Valvular Disorders

Question 1

most common right-sided valve disease in the adult

Answer 1

Annular dilation

Question 2

Tricuspid Regurgitation Physical Exam

Answer 2

Right sided failure
Abnormal pulse in jugular vein
High pitched systolic murmur
EKG: Rt Atrial Enlargement

Question 3

Tricuspid Stenosis

Answer 3

Most commonly rheumatic
right atrial pressure increases, venous congestion leads to distention of jugular veins, edema, hepatomegaly, ascites, pleural effusion, peripheral edema
right atrial wall thickens and chamber dilates
Systolic murmur at LLSB, tall P waves, RAE on EKG

Question 4

Medical Management for Ebsteins Anomaly

Answer 4

Fluid Restriction
Diuretics
Treat the complications (for example: rhythm disturbances)

Question 5

Mitral Stenosis: Etiology

Answer 5

Primarily a result of rheumatic fever
Congenital
Two-thirds of all patients with MS are female

Question 6

Mitral Stenosis:Pathophysiology

Answer 6

Normal valve area:  4-6 cm2
Mild mitral stenosis: 
MVA 1.5-2.5 cm2, Minimal symptoms
Mod mitral stenosis:
MVA 1.0-1.5 cm2  usually does not produce symptoms at rest
Severe mitral stenosis:
MVA < 1.0 cm2

Question 7

Mitral Stenosis: EKG

Answer 7

LAE
RVH
PVC’s
Atrial flutter and/or fibrillation

Question 8

Morphological Patterns of RVD and MVP

Answer 8

RVD-annular dilatation and leaflet thickening

MVP-leaflet redundancy and thickening

Question 9

Systolic Murmurs

Answer 9

Aortic stenosis
Mitral insufficiency
Mitral valve prolapse
Tricuspid insufficiency

Question 10

Diastolic Murmurs

Answer 10

Aortic insufficiency

Mitral stenosis

Question 11

“Cardinal” symptoms of severe aortic stenosis

Answer 11

Dyspnea
Angina
Syncope

Question 12

Key Physical Findings in SevereAortic Stenosis

Answer 12

Carotids: may hear transmitted murmur (bruits)
Heart: Systolic Ejection Murmur
Lungs: Rales (Failure)
Extremities: Cold and decreased pulses
EKG: LVH with repolarization changes
Chest X-Ray: Aortic root dilation and failure