Valvular Heart Disease

Question 1

etiology of mitral stenosis

Answer 1

rheumatic with the exception of rare congenital forms

Question 2

symptoms of mitral stenosis

Answer 2

dyspnea from pulmonary congestion

fatigue from low output

Question 3

describe the hemodynamics of mitral stenosis

Answer 3

increased atrial pressures

presence of a murmur

as the pressure increases over time, the opening snap occurs earlier and earlier

Question 4

physical findings of mitral stenosis

Answer 4

normal to decreased LV impulse

increased RV impulse

loud first heart sound

opening snap in early systole

diastolic rumble with presystolic accentuation

signs of pulmonary hypertension

Question 5

the effect of mitral balloon valvotomy on mitral stenosis

Answer 5

decreases left atrial pressures

restores pressures during diastole and systole

not complete recovery

Question 6

treatment of mitral stenosis

Answer 6

diruetics to reduce pulmonary venous congestion

beta blockers to prevent tachycardia

digoxin and/or beta blockers in patients with afib to control ventricular rate

anticoagulants to prevent emboli

percutaneous balloon mitral valvotomy (PBMV)

surgical mitral valve commissurotomy

surgical mitral valve replacement

Question 7

aortic stenosis pathophysiology

Answer 7

obstruction to LV outflow

leads to LV hypertrophy

elevated LV diastolic pressures

pulmonary congestion

LV systolic dysfunction

MI

low CO

Question 8

etiology of AS

Answer 8

conegnital

degenerative (calcific)

rheumatic

Question 9

symptoms of AS

Answer 9

dyspnea

angina

presyncope and syncope

Question 10

physical findings of AS

Answer 10

sustained LV impulse

systolic thrill

delayed carotid upstroke

soft second heart sound, often with paradoxic splitting

midsystolic outflow murmur

apical fourth heart sound

Question 11

treatment of AS

Answer 11

no medical treatment

when symptoms develop, surgery is essential

transcatheter aortic valve implantation

Question 12

describe the hemodynamics of aortic stenosis

Answer 12

Louder, then softer - decrescendo murmur

The carotid arteries are also delayed

Emptying of the ventricle into the aorta is delayed

Murmur and delay in upstroke are key findings

Question 13

paradoxic splitting

Answer 13

splitting during expiration in patients with aortic stenosis because it takes longer for the valve to close

Question 14

benefits of aortic valve replacement

Answer 14

improve symptoms

improves LV function

improves survival

no evidence that replacement improves outcomes in asymptomatic patients