Valvular Heart Disease (Johnston)

Question 1

stenosis leads to __ overload while regurgitation leads to __ overload

Answer 1

pressure

volume

Question 2

what happens to the LA in mitral stenosis?

Answer 2

Left atrium becomes enlarged and can get A fib d/t turbulence

also get pulm vascular changes, RVH

Question 3

Ortner syndrome is hoarsenss d/t compression of the left recurrent laryngeal n. and is associated with this valvular disease:

Answer 3

mitral stenosis

Question 4

what type of murmur do you hear in mitral stenosis?

Answer 4

Rumbling, DIASTOLIC murmur-low pitched, best heard at apex. Use the bell

Question 5

how can you tx mitral stenosis?

Answer 5

anticoagulant if in A fib
percutaneous balloon valvuloplasty
MV replacement

Question 6

what is the name of the syndrome that causes hoarseness of voice in mitral stenosis?

Answer 6

ortner’s syndrome

Question 7

what are 2 chronic conditions associated with mitral regurgitation?

Answer 7

MVP-most common etiology

Mitral annular calcification

Question 8

what are some acute conditions associated with mitral regurg?

Answer 8

rupture of chord tendinae
rupture of papillary muscle
ischemic papillary muscle dysfunction

Question 9

what type of murmur is heard in mitral regurg?

Answer 9

SYSTOLIC murmur –> blowing, prominent at apex, radiates into left axilla

Decreased S1, S3 gallop with radiation into left axilla

loudness of murmur correlates with severity

Question 10

how can you tx mitral regurg?

Answer 10

vasodilators-Afterload reduction
decrease resistance to flow
ACEi-Chronic MR

Question 11

describe the epidemiology of MVP:

Answer 11

7:1 female:male ratio

associated with Marfan’s/skeletal changes

Question 12

what type of murmur do you hear with MVP?

Answer 12

SYSTOLIC murmur; may have mid-systolic click

Question 13

how can you tx MVP?

Answer 13

If hyper adrenergic state (anxious, palpitations), consider B blocker

Question 14

what are some etiologies of aortic stenosis?

Answer 14

degenerative (calcific or senile)
congenital bicuspid aortic valve
rheumatic or post inflamm scarring

Question 15

what is the prognosis of aortic stenosis if untreated?

Answer 15

without tx prognosis is poor

without tx most will die within 3 yrs of developing syncope and within 2 years of onset of HF

Question 16

what type of murmur is heard in aortic stenosis?

Answer 16

SYSTOLIC murmur, HARSH, 2nd ICS RSB; radiates into suprasternal notch/carotids

Question 17

how can you tx aortic stenosis?

Answer 17

percutaneous balloon valvuloplasty

temporary aortic valve replacement

Question 18

what can aortic regurgitation be due to?

Answer 18

leaflet abnormalities

aortic root abnormalities (Marfans, aortic dissection, aging, HTN)

Question 19

what are causes of acute aortic regurg?

Answer 19

Infectious endocarditis
aortic dissection
Bicuspid aortic valve

Question 20

what are causes of chronic aortic regurg?

Answer 20

syphyllis

ankylosing spondylitis

Question 21

what type of murmur do you hear in aortic regurg?

Answer 21

DIASTOLIC, decrescendo murmur, 3rd ICS LSB

this is the hallmark of aortic regurg

Question 22

how can you tx aortic regurg?

Answer 22

ARB–> decrease after load to decrease regurg volume

Surgery-Aortic valve replacement when symptomatic of EF < 55%

Question 23

De Musset sign (head bobbing) is associated with which valvular disease?

Answer 23

aortic regurg