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IM > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

S1 Intensity increase in (2)

A

Early stages of rheumatic MS

Hyperkinetic States

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2
Q

S1 becomes SOFTER in (2)

A

Late stages of MS

Contractile Dysfunction

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3
Q

A2-P2 Interval unusually narrow

A

Pulmonary Hypertension

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4
Q

A2-P2 Interval widened

A

Severe MR

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5
Q

Fixed Splitting A2-P2 interval

A

ASD

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6
Q

Reverse or Paradoxical Splitting of A2-P2 interval

A

Severe AS, HOCM, MI

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7
Q

A2-P2 Interval INCREASES during

A

INSPIRATION

narrows with expiration

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8
Q

Opening Snap

A

Mitral Stenosis

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9
Q

Tumor plop

A

Atrial Myxoma

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10
Q

Pericardial Knock

A

Constrictive Pericarditis

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11
Q

Crescendo Mid-systolic Murmur

A

Aortic Stenosis

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12
Q

Holosystolic Murmur

A

Mitral/Tricuspid Regurgitation

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13
Q

Murmur of VSD

A

Holosystolic murmur at Left Lower Sternal Border (Tricuspid)

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14
Q

Murmur of ASD

A

Systolic Ejection Murmur at 2nd ICS Left of Sternum (Pulmonic)

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15
Q

All other murmurs diminishes with standing and valsalva maneuver except?

A

HOCM, MVP

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16
Q

All other murmurs are louder when squatting except?

A

HOCM, MVP

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17
Q

70/M with chest pain on exertion, SOB for 2 months. 1 episode of syncope. 3/6 midsystolic murmur at the 2nd ICS right sternal border. With weak and delayed pulse.

DIAGNOSIS?

A

Aortic Stenosis

18
Q

Cardinal Symptoms of AS

A

SYNCOPE
ANGINA
DYSPNEA

19
Q

Best initial test for AS/AR

A

Transthoracic Echocardiogram

20
Q

Treatment of choice for AS

A

AV valve replacement surgery

21
Q

3 Principal Causes of AS

A

1 Congenital Bicuspid Valve with superimposed calcification
2 Calcification of normal trileaflet valve
3 Rheumatic Disease

22
Q

Term for murmur transmitted downward confusing AS with MR

A

Galliverdin Effect

23
Q

Average rate of hemodynamic progression in AS

A

decrease in aortic valve area of 0.12cm2/yr

24
Q

62/M with HTN complains of fatigue and SOB. With high pitched, blowing, diastolic murmur on the left sternal border and widened pulse pressure. With murmur heard on femoral artery. DIAGNOSIS?

A

Aortic Regurgitation

25
Q

Murmur heard over femoral artery is known as

A

DUROZIEZ SIGN

26
Q

Etiology AR

A

Primary Valve disease and/or aortic root disease

27
Q

Rumbling sound heard in severe AR

A

Austin Flint murmur

28
Q

Jarring of the entire body and bobbing motion of the head in AR

A

De Musset Sign

29
Q

Bounding ans forceful pulse, rapidly increasing and subsequently collapsing in AR

A

Water-Hammer or Corrigan’s pulse

30
Q

Capillary pulsation at the root of the nail

A

Quincke’s pulse

31
Q

Booming “pistol shot” sound over femoral arteries

A

Traube sign

32
Q

Management for Acute AR

A

Diuretics, Vasodilators
Surgery within 24hrs

NO TO X BETA BLOCKERS

33
Q

Management for Chronic AR

A

ACEi or ARBs
Diuretics
DHP CCB/BB
Surgery

34
Q

30/F with hx of rheumatic fever presents with dyspnea and palpitation. Opening Snap heard followed by low pitched, tumbling, diastolic murmur at apex. DIAGNOSIS?

A

MITRAL STENOSIS

35
Q

Most common cause of MS

A

Rheumatic Fever

36
Q

Earliest CXR finding in MS

A

straightening of the upper left border of the cardiac silhoutte

37
Q

Treatment of choic for MS

A

Percutaneous Transmitral Commissurotomy

38
Q

Hemodynamic hallmark of MS

A

Abnormally elevated AV pressure gradient on 2D Echo or hemodynamic studies

39
Q

2D Echo showed symmetric fusion of commissures, resulting in DOMING of leaflets in diastole (Hockey Stick Sign)

DIAGNOSIS?

A

MS

40
Q

Normal Mitral valvular area

A

4 - 6 cm2

Mitral Stenosis
Mild - >1.5cm
Moderate - 1-1.5cm
Severe - <1.5cm

41
Q

MS management

A

Diuretics for pulmonary congestion
Slow down HR - BB, Digoxin, NDHP CCB
Warfarin if with AF
Percutaneous Mitral Balloon valvotomy (most effective tx)
Valve replacement surgery
Penicillin prophylaxis for Group A B-hemolytic strep (rheumatic fever)

IM (9 decks)

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