Valvular Heart Disease II

Question 1

CV wave in left atrium

Answer 1

mitral regurg

Question 2

Tx of mitral regurg

Answer 2

replace valve - when EF starts to decline (to 60%)
-even asymptomatic pt

or if ERO - effective regurg orifice is 40mm

repair - if no calcification in annulus or valve

chordae cannot be maintinaed - need replacement

Question 3

anxious 32yo female chest pain and palpitations, mid-systolic click, late systolic murmur, shortens with lying down, handgrip, and squatting

Answer 3

mitral valve prolapse

Question 4

myxomatous

Answer 4

prolapsing of mitral valve

Question 5

standing with mitral regurg**

Answer 5

less murmur

Question 6

standing with mitral valve prolapse**

Answer 6

longer murmur

Question 7

mitral valve prolapse

Answer 7

aortic root disease, hyperadrenergic syndrome, myxomatous degeneration (marfans, ehler-danlos)

mid systolic click

murmur lengthens with standing, valsalva, and amyl nitrate

A and V arrhythmias

Question 8

Tx of mitral valve prolapse

Answer 8

beta blockers
mitral valve repair - wedge repair
mitral replacement

Question 9

ejection sound with diamond shaped harsh systolic murmur at base and high pitched systolic murmur at apex

Answer 9

aortic stenosis

decreases with squatting

Question 10

gallaverdin phenomenon

Answer 10

dissociation between the noisy and musical components of the systolic murmur heard in aortic stenosis

Question 11

path of aortic stenosis

Answer 11

bicuspid valve

degeneratie (calcification)

Question 12

syncope in aortic stenosis

Answer 12

peripheral vasodilation
-from high V pressure stimulates baroreceptors in left ventricle

reduced afterload - calls for increased SV which can’t occur
-due to aortic stenosis

BP falls - patient passes out

Question 13

parvus et tardus

Answer 13

aortic stenosis

weak and late pulse

at carotid

Question 14

EKG with aortic stenosis

Answer 14

LVH and LAH

Question 15

peak doppler gradient

Answer 15

measurement of flow through valve orifice squared x4

ex/ 4 flow = 64 gradient

LV failure, angina, or syncope occur when peak valvular gradient reaches 64

Question 16

critical valve area

Answer 16

valve area < 1 cm2

Question 17

dangers in catheterization

Answer 17

crossing aortic valve
can induce cardiogenic shock, PE, stroke, or death

nitrates also dangerous

Question 18

critical aortic stenosis

Answer 18

mean gradient > 50
valve area < 0.75

severe calcification density, pulmonary HTN > 50 and elevated C-terminal BNP

Question 19

severe aortic stenosis to have gradient less than 30?

Answer 19

low gradient, low flow aortic stenosis with reduced EF

increased afterload or cardiac contractility problem (IHD, MI, fibrosis)

Question 20

diagnosis of low gradient, low flow aortic stenosis

Answer 20

dobutamine ECHO

<20% increase in SV indicates no muscle reserve

Question 21

bicuspid aortic valve

Answer 21

prone to stenosis, regurg, or both

associated with root dilation and coarctation

Question 22

Tx for aortic stenosis

Answer 22

young - valvuloplasty
elderly - pig valve
middle age - mechanical valve plus anticoag

often need CABG as well

transcutaneous aortic valve replacement (TAVR) - associated with strokes

Question 23

squatting and handgrip

Answer 23

increased afterload

increases aortic regurg

Question 24

3/6 decrescendo diastolic murmur

Answer 24

aortic regurg

increases with squatting and handgrip

decreased with standing or valsalva

Question 25

wide pulse pressure

Answer 25

aortic insufficiency bounding pulse with huge pulse pressure

Question 26

BP of 140/50

Answer 26

wide pulse pressure with aortic insufficiency

Question 27

quinckes sign

Answer 27

gentle pressure on fingernail will blanch and fill alternatively if wide pulse pressure

Question 28

corrigans sign

Answer 28

pulse that is forceful then collapses aortic regurg

Question 29

de mussets sign

Answer 29

rhythmic nodding or bobbing of the head in synchrony with the beating of the heart with aortic regurg

Question 30

causes of aortic regurg

Answer 30

``` atherosclerosis AV fistula thyrotoxicosis anemia fever heart block ```

Question 31

light house

Answer 31

malar flushing with heartbeat

Question 32

hills

Answer 32

systolic BP in lower limb greater than upper limb | -by 20 mmHg

Question 33

duroziers

Answer 33

diastolic murmur over femoral arter on distal pressure

Question 34

pulsus bisferiens

Answer 34

aortic regurg in association with stenosis

Question 35

pulsus alterans

Answer 35

alternating strong and weak beats left ventricular systolic impairment

Question 36

massive hypertrophy of the left ventricle of the heart due to volume overload

Answer 36

cor bovinum

Question 37

surgery in aortic regurg

Answer 37

symptoms of exertional dyspnea, orthopnea, and PND LV dysfunction and contractility failure -EF < 55% BNP > 130

Question 38

low pitched rumbling murmur heard at apex midsystolic or presystolic

Answer 38

austin flint murmur aortic regurg

Question 39

absent MI, austin flint murmur, 1/6 diastolic murmur and acute CHF

Answer 39

``` aortic dissection endocarditis HTN inflammatory disease seronegative spondyloarthropathy ```

Question 40

Tx of aortic insufficiency

Answer 40

afterload reduction BNP evaluation root replacement