Heart Failure and Valvular Pathology Quiz

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Questions and Answers

What is a key characteristic of a normal ventricle's diastolic filling?

Atria must undergo significant hypertrophy

Filling occurs at low atrial pressures (correct)

Most filling occurs during late diastole

Filling requires high atrial pressures

Which condition commonly leads to impaired oxygen supply in heart failure?

Mitral valve regurgitation

Myocardial infarction (correct)

Hypertrophic cardiomyopathy

Aortic stenosis

What consequence arises from prolonged increased afterload on the ventricles?

Dilation of chamber size (correct)

Increased contractility

Decreased wall thickness

Improved compliance

What pathophysiological adaptation occurs in heart failure related to reduced compliance?

Fibrosis of the cardiac tissue Signup and view all the answers

How does hypertensive heart disease contribute to heart failure?

It causes left ventricular hypertrophy Signup and view all the answers

What defines HFpEF in the context of heart failure?

Impaired diastolic filling with preserved systolic function Signup and view all the answers

Which medication mechanism is commonly associated with treating heart failure?

Enhanced contractility through calcium modulation Signup and view all the answers

Which statement correctly reflects the features of congestive heart failure?

Left-sided failure can cause pulmonary congestion Signup and view all the answers

What is a common consequence of long-term mitral valve prolapse (MVP)?

Mitral valve regurgitation Signup and view all the answers

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

Chronic obstructive pulmonary disease Signup and view all the answers

What type of damage can cause acute mitral regurgitation?

Rupture of chordae tendinae Signup and view all the answers

What is the primary immune response responsible for rheumatic heart disease?

Autoimmune reaction to Group A streptococcus Signup and view all the answers

How does mitral regurgitation impact left atrial pressures?

It causes increased left atrial pressures. Signup and view all the answers

Which characteristic of rheumatic fever indicates a genetic susceptibility?

Occurrence in 3-6% of the population Signup and view all the answers

What is a potential consequence of papillary muscle rupture?

Acute life-threatening mitral regurgitation Signup and view all the answers

Which layer of the heart is primarily affected in endocarditis related to rheumatic heart disease?

Endocardium Signup and view all the answers

What is the most common lesion associated with mitral valve in chronic rheumatic heart disease?

Mitral stenosis Signup and view all the answers

Which of the following symptoms is NOT typically associated with aortic stenosis?

Shortness of breath Signup and view all the answers

What is the primary clinical feature associated with rheumatic fever that causes morbidity and death?

Carditis Signup and view all the answers

Which complications are associated with aortic stenosis that can lead to poor prognosis?

Volume-overload left ventricular hypertrophy Signup and view all the answers

In what order do the valves typically become involved with rheumatic fever?

Mitral, aortic, tricuspid Signup and view all the answers

What is the typical murmur associated with aortic regurgitation?

Diastolic decrescendo murmur Signup and view all the answers

What is a common consequence of untreated chronic rheumatic heart disease?

Life-long valvular damage Signup and view all the answers

Which valve disorder in rheumatic heart disease is often characterized by fused aortic commissures?

Aortic stenosis Signup and view all the answers

Which condition is associated with a mid- or late-systolic 'click' and is typically asymptomatic?

Mitral Valve Prolapse Signup and view all the answers

What type of murmur is typically heard in severe mitral regurgitation?

Holosystolic murmur Signup and view all the answers

What is indicated when a patient with mitral valve regurgitation develops left ventricular hypertrophy (LVH)?

Immediate surgical intervention Signup and view all the answers

What symptom becomes apparent in mitral stenosis as it progresses and worsens with activity?

Cough and dyspnea Signup and view all the answers

Which sign would you expect to find on examination of a patient with mitral stenosis?

Opening snap followed by a rumbling diastolic murmur Signup and view all the answers

What is the prognosis for most patients with mitral valve prolapse?

Good prognosis, do not urgently need surgery Signup and view all the answers

Which of the following best describes the complications associated with mitral regurgitation?

Can cause CHF symptoms if severe Signup and view all the answers

During auscultation of a patient with possible mitral valve issues, which finding is characteristic of mitral regurgitation?

S1 hard to hear Signup and view all the answers

What signifies a diagnosis of HFrEF in terms of ejection fraction?

EF < 40% Signup and view all the answers

Which condition is most commonly associated with chronic heart failure?

Coronary artery disease Signup and view all the answers

What is true about BNP in relation to heart failure diagnostics?

It helps diagnose both chronic heart failure and acute exacerbations. Signup and view all the answers

What best describes the role of beta-blockers in the management of heart failure?

Reduce cardiac oxygen demand and reverse cardiac remodeling. Signup and view all the answers

Which mechanism of action best describes digoxin?

Inhibits the sodium-potassium pump leading to increased intracellular calcium. Signup and view all the answers

What is the characteristic feature of concentric left ventricular hypertrophy due to chronic hypertension?

Normal chamber size with thickened walls. Signup and view all the answers

Which class of medications directly addresses fluid overload in CHF?

Diuretics Signup and view all the answers

What is a major complication of aortic stenosis?

Hypertrophy of the heart walls proximal to the stenosis. Signup and view all the answers

What causes aortic regurgitation when compared to normal valve function?

Incomplete closure leading to backflow. Signup and view all the answers

What is the primary effect of statins in managing dyslipidemia?

Reduce the hepatocyte's capability to produce cholesterol. Signup and view all the answers

Ezetimibe primarily functions by which mechanism in lipid management?

Reducing cholesterol absorption in the intestine. Signup and view all the answers

What does mitral valve prolapse lead to in terms of blood flow?

Regurgitation of blood into the left atrium. Signup and view all the answers

Which condition results from a 'wear and tear' process on heart valves?

Aortic sclerosis Signup and view all the answers

Study Notes

Heart Failure

Normal ventricle is compliant, able to relax quickly and fill with low pressure, and strong, able to generate enough force at rest.
Common causes of heart failure: Ventricular overload, impaired oxygen supply from chronic ischemia, reduced compliance, cardiomyopathies.
Heart failure can be diagnosed with echocardiography and BNP.
Chronic IHD is the most common cause of heart failure.
Chronic hypertension is the second most common cause of heart failure.
Medications for heart failure and/or angina: beta-blockers, cardiac glycosides, diuretics, ACE inhibitors.
Digoxin inhibits sodium-potassium pump, increasing contractility and decreasing heart rate.
Medications for angina: calcium channel blockers, nitrates.
Dyslipidemia medications: statins, PCSK9 inhibitors, ezetimibe, niacin.

Valvular Pathology

Valves are lined by endocardium with underlying connective tissue, connected to fibrous rings.
Valvular pathologies can be caused by congenital disorders, wear and tear, inflammation, acute impairment, idiopathic causes.
Stenosis: Narrowed orifice or difficult opening, leading to strain on the proximal heart wall and hypertrophy.
Regurgitation: Backflow of blood, leading to increased preload and chamber enlargement.
Incompetence: Valve does not close completely.
Prolapse: Excessive valve movement into the proximal chamber.

Selected Valvular Pathologies

Mitral valve prolapse (MVP) - most cases are idiopathic.
Mitral regurgitation (MR) – usually due to MVP, ischemia, infective endocarditis, rheumatic heart disease, left ventricular/atrial enlargement.
RHD is an autoimmune reaction caused by Group A Streptococcus.
RHD primarily affects children and teens, but can recur.
RHD affects the entire heart wall (valves, myocardium, pericardium).
RHD is common in less-industrialized countries, and is responsible for significant morbidity and mortality.
Common RHD valvular lesions: mitral stenosis and aortic stenosis.
Aortic stenosis (AS) - common cause of CHF.
Aortic regurgitation (AR) - very dangerous if acute and severe.

Aortic Stenosis & Regurgitation

Valvular Defect	Symptoms	Signs - Murmur	Prognosis
Aortic Stenosis	Chest pain, syncope, asymptomatic if not severe	Systolic crescendo-decrescendo murmur, loudest @ 2nd Rt IC space, radiates to neck and downwards. Heard between S1 and S2.	Common cause of CHF. If it causes LVH, a risk factor for IHD. Valve replacement helpful if done prior to LVH. LVH common.
Aortic Regurgitation	Dangerous if acute and severe. Flash pulmonary edema.	Diastolic decrescendo murmur. Can be Lt or Rt IC space, radiates parasternally.	If significant, replacement is necessary. Volume-overload LVH.

Cardiogenic Shock

Asymptomatic unless severe
Causes bounding, water-hammer pulse (large pulse pressure)
Heard after S2 - starts strong/loud then becomes less
This is found in eccentric hypertrophy and CHF over time in significant defects

Mitral Valve Prolapse

Many patients are asymptomatic
Most have a good prognosis, surgery not usually needed urgently
Many have non-specific findings – pre-syncope, palpitations, poorly-characterized chest pain
If regurgitation develops + LVH then surgery is more urgently needed

Mitral Valve Regurgitation

Asymptomatic if regurgitation is minor
If LVH or symptomatic (CHF symptoms) then surgery more urgently needed
Volume overload, CHF symptoms if severe
Holosystolic murmur, hard to hear S1, usually best heard at apex but sometimes can radiate to heart base

Mitral Valve Stenosis

Often asymptomatic, when symptoms do appear it's due to elevated atrial pressures
Cough, dyspnea (worsens with exercise)
Opening snap then rumbling, diastolic murmur that is best heard at the apex
Symptomatic patients and those with severely reduced MV orifice usually need surgery

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Description

Test your knowledge on heart failure and valvular pathology, including causes, diagnosis, and treatment options. This quiz covers essential information about the cardiovascular system and its disorders, focusing on medications and underlying conditions. Perfect for students and healthcare professionals alike!