Valvular heart disease

Question 1

In a pressure-volume loop, this segment occurs during ejection

Answer 1

CD

Question 2

In a pressure-volume loop, this segment occurs during isovolumic contraction

Answer 2

BC

Question 3

In a pressure-volume loop, this segment occurs during ventricular filling.

Answer 3

AB

Question 4

This segment occurs during isovolumic relaxation

Answer 4

DA

Question 5

In a pressure-volume loop, this point represents the aortic valve closing.

Answer 5

D

Question 6

In a pressure-volume loop, this point represents mitral valve (MV) opening.

Answer 6

A

Question 7

In a pressure-volume loop, this point represents MV closing.

Answer 7

B

Question 8

In a pressure-volume loop, this point represents aortic valve opening.

Answer 8

C

Question 9

Stroke volume through the aortic valve

is the distance between which points?

Answer 9

C & D

Question 10

End-systolic volume can be measured at the ___ point.

Answer 10

D

Question 11

End-diastolic volume can be measured at the ___ point.

Answer 11

B

Question 12

Most common cause of aortic stenosis?

Answer 12

Rheumatic heart disease

Question 13

AS severity is graded on the basis of a variety of hemodynamic and natural history data using definitions of (3)?

Answer 13

1) Valve area
2) Mean pressure gradient
3) Aortic jet velocity

Question 14

AS is mild if based on the 3 factors?

1) Valve area
2) Mean pressure gradient
3) Aortic jet velocity

Answer 14

1) Valve area (>1.5 cm2)
2) Mean pressure gradient (<25 mmHg)
3) Aortic jet velocity (<3)

Question 15

AS is severe if based on the 3 factors?

1) Valve area
2) Mean pressure gradient
3) Aortic jet velocity

Answer 15

1) Valve area (<1 cm2)
2) Mean pressure gradient (>40 mmHg)
3) Aortic jet velocity (>4)

Question 16

What are the indications for aortic valve replacement in aortic stenosis?

Answer 16

1. Symptomatic
2. EF < 50%
3. Severe AS (CABG)
4. Severe AS (Aortic or valvular surgery)
5. Moderate AS (aortic or valvular surgery)

Question 17

Most common cause of aortic insufficiency?

Answer 17

Rheumatic heart disease

Question 18

What parameters can be used in echocardiography to characterize the severity of aortic insufficiency? (6)

Answer 18

1. Color Doppler jet width
2. Color Doppler vena contracta
3. Regurgitant volume
4. Regurgitant fraction
5. Regurgitant orifice area
6. Left ventricle size

Question 19

Describe mild aortic insufficiency?

Answer 19

1. Color Doppler jet width (<25%)
2. Color Doppler vena contracta (<0.3)
3. Regurgitant volume (<30)
4. Regurgitant fraction (<30)
5. Regurgitant orifice area (<0.1)
6. Left ventricle size (Normal)

Question 20

Describe severe aortic insufficiency?

Answer 20

1. Color Doppler jet width (>65%)
2. Color Doppler vena contracta (>0.6)
3. Regurgitant volume (>60)
4. Regurgitant fraction (>50)
5. Regurgitant orifice area (>0.3)
6. Left ventricle size (Increased)

Question 21

What is the indication for aortic valve replacement in aortic stenosis? (4)

Answer 21

1. Symptomatic
2. Asymptomatic (EF <50%)
3. Asymptomatic (CABG)
4. Asymptomatic with EF <50% and severe LV dilatation (EDDimension >75 mm or ESD > 55mm)

Question 22

Leading cause of mitral stenosis?

Answer 22

Rheumatic heart disease

Question 23

Critical stenosis of the valve occurs ____ to ___ years after the initial rheumatic disease.

Answer 23

10 to 20

Question 24

What parameters can be used in echocardiography to characterize the severity of mitral stenosis?

Answer 24

1. Mean mitral valve pressure gradient
   2, Valve area
2. Pulmonary artery systolic pressure

Question 25

Define mild mitral stenosis

Answer 25

1. Mean mitral valve pressure gradient (< 5 mmHg)
   2, Valve area (>1.5 cm2)
2. Pulmonary artery systolic pressure (<30 mmHg)

Question 26

Define severe mitral stenosis

Answer 26

1. Mean mitral valve pressure gradient (>10 mmHg)
   2, Valve area (<1 cm2)
2. Pulmonary artery systolic pressure (>50 mmHg)

Question 27

Atrial contraction contributes about ___ % of the stroke volume

Answer 27

30

Question 28

The primary causes of this valvular disease include MV prolapse, infective endocarditis, trauma, rheumatic heart disease, drugs (ergotamine, pergolide), and congenital valve cleft.

Answer 28

Mitral regurgitation

Question 29

The secondary causes of this valvular disease include ischemic heart disease, LV systolic dysfunction, and hypertrophic cardiomyopathy.

Answer 29

Mitral regurgitation

Question 30

This valvular disease becomes more common with age. This is because of the age-related wear and tear of the valve.

Answer 30

Mitral regurgitation

Question 31

Study:

Answer 31

Chronic MR:
Left ventricular end-systolic volume is normal; thus the stroke volume is high, but part of the stroke volume escapes through the incompetent valve into the left atrium. Ejection fraction is usually high because of the low resistance against the regurgitation. An ejection fraction of 50% may indicate significant LV dysfunction.

Question 32

Regurgitant chronic MR flow depends on (3)?

Answer 32

1) Regurgitant orifice size
2) Time available for regurgitant flow (bradycardia)
3) Transvalvular pressure gradient

Question 33

Acute MR may occur in the setting of (3)

Answer 33

1) Flailed leaflet caused by MV prolapse
2) Infective endocarditis
3) Trauma

Chordae tendineae may rupture spontaneously or from trauma, infective endocarditis, or rheumatic fever. Papillary muscles may rupture because of acute myocardial infarction or trauma.

Question 34

What parameters can be used in echocardiography to characterize the severity of mitral regurgitation?

Answer 34

1. Color Doppler jet area
2. Color Doppler jet area
3. Color Doppler vena contracta
4. Regurgitant volume
5. Regurgitant fraction
6. Regurgitant orifice area
7. Left atrial end ventricular size

Question 35

Describe mild MR with the following characteristics?

Answer 35

1. Color Doppler jet area (<4 cm2)
2. Color Doppler jet area (<20%)
3. Color Doppler vena contracta (<0.3cm)
4. Regurgitant volume (<30 mL)
5. Regurgitant fraction (<30 mL)
6. Regurgitant orifice area (<0.1)
7. Left atrial end ventricular size (Normal)

Question 36

Describe severe MR with the following characteristics?

Answer 36

1. Color Doppler jet area (> 8 cm2)
2. Color Doppler jet area (>40%)
3. Color Doppler vena contracta (>0.7cm)
4. Regurgitant volume (>60 mL)
5. Regurgitant fraction (>50 mL)
6. Regurgitant orifice area (>0.3)
7. Left atrial end ventricular size (Enlarged)