Valvular Disease Cases

Question 1

physical presentation aortic stenosis

Answer 1

sustained LV impulse, little LV displacement

Lulsus parvus et Tardus of carotid muscle

Absent A2 or paradoxical split A2

Mumur systolic dcrescendo at base or upper right sternum - radiates to carotids

Question 2

aortic stenosis on CXR

Answer 2

small cardiac enlargement (LVH)

post stenotic delation of ascending aorta

calcification of valve

Question 3

point of intervention for aortic stenosis

Answer 3

severe stenosis with symptoms

Question 4

causes of aortic regurgitation

Answer 4

abnormal leaflets

dilation of aortic root (anyeurism, dissection, syphilis, annuloaortic ectasia)

Question 5

acute aortic regurg results in

Answer 5

quick rise in diastolic pressure > backs up to left atrium and into pulmonary vasc > edema or pulmonary congestions

Question 6

chronic aortic regurg results in

Answer 6

volumne overload and some pressure overload of LV

ventricle dilates over time with increased compliance

reudced pressure to LA and pulmonary vasc

Question 7

aortic regurgitation clinical presentaion

Answer 7

dyspnea on exertion

fatigue

reduced exercise tol

chest pain

Question 8

physcial signs aortic regurg

Answer 8

hyperdynamic pulses

widened pulse pressure (diastolic less than half systolic)

decrcendo diastolic murmur

austin flint mumur (diastolic rumble)

Question 9

CXR aortic regurg

Answer 9

enlarge LV

(acute unlikely to show, more likely to show pulmonary vascular congestion)

Question 10

treatment acute aortic regurgitation

Answer 10

immediate surgical replacement

Question 11

chronic aortic regurg treatment

Answer 11

asymptomatic w/ normal LVEF - followup with echo, Ca channel blocker or ACE if hypertensive

asymptomatic w/ low LVEF - valve replacement

symptomatic w/ normal LVEF - valve replacement

Question 12

Acute mitral regurgitation leads to

Answer 12

normal LA size and compliance

high LA pressure

high pulmonary venous pressure

pul edema+congestion

prominent V waves on Cath

Emergency

Question 13

chronic mitral regurg leads to

Answer 13

increased LA size and compliance

normal LA and pulmonary venous pressure

lower forward Cardiac Output

LVH

posible systolic dysfunction

Question 14

auscultation Mitral valve regurg

Answer 14

holosytolic murmur at apex of heart

Question 15

treatment acute mitral regurg

Answer 15

stablize with diuertics and vasodilators

consider emergent surgery (eg, if via endocarditis)

Question 16

treatment chronic mitral regurg

Answer 16

monitor asymptomatic

repair or valve replace

little can be done if LV dysfxn

Question 17

blood supply to papilary muscles

Answer 17

posteriomedial - right coronary

anterolateral - dual supply

Question 18

most common caue mitral stenosis

Answer 18

Rheumatic fever

Question 19

clinical presentation mitral stenosis

Answer 19

dyspnea+ reduced exercise capacity

worsens with increased HR (pregnancy)

possible sings of right sided failure

possible hoarseness, hemoptysis

Question 20

physical exam findings mitral stenosis

Answer 20

early - opening snap and murmur

late - opening snap and murmur, RV lift

Question 21

treatment mitral stenosis

Answer 21

dieretics if vasc congestion

if Afib - Beta block and Ca block, also anticoag therapy

valve replacement if refractive or severe Pul HTN