Valvular Diseases

Question 1

What is the most common cause for Tricuspid Stenosis?

Answer 1

Rheumatic Disease

- w/ or w/o coexistent tricuspid regurgitation

Question 2

How should Tricuspid Stenosis be treated?

Answer 2

• Medical management of HF (Digoxin, Diuretics, ACEI, & Anticoagulants)
• Valvotomy or balloon valvuloplasty (less calcification than the other valvular diseases)

Question 3

What condition is most common w/ systemic venous congestion (prominent a-waves in jugular veins), dyspnea, fatigue, abdominal discomfort, and liver dysfunction?

Answer 3

Tricuspid Stenosis

- > 2mmHg or greater gradient

Question 4

Tricuspid Stenosis Pathophysiology

Answer 4

• reduced tricuspid orifice size (inadequate filling of RV during diastolic)
• ^ pressure gradient across valve
• often presents w/ atrial shunt & cyanosis

Question 5

Tricuspid Regurgitation Pathophysiology

Answer 5

• incomplete closure of valve during RV systole (blood flows back to RA)
• primary (abnormal morphology) or secondary (normal valve morphology)

Question 6

Tricuspid Regurgitation Tx

Answer 6

• treat underlying HF (Digoxin, Diuretics, ACEI, & Anticoagulants) or antiarrhythmics for a-fib
• rarely need surgery (50-60% of asymptomatic young adults exhibit)
• lifestyle changes (Na reduction, raise HOB)

Question 7

Which valve condition is most likely seen w/ fatigue, dyspnea, LE edema, Holostolic murmur, and maybe early satiety & abd distension?

Answer 7

Tricuspid Regurgitation

Question 8

What disorders can lead to mitral valve prolapse?

Answer 8

• Marfan Syndrome
• Ehlers-Danos syndrome
• Graves disease
• Muscular dystrophy
• Ebstein’s anamoly
• Scoliosis
• Rheumatic heart diseaes

Question 9

Characteristics of chest pain associated with mitral valve prolapse?

Answer 9

Atypical or nonanginal chestpain (sharp, jabbing, burning or pressure)

Question 10

How do you diagnose MVP?

Answer 10

• ascultate the heart
• echocardiograph
• angiography

Question 11

What does MVP sound like on ascultation?

Answer 11

Nonejection click, with a mid-to-late systolic murmur heard at the apex

Question 12

How do you treat MVP complicated by palpitations, arrhythmia’s and/or chest pains?

Answer 12

Beta blockers

Question 13

MVP is the most common cause of

Answer 13

Mitral regurgitation

Question 14

What are the three main causes of Aortic Stenosis?

Answer 14

Idiopathic calcification of aortic valve, congenital bicuspid aortic valve, Rheumatic disease

Question 15

What is the classic sign usually heard during physical examination that suggest Aortic Stenosis? What are the other s/s?

Answer 15

Systolic ejection murmur with radiation to the neck heard at the second intercostal space on the right sternal border. Angina, syncope, and heart failure

Question 16

What is the only effective treatment for symptomatic Aortic Stenosis?

Answer 16

Aortic Valve Replacement

Question 17

What is the recommended treatment of asymptomatic patients with Aortic Stenosis?

Answer 17

Close follow-up, no treatment is recommended

Question 18

What class of drugs should be avoided in patients with Aortic Stenosis?

Answer 18

vasodilators→ vasodilation reduces pressure distal to the obstruction without increasing cardiac output and may cause syncope.