Valvular Path

Question 1

aortic stenosis

Answer 1

• PRESSURE overload
• CONCENTRIC hypertrophy
• angina (O2 supply mismatch)
• CHF (filling pressure backs up into lungs)
• delayed carotid upstroke
• LATE PEAKING SYSTOLIC AORTIC MURMUR
• absent A2

Question 2

aortic regurgitation

Answer 2

• VOLUME overload
• ECCENTRIC hypertrophy
• dilatation to normalize stress
• increased EDV
• increased SV
• LONG LOUD DIASTOLIC MURMUR along sternal border
• austin flint murmur
• bounding pulses (lare SV)
• wide pulse pressure
• Rx tx: reduce afterload with CCB, ACEi

Question 3

mitral stenosis

Answer 3

• RHEUMATIC FEVER if in adults
• increased LA pressure
• enlarged LA
• pulm HTN, edema
• calcification + stiffening
• afib (stretched atrium)
• LOUD S1, opening snap
• low diastolic rumble
• HF cells
• diuretics to decr LA pressure
• B blockers to decr HR

Question 4

mitral regurgitation

Answer 4

• VOLUME overload
• LA dilation
• pulm HTN, RV failure
• afib
• HOLOSYSTOLIC murmur, radiates to AXILLA
• decreased S1
• diuretics to decrease afterload

Question 5

calcific aortic stenosis

Answer 5

• congenital bicuspid, or developed senile
• concentric LVH, ischemia
• triad: chest pain, HF, syncope
• angina, DOE

Question 6

mitral valve prolapse

Answer 6

• young females, Marfan’s
• floppy enlargement/ballooning of mitral leaflets
• myxoid, mucus-y center
• alcian blue stain
• MIDSYSTOLIC CLICK
• mitral regurgitation

Question 7

rheumatic fever

Answer 7

• B hemolytic strep infection of pharynx
• licks joints, bites the heart
• usually mitral valve
• fibrinous pericarditis, endocarditis, mitral valve stenosis/fish mouth
• ASCHOFF NODULES: lymphocytes, histiocytes, ANITSCHKOW catepillar cells
• vegetations on CLOSURE LINES of cusps

JONES criteria
Joints, polyarthritis
<3 carditis
Nodules, subcutaneous
Erythema marginatum (truncal rash)
Sydenham chorea

Question 8

infective endocarditis

Answer 8

• infection of valves
• bulky, friable vegetations
• ANYWHERE on valve (except closure)
• usually L sided, but can be on R esp with IV drug users
• fibrin, PMNs, bacterial colonies
• fibrosis, calcifications
• septic emboli

-alpha hemolytic strep, staph aureus, enterococci/HACEK, staph epidermidis, fungi

Question 9

nonbacterial thrombotic endocarditis

Answer 9

NBTE

• risk factors: hypercoaguable states, malignancy
• vegetations on CLOSURE LINES of valves

Question 10

Libman Sacks Endocarditis

Answer 10

SLE

• mitral and tricuspid valves
• STERILE vegetations
• UNDERSURFACE of valves
• hematoxyphil bodies