The early diastolic decrescendo murmur can progress into Austin flint murmur which is harsh crescendo decrescendo mid systolic murmur - representing aortic stenosis ( this is blood rushing back and hitting the mitral valve )

Question 9

X

Answer 9

X

Question 10

X

Answer 10

C

Question 11

X

Answer 11

X

Question 12

X

Answer 12

X

Question 13

Cause of aortic stenosis in more than 65

Answer 13

degenerative calcification (most common cause in older patients > 65 years)

post-rheumatic disease

Question 14

Causes of aortic stenosis
In less than 65

Answer 14

bicuspid aortic valve (most common cause in younger patients < 65 years) = Turner syndrome

Suprvalvular - william’s syndrome
( elfin-like facies
characteristic like affect - very friendly and social
learning difficulties
short stature)

Haydes Syndrome -
angiodysplasia angiodysplasia is a small vascular malformation of the gut. It is a common cause of otherwise unexplained gastrointestinal bleeding and anemia
Aortic stenosis
CKD

subvalvular: HOCM

Question 15

What are the clinical features of aortic stenosis

Answer 15

Pulsus tardus et parvus - late and small pulse
Systolic thrill at the bifurcation of the carotid arteries

Question 16

What are the auscultation signs of aortic stenosis

Answer 16

Systolic ejection click
Systolic ejection murmur - harsh crescendo decrescendo murmur
The murmur propagates to the carotid arteries

Manuevers such as valsalva which increases pre load does not change or increase the murmur unlike hypertrophic cardiomyopathy that increases the murmur

SOFT S2 - AS AORTIC VALVE DOES NOT CLOSE PROPERLY - IN SEVERE CASES

Question 17

Severity of aortic stenosis is by ?

Answer 17

S4

Question 18

On other physical examinations what are the signs of aortic stenosis ?

Answer 18

Narrow pulse pressure

Question 19

Mx of aortic stenosis

Answer 19

If symptomatic valve replacement
Surgical AVR- young , reduce risk of bleeding ,
Transcutaneous AVR - high operative risk

Valvular gradient over 40mg - surgery

Question 20

When is aortic balloon valvuloplasty done ?

Answer 20

Children with no aortic valve calcification
Adults - critical condition - not fit for valve replacement.

Question 21

X

Answer 21

X

Question 22

etiology of mitral valve stenosis ?

Answer 22

rheumatic fever!

Question 23

What are the clinical features of mitral valve stenosis

Answer 23

hemoptysis -pink frothy sputum to sudden haemorrhage

dyspnea - pulmonary venous hypertension

MALAR FLUSH

ATRIAL FIBRILLATION
SECONDARY TO ↑ LEFT ATRIAL PRESSURE → LEFT ATRIAL ENLARGEMENT

Severe - hepatomegaly

LOW VOLUME PULSE

Question 24

What are the auscultation features in mitral stenosis ?

Answer 24

Mild
Preceding S1 pre systolic murmur or rumble
Early diastolic opening snap
Mid diastolic murmur - heard best in expiration

Moderate
Loud S1
Now loud P2
Early diastolic snap , mid diastolic murmur however the gap has decreased

Severe
Pandiastolic or no murmur at all
S1 can be loud or quiet
P2 can increase

Question 25

X

Answer 25

X

Question 26

X

Answer 26

X

Question 27

X

Answer 27

X

Question 28

X

Answer 28

C

Question 29

C

Answer 29

D

Question 30

Treatment of mitral valve stenosis ?

Answer 30

narrow pulse pressure
resistant cardiac failure
= percutaneous mitral valvotomy

Percutaneous mitral only indicated where :
PERCUTENAOUS MITRAL VALVULOTOMY IS CONTRA
SEVERE HF

surgical replacement if the above unsuccessful

Question 31

contra of percutaneous mitral valvotomy ?

Answer 31

mitral valve are of more than 1.5cm2

presence of left atrial thrombus

greater than mild mitral regurgitation

severe valve calcification

concomitant valve disease of the same side

concomitant coronary artery disease

Question 32

x

Answer 32

x

Question 33

What are the osculatory manifestations of mitral regurgitation?

Answer 33

Acute cases - soft systolic decrescendo murmur

Chronic cases quiet s1
Pansystolic murmur radiating to left axilla
S3

Question 34

Mx for for mitral regurgitation or prolapse.

Answer 34

Mitral valve repair

Question 35

x

Question 36

x

Question 37

valve replacement with warfarin INR target ?

Answer 37

aortic - 3
mitral - 3.5

Question 38

Valve replacement anticoagulation

Answer 38

Prosthetic heart valves - antithrombotic therapy:

bioprosthetic: warfarin in the begining then aspirin long term

mechanical: warfarin + aspirin

Question 39

x

Question 40

x

Question 41

ostium secundum on ECG ? ((70% of ASDs)

Answer 41

RBBB with RAD

Question 42

Ostium primum on ECG

Answer 42

RBBB with LAD, prolonged PR interval