Vavular Disease

Question 1

Causes of aortic stenosis

Answer 1

Congenital (bicuspid, unicuspid valve)
Calcification of valve (wear and tear)
Rheumatic disease

Question 2

Definition of aortic stenosis

Answer 2

Aortic valve area <0.5cm2

Question 3

Symptoms of aortic stenosis

Answer 3

Exertional angina
Syncope
Dyspnea
PND
Orthopnea
Peripheral edema

Question 4

Signs of aortic stenosis

Answer 4

Pulsus parvus et tardus
Brachial-radial delay
Narrow pulse pressure

Question 5

Murmur of aortic stenosis

Answer 5

Crescendo-decrescendo
Radiates to carotid
S4 if stiff ventricle

Question 6

ECG signs of aortic stenosis

Answer 6

LVH and strain
LAE
LBBB
A fib

Question 7

CXR of aortic stenosis

Answer 7

LVH
LAE
CHF

Question 8

Echo signs of aortic stenosis

Answer 8

LVH
Reduced LV function (low EF)
Reduced valve area

Question 9

Treatment for asymptomatic aortic stenosis

Answer 9

Serial echos

Avoid exertion

Question 10

Treatment of symptomatic aortic stenosis

Answer 10

Avoid nitrates/arterial dilators
Avoid ACEi in severe AS

Surgical valve replacement

Question 11

Sequelae of aortic stenosis

Answer 11

Outflow obstruction, increased EDP, concentric LVH, LV failure, CHF

Question 12

Causes of aortic regurg

Answer 12

Supravalvular: CT disorder, atherosclerosis
Valvular: congenital bicuspid valve, IE

Acute Onset: IE, dissection, failed prosthetic vavle

Question 13

Sequelae of aortic regurg

Answer 13

Volume overload, LV dilatation to increase SV, increases wall tension, pressure overload, LVH/LV failure

Question 14

Symptoms of aortic regurg

Answer 14

Only symptomatic in late disease when LV failure

Dyspnea, orthopnea, PND, syncope, angina

Question 15

Auscultation of aortic regurg

Answer 15

Early decrescendo murmur

Heard right after S2, as aortic valve closes

Question 16

ECG of aortic regurg

Answer 16

LVH, LAE

Question 17

CXR of aortic regurg

Answer 17

LVH, LAE, aortic root dilatation

Question 18

Echo of aortic regurg

Answer 18

Quantify regurgitation, leaflet/root abnormalities

Question 19

Treatment of asymptomatic aortic regurg

Answer 19

Reduce afterload (ACEi, nifedipine, hydralazine)

Nifedipine is a CCB that reduces systemic vascular resistance, lowers BP
Hydralazine is a SM relexant, that arterially vasodilates

Question 20

Treatment of symptomatic aortic regurg

Answer 20

Avoid exertion, treat CHF

Valve replacement if NYHA III/IV CHF or LVEF<50%

Question 21

Causes of mitral stenosis

Answer 21

Rheumatic disease (most)
Congenital causes rare

Question 22

Definition of mitral stenosis

Answer 22

Mitral valve area <1.2cm2 (severe)

Question 23

Sequelae of mitral stenosis

Answer 23

Fixed CO + LAE, increased LA pressure, pulmonary vascular resistance and CHF

Worse with A fib (no atrial kick)
Worse with tachycardia (less atrial emptying time)
Worse with pregnancy (higher preload)

Question 24

Symptoms of mitral stenosis

Answer 24

SOBOE
Orthopnea
Fatigue, palpitations, peripheral edema

Question 25

Physical signs of mitral stenosis

Answer 25

A fib | diastrolic thrill at apex

Question 26

Auscultation of mitral stenosis

Answer 26

Mid-diastolic rumble at apex

Question 27

ECG of mitral stenosis

Answer 27

A Fib LAE (p mitrale) RVH, RAD

Question 28

ECHO of mitral stenosis

Answer 28

restricted mitral valve opening

Question 29

Treatment of mitral stenosis

Answer 29

Treat A fib and CHF B-blocker to increase diastolic filling time Surgery if NYHA III/IV CHF and failure of medical management Balloon valvuloplasty or valve replacement

Question 30

Causes of mitral regurg

Answer 30

``` Mitral valve prolapse LV dilatation CT disorder Papillary muscle rupture acute MI Mitral valve annulus calcification ```

Question 31

Sequelae of mitral regurg

Answer 31

Reduced CO, increased LV and LA pressure, LV and LA dilatation, CHF and pulmonary HTN

Question 32

Symptoms of mitral regurg

Answer 32

Dyspnea, PND, Orthopnea, palpitations, peripheral edema

Question 33

Auscultation of mitral regurg

Answer 33

Holosystolic murmur at apex Radiates to axilla +/- mid-diastolic rumble Loud S2 if pulmonary HTN S3 (rapid filling of ventricle because regurg causes LA overfilling)

Question 34

Physical signs of mitral regurg

Answer 34

Lateral displaced apex due to LV dilatation (from increased LV pressure due to reduced CO)

Question 35

ECG of mitral regurg

Answer 35

``` LAE LA delay (bifid p waves) ```

Question 36

Treatment of asymptomatic mitral regurg

Answer 36

Serial echos

Question 37

Treatment of symptomatic mitral regurg

Answer 37

Diuretics to decrease preload ACEi to decrease afterload Surgery if NYHA III/IV CHF, acute MR with CHF, papillary muscle rupture Valve REPAIR first, then valve replacement if failure of repair