VALVULAR EMERGENCIES

Question 1

Patients with normal cardiac anatomy may have systolic murmurs associated with (7)

Answer 1

anemia, 
arteriovenous fistula, 
thyrotoxicosis, 
sepsis, 
fever, 
renal failure with volume overload, 
pregnancy

Question 2

…, despite declining frequency, remains the most common cause of mitral stenosis.

Answer 2

Rheumatic heart disease

Question 3

Mitral stenosis exam

Answer 3

Mid-diastolic rumble, crescendos into S2

Loud snapping S1, apical impulse is small, and tapping due to underfilled ventricle.

Question 4

in MS, On chest radiograph… is a typical and early radiographic finding.

Answer 4

straightening of the left heart border (i.e., loss of the pulmonary window), indicating left atrial enlargement ,

Question 5

The most common causes of chronic MR are

Answer 5

1 myocardial infarction or ischemia, 
2 mitral valve prolapse (MVP) syndrome, 
3 left ventricular dilatation, 
4 rheumatic heart disease, 
5 collagen-vascular disease.

Question 6

Acute MR is typically caused by (2)

Answer 6

1 papillary muscle or chordae tendineae rupture from myocardial infarction
2 valve leaflet perforation from infective endocarditis.

Question 7

Meds that increase risk of MR

Answer 7

1 Appetite-suppressant drugs,
2 fenfluramine,
3 phentermine,
4 dexfenfluramine

Question 8

Acute MR is characterized by …,… ,…

Answer 8

severe dyspnea,
tachycardia,
pulmonary edema.

Question 9

…, …. and … place the patient in a higher risk group for complications.

Answer 9

Male sex,
age >45 years old,
the presence of regurgitation

Question 10

The classic auscultatory finding of MVP is

Answer 10

a mid-systolic click

Question 11

The classic triad of aortic stenosis is

Answer 11

dyspnea, chest pain, and syncope.

Question 12

Classic physical examination findings in aortic stenosis are

Answer 12

1 a late peaking systolic murmur at the right second
2 intercostal space, radiating to the carotids,
3 a single or paradoxically split S2,
4 an S4gallop,
5 a diminished carotid pulse with a delayed upstroke (pulsus parvus et tardus)
6 Brachioradial delay

Question 13

Critical AS is valve area

Answer 13

0.7

Question 14

(5) cause most chronic cases of AR.

Answer 14

Calcific degeneration,
congenital disease (most commonly bicuspid valves), systemic hypertension,
myxomatous degeneration,
rheumatic heart disease

Question 15

(5) are less frequent causes of the AR.

Answer 15

Marfan syndrome, 
syphilis, 
ankylosing spondylitis, 
Ehlers-Danlos syndrome, 
Reiter syndrome

Question 16

The most common causes of acute AR are (3)

Answer 16

infective endocarditis,
aortic dissection at the aortic root,
blunt chest trauma.

Question 17

Acute AR Rx

Answer 17

Surgery

Question 18

…. is often the first symptom in patients with right-sided valvular disease associated with pulmonary hypertension.

Answer 18

Exertional dyspnea

Question 19

… and … are common complications of prosthetic heart valves.

Answer 19

Bleeding

systemic thromboembolism

Question 20

Embolic risk is increased during …. and is more common in … than …. valve replacement.

Answer 20

the first 3 postoperative months
mitral
aortic

Question 21

Infections occur most frequently during … after valve replacement surgery.

Answer 21

the first 2 months

Question 22

The most common organism during the initial postoperative period of valve replacement is … followed by …..
…. organisms and… are also frequent causes of early endocarditis.

Answer 22

S. epidermidis
S. aureus

Gram-negative
fungi

Question 23

Patients with prosthetic valve endocarditis may develop a …,…., or …., which requires valve replacement.

Answer 23

valve ring abscess
fistula
paravalvular leak

Question 24

Mechanical mitral valves require an INR of …., whereas bileaflet mechanical valves in the aortic position require an INR of …

Answer 24

2. 5 to 3.5

2. 0 to 3.0.

Question 25

….is recommended for all patients with prosthetic valves, mechanical or bioprosthetic.

Answer 25

Aspirin