Valvular Disorders

Question 1

Most common valvular disease in the US and second most frequent cause for cardiac surgery

Answer 1

Aortic Stenosis

Question 2

Narrows valve opening, impeding ejection function of the left side of the heart

Answer 2

Aortic Stenosis

Question 3

Results in volume overloading due to retrograde blood flow into the left ventricle

Answer 3

Aortic insufficiency / regurgitation

Question 4

Impedes blood flow between left atrium and ventricle

Answer 4

Mitral stenosis

Question 5

Allows retrograde blood flow and volume overload of left atrium

Answer 5

Mitral insufficiency / regurgitation

Mitral valve prolapse

Question 6

What does valve-related progressive heart failure lead to?

Answer 6

Pulmonary HTN and congestion

Question 7

Most frequent causes of mitral and aortic valve disorders

Answer 7

Congenital defects

Question 8

Other causes of mitral and aortic valve disorders

Answer 8

Rheumatic heart disease
Connective tissue disorders
Infection
Senile degeneration

Question 9

Most common presenting symptoms of mitral and aortic valve disorder

Answer 9

Dyspnea, fatigue, decreased exercise tolerance

Question 10

Additional symptoms of mitral and aortic valve disorders

Answer 10

Cough, rales, paroxysmal nocturnal dyspnea, hemoptysis, hoarseness

Question 11

How would aortic stenosis affect carotid pulse?

Answer 11

Thready (not enough volume being ejected)

Question 12

How would aortic insufficiency affect carotid pulse?

Answer 12

Bounding pulses, widened pulse pressures (fluid overload)

Question 13

Most patients with this disorder are thin females with minor chest wall deformities, mid systolic clicks, and late systolic murmur

Answer 13

Mitral Valve Prolapse

Question 14

Murmur location and quality of Aortic Stenosis

Answer 14

2nd RICS

Loud, harsh, midsystolic

Question 15

Murmur location and quality of Aortic Regurgitation

Answer 15

2nd-4th LICS

High-pitch blowing, Systolic (soft) and diastolic decrescendo

Question 16

Murmur location and quality of Mitral Stenosis

Answer 16

Apex (4th-5th LICS) - patient in Left Lateral Position

Low pitch, Middiastolic

Question 17

Murmur location and quality of Mitral Regurgitation

Answer 17

Apex (4-5th LICS)

Med-High pitch blowing, Pansystolic

Question 18

Treatment for Mitral / Aortic Valve disorders

Answer 18

Surgical repair / replacement only longterm treatment

Question 19

Medical treatment options for mitral / aortic valve disorders

Answer 19

1. Diuretics / vasodilators for pulmonary congestion
2. Digoxin / beta blockers for dysrhythmias
3. Anticoagulant therapy to prevent thromboemboli
4. Antibiotics to prevent endocarditis (esp for Regurge)

Question 20

Patients with congenital anomalies of these valves usually present during infancy or childhood; adults may present with stenosis resulting from rheumatic scarring or connective tissue disease

Answer 20

Tricuspid / Pulmonic Valve disorders

Question 21

Tricuspid regurgitation murmur location / quality

Answer 21

LLSB

Blowing, Pansystolic / Holosystolic

JVP often elevated

Question 22

Pulmonic stenosis murmur location / quality

Answer 22

2nd-3rd LICS

Harsh, Midsystolic crescendo-decrescendo

Question 23

Clinical features of pulmonic / tricuspid valve disorders

Answer 23

Patients usually present with exercise intolerance

Right Heart fluid overload: Jugular venous distention, peripheral edema, hepatomegaly

Question 24

Only definitive means of identifying structural / functional abnormalities in valvular disorders

Answer 24

Transesophageal Echocardiography

Cardiac catheterization as well
Doppler ultrasound for pressure gradient assessment