Valvular Heart Disease

Question 1

what vasoactive substances are secreted in carcinoid syndrome?

Answer 1

serotonin and kallikiren

Question 2

what does kallikiren cause?

Answer 2

flushing of the skin

Question 3

where are carcinoids normally found, and is this a problem?

Answer 3

normally in appendix or ileum, but are asymptomatic because the substances are deactivated by the liver

Question 4

what is normal area of the tricuspid valve?

Answer 4

7 cm

Question 5

in tricuspid stenosis, what increased mean diastolic pressure leads to venous congestion?

Answer 5

> 4 mmHg

Question 6

what kind of murmur would you hear for tricuspid stenosis?

Answer 6

diastolic murmur on inspiration

Question 7

in what valvular disease would you see elevated RA pressure with a prominent A wave?

Answer 7

tricuspid stenosis

Question 8

what are three treatment options for tricuspid stenosis?

Answer 8

sodium restriction diet
balloon valvuloplasty
open valve replacement

Question 9

is tricuspid regurgitation well tolerated?

Answer 9

yes

Question 10

what kind of murmur would you hear with tricuspid regurgitation?

Answer 10

pansystolic murmur on inspiration

Question 11

in what valvular disease would you see a prominent V wave on a RA pressure curve?

Answer 11

tricuspid regurgitation

Question 12

if surgical intervention is needed for tricuspid regurgitation, what two conditions should you think of?

Answer 12

endocarditis or carcinoid

Question 13

when does pulmonary stenosis often present?

Answer 13

fourth or fifth decade of life

Question 14

what kind of murmur would you hear with pulmonic stenosis?

Answer 14

SEM in 3rd or 4th intercostal space

Question 15

what is the most common cause of pulmonic stenosis?

Answer 15

congenital

Question 16

in pulmonic stenosis, what Doppler pressure gradients are mild, moderate and severe

Answer 16

< 40 mmHg is mild
40-80 mmHg is moderate
> 80 mmHg is severe

Question 17

what is the preferred treatment for pulmonic stenosis?

Answer 17

mild to moderate needs no treatment

for severe, balloon valvuloplasty is preferred

Question 18

what kind of murmur would you hear with pulmonic regurgitation?

Answer 18

low pitched murmur in 3rd or 4th intercostal spaces

Question 19

what is a Graham steel murmur in pulmonic regurgitation?

Answer 19

high pitched diastolic blowing murmur when PAP > 70 mmHg

Question 20

what is the difference between primary and secondary mitral regurgitation?

Answer 20

primary is if there is a defect with the leaflets

secondary is due to dilation of the heart muscle pulling the leaflets apart

Question 21

how is chronic mitral regurgitation treated?

Answer 21

vasodilator therapy with ACEs, ARBs or hydralazine

Question 22

how is pulmonary congestion treated

Answer 22

diuretics

Question 23

what are two drugs to use in the treatment of mitral regurgitation?

Answer 23

sodium nitroprusside and nitroglycerine

Question 24

what happens to left ventricular function following a mitral valve replacement?

Answer 24

it worsens, because the low impedance route is eliminated

Question 25

mitral valve replacement is indicated in symptomatic patients as long as LV function is above what level?

Answer 25

35%

Question 26

what is the normal area of the mitral valve?

Answer 26

4-6 cm

Question 27

what area is considered mild, moderate and severe for mitral stenosis?

Answer 27

> 1.5 cm is mild
1-1.5 cm is moderate
< 1 is severe

Question 28

what kind of murmur would you hear with mitral stenosis?

Answer 28

low rumbling murmur at apex

Question 29

what is acute rheumatic fever?

Answer 29

a disease affecting the peri-arteriolar tissue due to untreated group A strep infection

usually causes mitral regurgitation, then mitral stenosis

Question 30

in mitral stenosis, what trans-valvular gradient is considered mild, moderate and severe?

Answer 30

< 5 mmHg is mild
5-12 mmHg is moderate
> 12 mmHg is severe

Question 31

surgical intervention is required once pulmonary hypertension reaches what level?

Answer 31

55 mmHg

Question 32

what is the most common cause of MR in the US?

Answer 32

mitral valve prolapse

Question 33

what is the difference between primary and secondary mitral valve prolapse?

Answer 33

primary deals with a congenital problem, such as Marfan’s syndrome

secondary has normal valve tissue, normally happens in younger women

Question 34

what is defined as mitral valve prolapse on TTE?

Answer 34

> 2 mm displacement of leaflets into LA during systole

Question 35

what medications help alleviate symptoms in mitral valve prolapse?

Answer 35

beta blockers