Valvular Emergencies

Question 1

Initial management for acute mitral regurgitation

Answer 1

Airway: O2/PPV for RF

Question 2

TOC for acute MR

Answer 2

Emergency Surgery

Question 3

management in patients with chronic MR presenting with acute symptoms, AF in RVR

Answer 3

rate control: BB/CCB
avoid embolization with anticoagulation

Question 4

Patient came in due to syncope. During history taking, noted with decreased exercise tolerance and dyspnea. Patient also complains of occasional chest pain. Physical examination revealed systolic murmur at R 2nd ICS. ECG and CXR revealed LVH.

Diagnosis

Answer 4

Aortic Stenosis

Dyspnea - > Chest Pain -> syncope

Question 5

high pitched blowing diastolic murmur heard immediately after S2 in the LUSB 2nd ics

Answer 5

Aortic Regurgitation

Question 6

1. Austin flint murmur
2. Corrigan pulse
3. Duroziez sign
4. Quinke sign
5. de Musset sign

match
A. Capillary pulsation visible at the he proximal nail bed while pressure is applied at the tip
B.a “to-and-fro” femoral murmur
C. The classic “water hammer pulse”
D. Mid-diastolic rumble best heart in left lateral decubitus
E. pulsatile head bobbing

Answer 6

1. D. In the left lateral decubitus position, listen for a mid-diastolic rumble
   2.. C. The classic “water hammer pulse” (Corrigan pulse) is a peripheral pulse with a quick rise in upstroke due to increased stroke volume followed by collapse from a rapid fall in diastolic pressure.
2. B. Duroziez sign (a “to-and-fro” femoral murmur)
3. A. Quincke sign (capillary pulsations visible at the proximal nail bed while pressure is applied at the tip).
4. E. de Musset sign (pulsatile head bobbing)

Question 7

INR goal for
1. mechanical mitral valve
2. Bileaflet mechanical valves in aortic positon

Answer 7

1. 2.5 - 3.5
2. 2.0 - 3.0

Question 8

True/False: Emboli are more common from mitral rather from aortic valves

Answer 8

True

Question 9

True/Fales: Patient on anticoagulation presenting with severe bleeding complications are best treated with Vitamin K

Answer 9

Patients with severe bleeding complications are best treated with fresh frozen plasma or prothrombin complex concentrate.3 Avoid parenteral, high-dose vitamin K due to the risk of overcorrection.

Question 10

Management of patients with an INR of 5-10 without bleeding

Answer 10

Withold Warfarin