Valvular Disease

Question 1

Gradient (what it is and equation)

Answer 1

Pressure difference formed from obstructed valve, = 4 x velocity^2

Question 2

4 Systolic Murmurs

Answer 2

Aortic stenosis
Mitral insufficiency
Mitral valve prolapse
Tricuspid insufficiency

Question 3

2 Diastolic Murmurs

Answer 3

Aortic insufficiency

Mitral stenosis

Question 4

General Management of Valve Disease

Answer 4

Most are chronic/progress slowly and have very serious surgeries, so wait and follow for awhile to see if it worsens. If surgery considered, it can be helpful as long as done before vents are seriously damaged

Question 5

Aortic Stenosis Development

Answer 5

Calcifications from artherosclerotic process (LDL deposits and mac consumption) buildup on valve, more common w/ bicuspid (and earlier)

Question 6

Aortic Stenosis Auscultory Sounds (Mild, Moderate, Severe, and 1 other)

Answer 6

Slow rising carotid pulse
Mild - EJ right after S1, systolic murmur
Moderate - lose EJ, late peak in murmur, smaller A2
Severe - lose A2

Question 7

Classification of Treatment Determination

Answer 7

I - Should be performed/administered
IIa - It is reasonable
IIb - may be considered
III - shouldn’t be done

Question 8

2 AS Non-surgical Treatments

Answer 8

Maybe statins

TAVI: Trans-Catheter Aortic Valve Implant

Question 9

2 Aortic Regurg Etiologies

Answer 9

Abnormal valve leaflets

Dilated aortic root (like from Marfan’s)

Question 10

AR Pressure Effect

Answer 10

Very wide pulse pressure (high systolic and low diastolic), so lots of pulsing/rhythmic signs like Quincke’s sign (capillary pulsation at nail beds)

Question 11

Austin-Flint Murmur

Answer 11

Mid-diastolic AR jet directed at anterior mitral leaflet in severe AR

Question 12

AR Angina

Answer 12

More nocturnal than exertional, bc decreased diastolic aortic pressure and increased LVEDP decrease coronary a. diastolic flow

Question 13

AR Medical Therapy

Answer 13

Anti-HTN and vasodilators like nifedipine or ACE inhibitors or something

Question 14

Chronic vs. Acute AR (BP, murmur, ECG, mitral closure)

Answer 14

Highsystolic/wide pulse vs. low
Long blowing diastolic vs. short diastolic
LVH vs. ST T abnormality
Normal mitral closure vs. Mitral preclosure before systole

Question 15

Mitral Stenosis Ascultation

Answer 15

S1 accentuated and snapping, opening sound (OS) after aortic valve closure (S2), and diastolic rumble

Question 16

Mitral Stenosis Complications

Answer 16

Can get pulmonary edema/heart failure w/ exercise, pregnancy, or Afib (which is commonly developed) as blood backs up in LA

Question 17

4 Treatments for MS

Answer 17

Treat arrhythmia/anti-coag for Afib
Rheumatic Fever Prophylaxis
If serious:
Valvuloplasty w/ percutaneous balloon
Valve replacement if valvuloplasty not possible

Question 18

4 Causes of Mitral Regurg

Answer 18

I - Normal leaflet motion: dilated annuls (dilated LA maybe?) or perforation
II - Increased leaflet motion - mitral prolapse, papillary or chordae fuck-ups
IIIa - Restricted opening and closure - fibrosis/calcified leaflets or chordae thickening
IIIb - Restricted closure - Leaflet tehtering

Question 19

Chronic MR Palpation/Auscultation

Answer 19

Holoysystolic murmur loudest at apex, w/ laterall displaced PMI and S3 gallop

Question 20

MR Intervention

Answer 20

Mitral valve clip

Question 21

Mitral Valve Prolapse

Answer 21

Flails into LA in systole, either from myxomatous degeneration of leaflets and chordae or maybe some fibroelastic deficiency

Question 22

MVP Auscultation

Answer 22

Midsystolic click w/ late systolic murmur (earlier and louder w/ small LV)

Question 23

Most Common Outcome of MVP

Answer 23

Benign course

Question 24

Biovalves

Answer 24

Less durable, but don’t require anticoagulants so might want for shitty patients you know won’t take their meds or young women who want babies later