Valvular Diseases

Questions and Answers

What primary condition leads to mitral stenosis?

Myocardial infarction

Infective endocarditis

Rheumatic fever (correct)

Congenital abnormalities

What is the normal area range of the mitral valve orifice?

1 to 3 cm²

2 to 4 cm²

4 to 6 cm² (correct)

6 to 8 cm²

What complication can arise from atrial fibrillation in mitral stenosis patients?

Systemic embolization risk (correct)

Enhanced pulmonary venous return

Increased left ventricular filling

Decreased risk of thrombosis

What is the consequence of a mitral valve area below 2.0 cm²?

Obstruction to blood flow into the left ventricle Signup and view all the answers

What happens to the left atrial pressure in mitral stenosis?

It increases due to reduced blood flow Signup and view all the answers

Which of the following is NOT a complication associated with mitral stenosis?

Acute myocardial infarction Signup and view all the answers

What results from severe pulmonary hypertension in patients with mitral stenosis?

Right ventricular dilation Signup and view all the answers

Which condition is often worsened by tachycardia or atrial fibrillation in mitral stenosis patients?

Diastolic filling time Signup and view all the answers

Which structure is NOT part of the mitral valve apparatus?

Tricuspid ring Signup and view all the answers

What is a common cause of acute mitral regurgitation (MR)?

Papillary muscle rupture in STEMI Signup and view all the answers

Acute severe mitral regurgitation can lead to which of the following immediate consequences?

Increased left ventricular diastolic pressure Signup and view all the answers

Which condition is a potential chronic cause of mitral regurgitation?

Calcification of mitral annulus Signup and view all the answers

What is the primary physiological impact of acute severe mitral regurgitation?

Acute pulmonary edema Signup and view all the answers

Which of the following is NOT a contributing factor to chronic mitral regurgitation?

Acute myocardial infarction Signup and view all the answers

What happens to the left atrium during acute severe MR?

It experiences increased pressure due to volume overload Signup and view all the answers

Which symptom is most commonly associated with acute pulmonary edema caused by acute MR?

Cyanosis Signup and view all the answers

Which peripheral sign is characterized by abrupt distension and quick collapse on palpation of the peripheral arterial pulse?

Water-Hammer pulse Signup and view all the answers

What is the best imaging method to assess the severity and hemodynamic consequences of aortic regurgitation?

Echocardiography Signup and view all the answers

Which sign is described as visible pulsations of the fingernail bed with light compression?

Quincke sign Signup and view all the answers

What sound is described by booming systolic and diastolic sounds auscultated over the femoral artery?

Pistol-shot (Traube sign) Signup and view all the answers

What is indicated by a popliteal cuff systolic blood pressure being 40 mmHg higher than the brachial cuff systolic blood pressure?

Hills sign Signup and view all the answers

Which of the following electrical changes on an ECG is indicative of aortic regurgitation?

Left atrial enlargement Signup and view all the answers

Which clinical finding is NOT associated with chronic aortic valve regurgitation?

Third-degree heart block Signup and view all the answers

Which sign reflects vigorous carotid pulsations and is indicative of aortic regurgitation?

Corrigan sign Signup and view all the answers

What heart sound may be heard in cases of mitral regurgitation?

Third heart sound S3 Signup and view all the answers

What type of murmur is typically associated with severe mitral regurgitation?

Harsh pan-systolic murmur Signup and view all the answers

What finding on an ECG can indicate left atrial enlargement?

P waves with a wide duration Signup and view all the answers

What echocardiographic assessment is crucial in patients with mitral regurgitation?

Assessing mitral valve morphology and function Signup and view all the answers

Which of the following symptoms is NOT typically associated with chronic mitral regurgitation?

Acute pulmonary edema Signup and view all the answers

What is a common first-line medical treatment for patients experiencing pulmonary congestion due to mitral regurgitation?

Diuretics Signup and view all the answers

For males over 40 or females over 50, what is the purpose of cardiac catheterization in the context of mitral regurgitation?

To assess coronary artery health Signup and view all the answers

What is the recommended long-term prophylaxis for patients with rheumatic heart disease?

Long-acting penicillin Signup and view all the answers

What characteristic is NOT typically observed in the pulse of a patient with severe aortic stenosis?

Normal volume Signup and view all the answers

Which of the following is a common feature noted during the cardiac examination of a patient with aortic stenosis?

Heaving apex due to left ventricular hypertrophy Signup and view all the answers

Which diagnostic tool is considered the gold standard in assessing aortic stenosis?

Echocardiography Signup and view all the answers

What is the primary purpose of performing a cardiac catheterization in patients with suspected aortic stenosis?

To obtain direct hemodynamic measurements when noninvasive tests yield inconclusive results Signup and view all the answers

Which of the following management strategies is appropriate for patients with aortic stenosis and existing comorbid conditions?

Guideline-directed medical therapy for comorbidities like hypertension Signup and view all the answers

Which statement regarding the impact of medical therapy on aortic stenosis is accurate?

There is currently no medical therapy that alters the natural history of aortic stenosis Signup and view all the answers

Which auscultation finding is associated with aortic stenosis?

Ejection systolic murmur with a rough character Signup and view all the answers

What is a classic symptom of aortic stenosis that patients often experience during physical activity?

Chest pain resembling angina Signup and view all the answers

Study Notes

Disorders of the Cardiac Valves

Mitral Valve Disease

Mitral Valve Anatomy:
- Composed of the mitral annulus, anterior and posterior leaflets, chordae tendineae, and papillary muscles.
- Dysfunction arises from abnormalities in one or more of these structures.
Mitral Regurgitation (MR):
- Can be chronic (due to rheumatic fever, ischemic heart disease, cardiomyopathy, etc.) or acute (due to papillary muscle rupture or infective endocarditis).
Pathophysiology of Acute MR:
- Results in acute left ventricular (LV) volume overload, leading to increased LV diastolic pressure, pulmonary edema, and signs like S3 heart sound and harsh pan-systolic murmur.
Investigations:
- ECG: May show P mitrale or left ventricular hypertrophy.
- Chest X-ray: Reveals left atrial enlargement and possible LV enlargement.
- Echocardiography: Visualizes mitral leaflets, assesses regurgitation severity, LV dimensions, and pulmonary hypertension.
- Cardiac Catheterization: For coronary risk evaluation in older patients.
Treatment of MR:
- Acute MR: Requires afterload reduction with vasodilators and diuretics; assisted ventilation may be necessary.
- Chronic MR: Focus on timely surgery before irreversible LV dysfunction develops; medical treatment includes diuretics and anticoagulation for atrial fibrillation.

Aortic Valve Disease

Aortic Stenosis (AS):
- Normal mitral valve orifice area is 4-6 cm²; stenosis occurs when the area is below 2.0 cm², causing diastolic pressure gradients and LV filling issues.
Pathophysiology of AS:
- Results in increased left atrial pressure and pulmonary venous hypertension, leading to right ventricular dilation and tricuspid regurgitation.
- Tachycardia or atrial fibrillation significantly worsens symptoms due to loss of atrial contraction.
Complications of AS:
- Atrial fibrillation (AF) increases pulmonary congestion and embolic risk.
- May lead to pulmonary hypertension, recurrent pulmonary infections, and possible angina-like symptoms.
Signs of Aortic Regurgitation:
- Characterized by hyperdynamic pulses and wide pulse pressure.
- Peripheral signs include Water-Hammer pulse, Pistol-shot sign, and visible pulsations in the nail bed (Quincke's sign).
Diagnosis of Aortic Regurgitation:
- ECG: Shows signs of left ventricular hypertrophy and left atrial enlargement.
- Chest X-ray: May show cardiomegaly and aortic aneurysm.
- Echocardiography: Gold standard for assessing etiology and severity of aortic regurgitation.
Management of Aortic Stenosis:
- No proven medical therapies to modify AS; however, managing comorbidities (like hypertension) is recommended.
- Gradual dose increase of antihypertensive medications is crucial for patients with severe AS.

This summary provides essential insights into mitral and aortic valve diseases, emphasizing their anatomy, pathophysiology, signs, diagnosis, and management strategies.

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Description

This quiz covers the essential aspects of cardiac valve disorders, particularly focusing on mitral valve diseases such as mitral regurgitation and stenosis. Students will learn to identify causes, understand pathophysiology, recognize symptoms, and explain diagnosis and management plans. Test your knowledge on valvular dysfunctions and their implications.