Valvular Disorders

Question 1

Which valves does rheumatic fever most often affect?

Answer 1

mitral

aortic

Question 2

Pathology of rheumatic fever

Answer 2

2-3 weeks post strep pharyngitis

M-protein of strep normally resists endocytosis

antibodies made to M-protein

antibodies cross-react with meromycin in endocardium

type II hypersensitivity

Question 3

Acute rheumatic fever presentation

Answer 3

migratory polyarthritis: swelling and pain in a large joint, usually resolves w/i days and moves to other joints

subcutaneous nodules

erythema mirginatum: annular, nonpruritic rash with erythematous borders involving trunk and limbs

sydenham chorea (rapid, involuntary muscle movements)

Question 4

Pathology of chronic rheumatic heart disease

Answer 4

repeated episodes of acute rheumatic fever

causes scarring on valve (mitral > aortic)

valvular stenosis

Question 5

Common complication of chronic rheumatic heart disease

Answer 5

endocarditis

Question 6

Asymptomatic aortic stenosis

on auscultation

Answer 6

systolic ejection click

then crescendo-decrescendo murmur

Question 7

Anemia in aortic stenosis

Answer 7

macroangiopathic hemolytic anemia

Question 8

Aortic regurgitation

murmur

Answer 8

early, blowing diastolic murmur

Question 9

Aortic regurgitation

affect on BP

Answer 9

elevated systolic

(to get blood out)

depressed diastolic

(becase it flows back in diastole)

therefore: increased pulse pressure

Question 10

Aortic regurgitation

physical exam finding

Answer 10

bounding pulses

due to increased pulse pressure

Question 11

Murmur in mitral valve prolapse

Answer 11

mid-systolic click followed by regurgitation murmur

Question 12

Mitral valve prolapse

etiology

Answer 12

ballooning of mitral valve into atrium during systole

Question 13

Mitral regurgitation

etiology

Answer 13

usually complication of mitral valve prolapse

Question 14

Mitral valve regurgitation

murmur

Answer 14

holosystolic “blowing” murmur

louder with increased afterload

louder with expiration (increased venous return)

Question 15

Mitral stenosis

etiology

Answer 15

usually chronic rheumatic valve disease

Question 16

Mitral stenosis

murmur

Answer 16

opening snap followed by diastolic rumble

Question 17

Complication of mitral stenosis

Answer 17

pulmonary congestion w/ edema and alveolar hemorrhage

pulmonary HTN and eventual right-sided heart failure

a-fib w/ associated risk for mural thrombi