Valvular disorders

Question 1

Aortic stenosis- Eti

Answer 1

• Middle age: congenital bicuspid
• Elderly- valvular calcification
• Men, smokers, HTN, Hyperlipid.

Question 2

Aortic stenosis-Sx

Answer 2

• Delayed, diminished carotid pulse
• Syncope, angina, CHF,
• LV failure with exertion

Question 3

Aortic stenosis- Murmur

Answer 3

• Diamond shape, crescendo- decrescendo
• Loudest in aortic area
• Systolic murmur- between S1 & S2, closer to S2 as disease progresses

Question 4

Aortic stenosis- Dx

Answer 4

• Echo- increased mmHg, aortic valve area

- Cadiac catheritization

Question 5

Aortic stenosis- Tx

Answer 5

• Valve replacement in symptomatic individuals

Question 6

Mitral stenosis- Eti

Answer 6

• F>M
• 40s-50s
• Underlaying rheumatic heart disease +/- rheumatic fever

Question 7

Mitral stenosis- Sx

Answer 7

• Opening snap following A2
• Exertional dyspnea, fatigue, tachy
• Pulm congestion, orthopnea, paroxysmal nocturnal dyspnea, A-fib

Question 8

Mitral stenosis- Murmur

Answer 8

• Opening snap after aortic valve closure
• Low pitch diastolic rumble at apex
• Presystolic murmur

Question 9

Mitral stenosis- Dx

Answer 9

• ECG: A-fib

- Echo: mitral leaflet

Question 10

Mitral stenosis- Tx

Answer 10

• A-fib: digoxin, beta blockers

- Anticoagulation

Question 11

Aortic Regurgitation -Eti

Answer 11

Many diseases which render aortic leaflet incompetent

- Rheumatic, HTN, syphillis, Marfan, endocarditis

Question 12

Aortic Regurgitation- Sx

Answer 12

• Wide pulse pressure
• Prominant carotid pulse
• Head bobbing
• Pistol shot sounds over femoral arteries
• Nail bed pulsations
• Water hammer pulse
• Retinal pulsations
• Femoral systolic > brachial

Question 13

Aortic Regurgitation- Murmur

Answer 13

High pitched, blowing, early diastolic decrescendo at left sternal border in expiration

Question 14

Aortic Regurgitation- Dx

Answer 14

Echo

Question 15

Aortic Regurgitation- Tx

Answer 15

• Nifedapine
• Beta blockers
• Surgery

Question 16

Mitral Regurgitation- Eti

Answer 16

• Mitral valve prolapse

- Endocarditis, MI, mitral enlargement

Question 17

Mitral Regurgitation- Sx

Answer 17

• Pansystolic murmur- radiates to axillae
• pulmonary edema
• Hemopytsis
• exertional dyspnea, fatigue

Question 18

Mitral Regurgitation- Murmur

Answer 18

Apical holocystolic with radiation to axillae- no gap, crested

• S3 = severe
• Increases with expiration, squatting, hand grip

Question 19

Mitral Regurgitation- Dx

Answer 19

ECG: LV hypertrophy
CXR: Atrial enlargement
Echo- L A & V involvement

Question 20

Mitral Regurgitation- Tx

Answer 20

• Restrict phys. activ.

- Surgical replacement

Question 21

Mitral Valve Prolapse- Eti

Answer 21

• Thin, females with chest wall deformities

- Common

Question 22

Mitral Valve Prolapse- Sx

Answer 22

• Chest pain- doesn’t resemble angina

- Arrythmias- syncope, palpations

Question 23

Mitral Valve Prolapse- Murmur

Answer 23

• Mid to late systolic click

- May be followed by whooping or honking

Question 24

Mitral Valve Prolapse- Dx

Answer 24

Clinical- confirmed by echo

Question 25

Mitral Valve Prolapse- Tx

Answer 25

• Beta blockers

- MV repair

Question 26

Tricuspid Regurgitation- Eti

Answer 26

• Pressure/ volume overload on RV

-

Question 27

Tricuspid Regurgitation- Sx

Answer 27

• Right sided failure
• High JVP
• Ascites
• Edema

Question 28

Tricuspid Regurgitation- Dx

Answer 28

• Echo and clinical findings

Question 29

Tricuspid Regurgitation- Murmur

Answer 29

• Holosystolic, increases with inspiration

- Left lower sternal border

Question 30

Tricuspid Regurgitation- Tx

Answer 30

• Underlying cause

- Diuretics