valvular heart disease

Question 1

what is the most common cause of mitral stenosis

Answer 1

rheumatic heart disease. rarely congenital, post-radiation, calcification.

Question 2

what is the consequence of mitral stenosis

Answer 2

impaired filling of the left ventricle, pulmonary congestion, increased left atrial pressure. reduced CO and secondary pulmonary vasoconstriction occurs. this causes right heart failure.

Question 3

what are the clinical presentations in mitral stenosis

Answer 3

dyspnea, orthopnea, fatigue, wasting, hemoptysis due to rupture of pulmonary vessels, systemic embolism, hoarseness. right sided heart failure.

Question 4

physical findings of mitral stenosis

Answer 4

Afib is common. decreased pulse pressure.

large left atria and right ventricle.

Question 5

what is the murmur of mitral stenosis

Answer 5

Loud S1, opening snap following S2. diastolic rumble.

Question 6

what is the treatment for mitral stenosis

Answer 6

balloon valvulotomy

Question 7

mitral regurgitation is what

Answer 7

when blood back flows from the ventricle into the atria due to insufficiency. t

Question 8

what is the most common cause of mitral regurg

Answer 8

ischemia. other causes of HTN, CHF, left ventricular hypertrophy, rheumatic fever.

Question 9

what are the consequences of mitral regurgitation

Answer 9

more blood in the left atria and reduced CO. this causes volume overload and an increase in preload. the after load is reduced due to reduced cardiac output. this leads to increased left ventricular function and eventually failure. which ultimately leads to Right-failure.

Question 10

what are the physical findings for mitral regurgitation

Answer 10

diminished but brisk carotid upstroke. distended neck veins.

large left ventricle and atria.

Question 11

what is the murmur of mitral regurgitation

Answer 11

holosystolic apical murmur that radiates to the axilla and often accompanied by thrill. S3 with soft S1 and widely split S2.

Question 12

what is mitral valve prolapse

Answer 12

when the leaflets of the mitral valve bulge in the left atria.

Question 13

what are the causes of MVP

Answer 13

usually congenital. occurs in greater frequency with EDS, marfans, PCKD, and greater in women.

Question 14

what are the symptoms of MVP

Answer 14

usually asymptomatic. can have lightheadedness, palpitations, syncope, and chest pain which is often due to arrhythmias.

Question 15

what is the murmur for MVP

Answer 15

mid-to-late systolic click and a late systolic murmur at the cardiac apex.

Question 16

what makes the murmur in MVP worse

Answer 16

valsalva or standing.

Question 17

what makes MVP murmur better

Answer 17

squatting or leg raise.

Question 18

what is aortic stenosis

Answer 18

calcification of the aortic valve and degeneration common in the elderly.

Question 19

what are the causes of aortic stenosis

Answer 19

aging, rheumatic fever that affected the valve. (the mitral valve is almost invariably affected if the aortic is).

Question 20

what is the consequence of aortic stenosis

Answer 20

left ventricular hypertrophy. the left atria must also have more forceful contractions to fill the noncompliant thickened left ventricle

Question 21

what is the murmur of aortic stenosis

Answer 21

harsh crescendo-decrescendo systolic heard best at the right upper sternal border. harsh quality that radiates to the carotids. S4 gallop. S2 single or paradoxically split. aortic ejection click.

Question 22

what is the clinical presentation of aortic stenosis

Answer 22

angina, syncope, dyspnea from CHF

pulsus tardes et parvus, carotid thrill, systolic ejection murmur in aortic area. aortic ejection click.

Question 23

what does valsalva do to aortic stenosis

Answer 23

decreases the murmur

Question 24

what does valsalva do to hypertrophic obstructive cardiomyopathy

Answer 24

increases the murmur

Question 25

what does valsalva do to mitral regurgitation

Answer 25

decreases

Question 26

what does squatting do to HOCM

Answer 26

decreases it

Question 27

what does squatting do to mitral regurgitation.

Answer 27

increases it

Question 28

what are the systolic murmurs

Answer 28

aortic stenosis, mitral regurgitation, ventricular septal defect, HOCM.

Question 29

what is aortic regurgitation

Answer 29

this is when there is insufficiency of the aortic valve which allows blood back into the left ventricle after systole.

Question 30

what are the causes of aortic regurgitation

Answer 30

hypertension and ischemia are the most common. can occur after Infective endocarditis. aortic dissection/trauma, Marfan, rheumatic fever, syphilis

Question 31

what are the consequences of aortic regurgitation

Answer 31

there is more blood back filled into the ventricle causing fluid overload. left ventricular dilation due to very high left ventricular end diastolic pressure. this can cause pulmonary edema secondary to mitral regurgitation.

Question 32

what are the clinical signs of aortic regurg

Answer 32

dyspnea, increased pulse pressure due to large stroke volume.
there will be left ventricular hypertrophy.

Question 33

what is the murmur ind AR

Answer 33

early diastolic decrescendo blowing. systolic flow murmur. best heard on the third left intercostal space with the patient sitting up and leaning forward with breath held in forced expiration.

Question 34

what are the causes of dilated cardiomyopathy

Answer 34

idiopathic is the most common, alcoholism, permpartum, viral infections, toxins (cobalt/lead/arsenic),

Question 35

what are the symptoms of dilated cardiomyopathy

Answer 35

systolic heart failure.

Question 36

what are the treatments for dilated cardiomyopathy

Answer 36

ACEi, BB, spironolactone for reduced mortality.

diuretics and digoxin reduce symptoms

Question 37

what is the characteristic finding for HOCM

Answer 37

there is unexplained hypertrophy with thickening of the inter ventricular septum.

Question 38

what are the causes of restrictive cardiomyopathy

Answer 38

amyloidosis, sarcoidosis, hemachromatosis, radiation, scleroderma

Question 39

what is restrictive cardiomyopathy

Answer 39

the myocardium becomes rigid and noncompliant impeding ventricular filling. and this raises the cardiac filing pressures. it mimics constrictive pericarditis.

Question 40

what are the clincal findings of restrictive cardiomyopathy

Answer 40

dyspnea, exercise intolerance, weakness, JVD, edema, hepatomegaly, ascites, kussmaul sign.