Valvular Path-Guo

Question 1

What is the most common cause of isolated aortic stenosis in adults? (normally found in 40-50 yo)

Answer 1

bicuspid aortic valve (in adults in 40s and 50s)

Question 2

What is the most common presentation of aortic stenosis?

Answer 2

Dyspnea on exertion (50%)

Angina (35%)

Syncope (exertional) (15%)

Split S2, crescendo-decrescendo systolic murmur

Question 3

What is the most likely cause of aortic stenosis in the older population (70+)?

Answer 3

degenerative calcific aortic stenosis

Question 4

What is the criteria for Rheumatic fever?

Answer 4

Jones criteria: 2 major criteria or one major and 2 minor criteria

Major Criteria: 
1 Carditis
2 Arthritis
3 Chorea
4 Subcutaneous nodules
5 Erythema marginatum

Minor criteria:

a) Fever
b) Arthralgia
c) Previous rheumatic fever or rheumatic heart disease

Laboratory Diagnosis
• Increased ASO titer or strep antibodies
• Positive throat culture for Group A beta-hemolytic strep

Question 5

What pathology findings will be seen in Acute Rheumatic Heart Disease?

Answer 5

Aschoff nodules

fibrinoid necrosis, mononuclear inflammatory infiltrate initially, with eventual infiltration of Anitschkow cells

Question 6

What will be seen in Chronic Rheumatic Heart Disease?

Answer 6

commissural fusion (fish mouth appearance), cusp fibrosis, retraction and calcification

shortening of the chordae

Question 7

What is the clinical presentation in Mitral stenosis?

Answer 7

Progressive Dyspnea (70%), worsen with:
exercise, fever, tachycardia and pregnancy

• Right heart failure
• Hemoptysis (coughing up blood)

Question 8

What are the physical exam findings in Mitral Stenosis?

Answer 8

Apical rumbling, diastolic murmur

A right ventricular lift

Elevated neck veins

Ascites and edema

Mitral facies (pinkish/purplish face from the diminished outflow of the left ventricle)

Question 9

What is the clinical presentation of aortic regurgitation?

Answer 9

Left-sided heart failure
(dyspnea, orthopnea and fatigue)

Angina, fatigue (decreased CO)

Wide pulse pressure (bounding pulse)

Hill sign: BP in leg is >20 mmHg higher than in the arm

Diastolic murmur (decrescendo murmur at left sternal border)

Florid pulmonary edema

Question 10

What is the most common cause of mitral valve regurgitation?

Answer 10

mitral valve prolapse

seen in marfan’s syndrome

Question 11

What is the clinical presentation of Mitral regurgitation?

Answer 11

Papitation

Fatigue

Orthopnea,

Pulm congestion and edema.

Enlarged R heart

R heart failure.

Question 12

What normally causes acute infective endocarditis? Subacute?

Answer 12

acute: staph aureus

subacute: alpha streptococci
- underlying structural valve disease present

Question 13

What valve is most likely affected in IV drug users?

Answer 13

Tricuspid

Question 14

Which pathogen normally affects the valves of DM or immunocompromised pts?

Answer 14

Gram negative

Question 15

What pathogen is most likely to cause a valvular disorder in a post-rhuematic heart disease pt?

Answer 15

S. viridans

Question 16

What is the clinical presentation of infective endocarditis?

Answer 16

fever, chills, night sweats, SOB, weakness

new cardiac murmur

Osler nodes (tender lesions on fingers)

Roth spots (pale lesions in the retina surrounded by hemorrhage)

Janeway lesions (red, contender lesion on palm or sole)

Question 17

What is the most common cause of isolated mitral stenosis?

Answer 17

rheumatic fever