Podcast
Questions and Answers
A 10-year-old child presents with new onset migratory polyarthritis, fever, and a rash following a recent sore throat. Which of the following is the most likely underlying etiology of these findings?
A 10-year-old child presents with new onset migratory polyarthritis, fever, and a rash following a recent sore throat. Which of the following is the most likely underlying etiology of these findings?
- Type III hypersensitivity reaction with immune complex deposition in joints
- Direct bacterial invasion of the synovium by Streptococcus pyogenes
- Molecular mimicry and antibody cross-reactivity following Group A streptococcal infection (correct)
- Type II hypersensitivity reaction to streptococcal M protein
According to the revised Jones criteria, which of the following is considered a major criterion for the diagnosis of acute rheumatic fever?
According to the revised Jones criteria, which of the following is considered a major criterion for the diagnosis of acute rheumatic fever?
- Prolonged PR interval on ECG
- Polyarthritis (correct)
- Elevated erythrocyte sedimentation rate
- Fever ≥ 38.5°C
A patient diagnosed with acute rheumatic fever is being treated. Which valvular lesion is the most common long-term sequelae of this condition?
A patient diagnosed with acute rheumatic fever is being treated. Which valvular lesion is the most common long-term sequelae of this condition?
- Aortic stenosis
- Tricuspid regurgitation
- Mitral stenosis (correct)
- Pulmonary regurgitation
A patient with suspected aortic stenosis is being evaluated. Which of the following physical exam findings is most suggestive of severe aortic stenosis?
A patient with suspected aortic stenosis is being evaluated. Which of the following physical exam findings is most suggestive of severe aortic stenosis?
In a patient with aortic stenosis, which of the following symptoms indicates advanced disease and a poorer prognosis?
In a patient with aortic stenosis, which of the following symptoms indicates advanced disease and a poorer prognosis?
Echocardiography is performed on a patient with suspected aortic stenosis. Which echocardiographic finding is consistent with severe aortic stenosis?
Echocardiography is performed on a patient with suspected aortic stenosis. Which echocardiographic finding is consistent with severe aortic stenosis?
A 75-year-old patient with symptomatic severe aortic stenosis is deemed a poor surgical candidate. Which of the following is a less invasive treatment option to provide symptomatic relief?
A 75-year-old patient with symptomatic severe aortic stenosis is deemed a poor surgical candidate. Which of the following is a less invasive treatment option to provide symptomatic relief?
Which of the following is the primary pathophysiological mechanism in chronic aortic regurgitation?
Which of the following is the primary pathophysiological mechanism in chronic aortic regurgitation?
A patient with chronic aortic regurgitation may remain asymptomatic for many years due to which compensatory mechanism?
A patient with chronic aortic regurgitation may remain asymptomatic for many years due to which compensatory mechanism?
Which of the following physical exam findings is classic for aortic regurgitation?
Which of the following physical exam findings is classic for aortic regurgitation?
An Austin Flint murmur is associated with which valvular heart disease?
An Austin Flint murmur is associated with which valvular heart disease?
Which class of medications is generally contraindicated in patients with aortic regurgitation?
Which class of medications is generally contraindicated in patients with aortic regurgitation?
According to the provided information, surgical intervention is recommended for chronic aortic regurgitation when the left ventricular ejection fraction falls below what percentage?
According to the provided information, surgical intervention is recommended for chronic aortic regurgitation when the left ventricular ejection fraction falls below what percentage?
A 75-year-old male presents to the emergency department with acute chest tightness and shortness of breath. Physical exam reveals a holosystolic murmur best heard at the apex. ECG shows evidence of myocardial infarction. Which valvular disease is most likely in this scenario?
A 75-year-old male presents to the emergency department with acute chest tightness and shortness of breath. Physical exam reveals a holosystolic murmur best heard at the apex. ECG shows evidence of myocardial infarction. Which valvular disease is most likely in this scenario?
What is the most common etiology of mitral stenosis?
What is the most common etiology of mitral stenosis?
Which of the following is a characteristic auscultatory finding in mitral stenosis?
Which of the following is a characteristic auscultatory finding in mitral stenosis?
A patient with mitral stenosis develops atrial fibrillation. What is the most significant hemodynamic consequence of atrial fibrillation in this patient population?
A patient with mitral stenosis develops atrial fibrillation. What is the most significant hemodynamic consequence of atrial fibrillation in this patient population?
What is the primary treatment strategy for symptomatic mitral stenosis?
What is the primary treatment strategy for symptomatic mitral stenosis?
Mitral regurgitation is defined as:
Mitral regurgitation is defined as:
A loud, high-pitched pansystolic murmur radiating to the axilla is most characteristic of which valvular lesion?
A loud, high-pitched pansystolic murmur radiating to the axilla is most characteristic of which valvular lesion?
What is the most common cause of mitral valve prolapse?
What is the most common cause of mitral valve prolapse?
Which auscultatory finding is most specific for mitral valve prolapse?
Which auscultatory finding is most specific for mitral valve prolapse?
In tricuspid stenosis, the diastolic murmur is typically augmented by:
In tricuspid stenosis, the diastolic murmur is typically augmented by:
Functional tricuspid regurgitation is most commonly secondary to:
Functional tricuspid regurgitation is most commonly secondary to:
A patient with tricuspid regurgitation is likely to exhibit which of the following physical exam findings related to venous congestion?
A patient with tricuspid regurgitation is likely to exhibit which of the following physical exam findings related to venous congestion?
Pulmonic stenosis is most commonly caused by:
Pulmonic stenosis is most commonly caused by:
A harsh systolic ejection murmur heard best at the 2nd left intercostal space, often with a palpable thrill, is characteristic of:
A harsh systolic ejection murmur heard best at the 2nd left intercostal space, often with a palpable thrill, is characteristic of:
Pulmonic regurgitation is most commonly associated with:
Pulmonic regurgitation is most commonly associated with:
Which of the following best describes the murmur of pulmonic regurgitation due to pulmonary hypertension (Graham Steell murmur)?
Which of the following best describes the murmur of pulmonic regurgitation due to pulmonary hypertension (Graham Steell murmur)?
According to current guidelines, endocarditis prophylaxis is recommended for patients with acquired valvular heart disease in which of the following scenarios?
According to current guidelines, endocarditis prophylaxis is recommended for patients with acquired valvular heart disease in which of the following scenarios?
A 52-year-old female presents with progressive dyspnea and palpitations. Physical exam reveals bounding peripheral pulses, wide pulse pressure, and a 4/6 diastolic decrescendo murmur. Which valvular disease is most consistent with these findings?
A 52-year-old female presents with progressive dyspnea and palpitations. Physical exam reveals bounding peripheral pulses, wide pulse pressure, and a 4/6 diastolic decrescendo murmur. Which valvular disease is most consistent with these findings?
A 45-year-old male with a history of rheumatic fever presents with progressive dyspnea and palpitations. On auscultation, an opening snap followed by a diastolic rumble is heard. Which valvular disease is most likely?
A 45-year-old male with a history of rheumatic fever presents with progressive dyspnea and palpitations. On auscultation, an opening snap followed by a diastolic rumble is heard. Which valvular disease is most likely?
A 50-year-old male presents with exertional chest pain and shortness of breath. Physical exam reveals a delayed carotid upstroke and a 3/6 late-peaking systolic ejection murmur radiating to the neck. Which valvular disease is most likely?
A 50-year-old male presents with exertional chest pain and shortness of breath. Physical exam reveals a delayed carotid upstroke and a 3/6 late-peaking systolic ejection murmur radiating to the neck. Which valvular disease is most likely?
Which of the following Jones criteria is specific to rheumatic fever and is considered a major manifestation?
Which of the following Jones criteria is specific to rheumatic fever and is considered a major manifestation?
A patient with known aortic stenosis and exertional angina is being evaluated for aortic valve replacement. Which of the following stress tests is generally contraindicated in this patient population?
A patient with known aortic stenosis and exertional angina is being evaluated for aortic valve replacement. Which of the following stress tests is generally contraindicated in this patient population?
A patient with chronic aortic regurgitation who is initially asymptomatic develops symptoms of dyspnea on exertion and orthopnea. Which of the following is the most likely underlying mechanism for the development of these symptoms?
A patient with chronic aortic regurgitation who is initially asymptomatic develops symptoms of dyspnea on exertion and orthopnea. Which of the following is the most likely underlying mechanism for the development of these symptoms?
In mitral stenosis, which of the following electrocardiogram (ECG) findings is most suggestive of advanced disease and pulmonary hypertension?
In mitral stenosis, which of the following electrocardiogram (ECG) findings is most suggestive of advanced disease and pulmonary hypertension?
A patient with mitral regurgitation presents with acute onset of severe dyspnea, hypotension, and pulmonary edema. Auscultation reveals a new holosystolic murmur. Which of the following is the most appropriate immediate management strategy?
A patient with mitral regurgitation presents with acute onset of severe dyspnea, hypotension, and pulmonary edema. Auscultation reveals a new holosystolic murmur. Which of the following is the most appropriate immediate management strategy?
Which type of prosthetic valve is typically preferred for tricuspid valve replacement due to the high risk of thrombosis with mechanical valves even with adequate anticoagulation?
Which type of prosthetic valve is typically preferred for tricuspid valve replacement due to the high risk of thrombosis with mechanical valves even with adequate anticoagulation?
In a patient with pulmonic stenosis, which of the following clinical features is most likely to be present in severe cases?
In a patient with pulmonic stenosis, which of the following clinical features is most likely to be present in severe cases?
The murmur of pulmonic regurgitation (PR) can be difficult to distinguish from which other valvular regurgitation murmur by auscultation alone?
The murmur of pulmonic regurgitation (PR) can be difficult to distinguish from which other valvular regurgitation murmur by auscultation alone?
What is the primary treatment strategy for pulmonic regurgitation?
What is the primary treatment strategy for pulmonic regurgitation?
Rheumatic fever is primarily a sequelae of infection with which of the following bacterial organisms?
Rheumatic fever is primarily a sequelae of infection with which of the following bacterial organisms?
According to the revised Jones criteria, which of the following is classified as a MINOR criterion for the diagnosis of acute rheumatic fever?
According to the revised Jones criteria, which of the following is classified as a MINOR criterion for the diagnosis of acute rheumatic fever?
A 9-year-old child is diagnosed with acute rheumatic fever. Which of the following valvular lesions is most commonly affected in the late sequelae of this condition?
A 9-year-old child is diagnosed with acute rheumatic fever. Which of the following valvular lesions is most commonly affected in the late sequelae of this condition?
Which of the following clinical manifestations is a MAJOR criterion for acute rheumatic fever, as defined by the Jones criteria?
Which of the following clinical manifestations is a MAJOR criterion for acute rheumatic fever, as defined by the Jones criteria?
A child with suspected acute rheumatic fever presents with involuntary, jerky movements. Which of the following major Jones criteria is most consistent with this presentation?
A child with suspected acute rheumatic fever presents with involuntary, jerky movements. Which of the following major Jones criteria is most consistent with this presentation?
What is the recommended duration of intramuscular benzathine penicillin G prophylaxis for secondary prevention of rheumatic fever in a child with documented rheumatic heart disease?
What is the recommended duration of intramuscular benzathine penicillin G prophylaxis for secondary prevention of rheumatic fever in a child with documented rheumatic heart disease?
Which of the following is the most common etiology of aortic stenosis in older adults in developed countries?
Which of the following is the most common etiology of aortic stenosis in older adults in developed countries?
A patient with aortic stenosis develops angina, syncope, and heart failure. These symptoms typically indicate:
A patient with aortic stenosis develops angina, syncope, and heart failure. These symptoms typically indicate:
On physical examination of a patient with aortic stenosis, which of the following pulse characteristics is most suggestive of this condition?
On physical examination of a patient with aortic stenosis, which of the following pulse characteristics is most suggestive of this condition?
What is the typical auscultatory finding in aortic stenosis?
What is the typical auscultatory finding in aortic stenosis?
Which of the following echocardiographic findings is consistent with severe aortic stenosis?
Which of the following echocardiographic findings is consistent with severe aortic stenosis?
In the management of asymptomatic patients with mild to moderate aortic stenosis, which of the following is generally recommended?
In the management of asymptomatic patients with mild to moderate aortic stenosis, which of the following is generally recommended?
Which type of stress test is generally CONTRAINDICATED in patients with symptomatic severe aortic stenosis?
Which type of stress test is generally CONTRAINDICATED in patients with symptomatic severe aortic stenosis?
For a patient with symptomatic severe aortic stenosis who is deemed a poor surgical candidate, which less invasive treatment option may be considered for symptomatic relief?
For a patient with symptomatic severe aortic stenosis who is deemed a poor surgical candidate, which less invasive treatment option may be considered for symptomatic relief?
Chronic aortic regurgitation leads to which type of ventricular remodeling?
Chronic aortic regurgitation leads to which type of ventricular remodeling?
A patient with chronic aortic regurgitation may remain asymptomatic for a prolonged period due to which compensatory mechanism?
A patient with chronic aortic regurgitation may remain asymptomatic for a prolonged period due to which compensatory mechanism?
Which of the following physical exam findings is considered CLASSIC for aortic regurgitation?
Which of the following physical exam findings is considered CLASSIC for aortic regurgitation?
Which class of medications is generally contraindicated in patients with significant aortic regurgitation?
Which class of medications is generally contraindicated in patients with significant aortic regurgitation?
What is the most common cause of mitral stenosis worldwide?
What is the most common cause of mitral stenosis worldwide?
Which of the following auscultatory findings is most characteristic of mitral stenosis?
Which of the following auscultatory findings is most characteristic of mitral stenosis?
The murmur of pulmonic regurgitation due to pulmonary hypertension (Graham Steell murmur) is best described as:
The murmur of pulmonic regurgitation due to pulmonary hypertension (Graham Steell murmur) is best described as:
A 9-year-old child is diagnosed with acute rheumatic fever. Which of the following cardiac valves is most frequently affected in the late sequelae of this condition?
A 9-year-old child is diagnosed with acute rheumatic fever. Which of the following cardiac valves is most frequently affected in the late sequelae of this condition?
A harsh, late-peaking systolic ejection murmur, radiating to the neck, is a characteristic auscultatory finding in which valvular heart disease?
A harsh, late-peaking systolic ejection murmur, radiating to the neck, is a characteristic auscultatory finding in which valvular heart disease?
Which echocardiographic finding is consistent with severe aortic stenosis?
Which echocardiographic finding is consistent with severe aortic stenosis?
A patient with aortic stenosis develops exertional syncope. This symptom is primarily due to:
A patient with aortic stenosis develops exertional syncope. This symptom is primarily due to:
In chronic aortic regurgitation, which compensatory mechanism allows patients to remain asymptomatic for a prolonged period?
In chronic aortic regurgitation, which compensatory mechanism allows patients to remain asymptomatic for a prolonged period?
What is the most common etiology of mitral stenosis worldwide?
What is the most common etiology of mitral stenosis worldwide?
An opening snap followed by a diastolic rumble murmur is most characteristic of which valvular lesion?
An opening snap followed by a diastolic rumble murmur is most characteristic of which valvular lesion?
In mitral stenosis, atrial fibrillation is a common complication. What is the most significant hemodynamic consequence of atrial fibrillation in a patient with mitral stenosis?
In mitral stenosis, atrial fibrillation is a common complication. What is the most significant hemodynamic consequence of atrial fibrillation in a patient with mitral stenosis?
A loud, high-pitched pansystolic murmur radiating to the axilla is most characteristic of:
A loud, high-pitched pansystolic murmur radiating to the axilla is most characteristic of:
Myxomatous degeneration is the most common pathological finding associated with:
Myxomatous degeneration is the most common pathological finding associated with:
In tricuspid stenosis, the diastolic murmur intensity is typically augmented by:
In tricuspid stenosis, the diastolic murmur intensity is typically augmented by:
Which of the following non-surgical treatments is contraindicated in patients with symptomatic aortic stenosis?
Which of the following non-surgical treatments is contraindicated in patients with symptomatic aortic stenosis?
A patient presents with signs and symptoms suggestive of acute rheumatic fever. According to the revised Jones criteria, what is the minimum requirement of major and minor criteria, along with evidence of preceding streptococcal infection, to diagnose acute rheumatic fever?
A patient presents with signs and symptoms suggestive of acute rheumatic fever. According to the revised Jones criteria, what is the minimum requirement of major and minor criteria, along with evidence of preceding streptococcal infection, to diagnose acute rheumatic fever?
A 74-year-old man presents with progressive dyspnea, dizziness on exertion, and no history of MI. Physical exam reveals a systolic murmur at the right upper sternal border radiating to the carotids. Which finding would support the diagnosis?
A 74-year-old man presents with progressive dyspnea, dizziness on exertion, and no history of MI. Physical exam reveals a systolic murmur at the right upper sternal border radiating to the carotids. Which finding would support the diagnosis?
In which of the following patients would surgical valve replacement be most urgent?
In which of the following patients would surgical valve replacement be most urgent?
Which of the following is not a typical feature of chronic aortic regurgitation on physical exam?
Which of the following is not a typical feature of chronic aortic regurgitation on physical exam?
A 70-year-old man with severe AI is being managed medically. Which medication class should be avoided due to its effect on diastolic time?
A 70-year-old man with severe AI is being managed medically. Which medication class should be avoided due to its effect on diastolic time?
A patient has a diastolic murmur with an opening snap, best heard in the left lateral decubitus position. Which other finding is most consistent with this diagnosis?
A patient has a diastolic murmur with an opening snap, best heard in the left lateral decubitus position. Which other finding is most consistent with this diagnosis?
Which of the following is a surgical indication in a patient with chronic AI?
Which of the following is a surgical indication in a patient with chronic AI?
Which valvular disease is most likely in a patient with a mid-systolic click and a late systolic murmur at the apex that varies with position?
Which valvular disease is most likely in a patient with a mid-systolic click and a late systolic murmur at the apex that varies with position?
A patient has a new diagnosis of mitral stenosis. Which of the following findings suggests the disease has progressed significantly?
A patient has a new diagnosis of mitral stenosis. Which of the following findings suggests the disease has progressed significantly?
A patient with dyspnea and a holosystolic murmur at the apex radiating to the axilla is diagnosed with mitral regurgitation. Which of the following is most accurate regarding acute vs chronic presentation?
A patient with dyspnea and a holosystolic murmur at the apex radiating to the axilla is diagnosed with mitral regurgitation. Which of the following is most accurate regarding acute vs chronic presentation?
A 28-year-old IV drug user presents with fever and a new murmur. JVP is elevated and a holosystolic murmur is heard at the LLSB, louder with inspiration. What is the most likely diagnosis?
A 28-year-old IV drug user presents with fever and a new murmur. JVP is elevated and a holosystolic murmur is heard at the LLSB, louder with inspiration. What is the most likely diagnosis?
A 72-year-old man with chronic hypertension is found to have a systolic murmur radiating to the carotids. What is the most likely cause of his valve disease?
A 72-year-old man with chronic hypertension is found to have a systolic murmur radiating to the carotids. What is the most likely cause of his valve disease?
A 45-year-old man has a loud diastolic murmur and bounding pulses. He had a febrile illness 2 weeks ago and now has a wide pulse pressure. What is the most likely etiology?
A 45-year-old man has a loud diastolic murmur and bounding pulses. He had a febrile illness 2 weeks ago and now has a wide pulse pressure. What is the most likely etiology?
A patient is found to have mitral stenosis. Which feature helps distinguish a rheumatic etiology from other causes?
A patient is found to have mitral stenosis. Which feature helps distinguish a rheumatic etiology from other causes?
A 65-year-old man presents with exertional dyspnea and angina. He has a systolic ejection murmur at the right upper sternal border. Which of the following is a contraindication to treadmill stress testing?
A 65-year-old man presents with exertional dyspnea and angina. He has a systolic ejection murmur at the right upper sternal border. Which of the following is a contraindication to treadmill stress testing?
Which valvular lesion most often results from papillary muscle rupture following myocardial infarction?
Which valvular lesion most often results from papillary muscle rupture following myocardial infarction?
Which of the following murmurs is always pathological and should prompt echocardiography in older adults?
Which of the following murmurs is always pathological and should prompt echocardiography in older adults?
A 67-year-old patient is diagnosed with severe aortic stenosis. He has no symptoms but is found to have reduced EF. What is the most appropriate next step?
A 67-year-old patient is diagnosed with severe aortic stenosis. He has no symptoms but is found to have reduced EF. What is the most appropriate next step?
Which of the following features best distinguishes tricuspid regurgitation from mitral regurgitation on physical exam?
Which of the following features best distinguishes tricuspid regurgitation from mitral regurgitation on physical exam?
A patient has severe MR and is being considered for surgery. Which of the following is not a standard surgical trigger in chronic MR?
A patient has severe MR and is being considered for surgery. Which of the following is not a standard surgical trigger in chronic MR?
A 70-year-old man is found to have mild aortic stenosis on routine echo. What is the recommended management?
A 70-year-old man is found to have mild aortic stenosis on routine echo. What is the recommended management?
A patient with severe chronic aortic regurgitation has a low-pitched diastolic rumble heard at the apex. There is no mitral stenosis. What murmur is this?
A patient with severe chronic aortic regurgitation has a low-pitched diastolic rumble heard at the apex. There is no mitral stenosis. What murmur is this?
Which murmur is associated with pulmonary hypertension and heard as a high-pitched early diastolic sound along the left sternal border?
Which murmur is associated with pulmonary hypertension and heard as a high-pitched early diastolic sound along the left sternal border?
A 70-year-old man with a mechanical aortic valve presents for follow-up. He is currently taking aspirin 81 mg daily. What is the most appropriate adjustment?
A 70-year-old man with a mechanical aortic valve presents for follow-up. He is currently taking aspirin 81 mg daily. What is the most appropriate adjustment?
Which of the following findings is least helpful in distinguishing mitral regurgitation from aortic regurgitation on auscultation?
Which of the following findings is least helpful in distinguishing mitral regurgitation from aortic regurgitation on auscultation?
A 74-year-old woman has mitral stenosis with a mean pressure gradient of 7 mmHg and valve area of 1.3 cm². She is asymptomatic. What is the appropriate next step?
A 74-year-old woman has mitral stenosis with a mean pressure gradient of 7 mmHg and valve area of 1.3 cm². She is asymptomatic. What is the appropriate next step?
Which of the following is most predictive of disease severity in mitral stenosis?
Which of the following is most predictive of disease severity in mitral stenosis?
A 69-year-old patient has a systolic murmur best heard at the apex, radiating to the axilla. Which of the following would make this murmur louder?
A 69-year-old patient has a systolic murmur best heard at the apex, radiating to the axilla. Which of the following would make this murmur louder?
A 65-year-old man has a crescendo-decrescendo systolic murmur at the right upper sternal border. He has normal LV function but is symptomatic with exertional dizziness. What is the most appropriate next step?
A 65-year-old man has a crescendo-decrescendo systolic murmur at the right upper sternal border. He has normal LV function but is symptomatic with exertional dizziness. What is the most appropriate next step?
Which of the following is a common complication of mitral stenosis?
Which of the following is a common complication of mitral stenosis?
A patient with mitral regurgitation is undergoing TTE. Which of the following findings indicates the need for surgical referral?
A patient with mitral regurgitation is undergoing TTE. Which of the following findings indicates the need for surgical referral?
Flashcards
Rheumatic Fever
Rheumatic Fever
Inflammatory disease after untreated strep throat. Affects joints, heart, skin, brain.
Major Jones Criteria
Major Jones Criteria
Polyarthritis, carditis, subcutaneous nodules, erythema marginatum, Sydenham's chorea.
Minor Jones Criteria
Minor Jones Criteria
Fever, arthralgia, elevated ESR/CRP, prolonged PR interval on ECG.
Rheumatic Fever Treatment
Rheumatic Fever Treatment
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Aortic Stenosis
Aortic Stenosis
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Aortic Stenosis Etiology
Aortic Stenosis Etiology
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Aortic Stenosis Symptoms
Aortic Stenosis Symptoms
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Aortic Stenosis Murmur
Aortic Stenosis Murmur
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Aortic Stenosis Diagnosis
Aortic Stenosis Diagnosis
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Aortic Stenosis Treatment
Aortic Stenosis Treatment
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Aortic Regurgitation
Aortic Regurgitation
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Chronic Aortic Regurgitation
Chronic Aortic Regurgitation
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Acute Aortic Regurgitation
Acute Aortic Regurgitation
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Chronic AR Pathophysiology
Chronic AR Pathophysiology
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Aortic Regurgitation Symptoms
Aortic Regurgitation Symptoms
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Aortic Regurgitation Murmur
Aortic Regurgitation Murmur
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AR Physical Exam
AR Physical Exam
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Aortic Regurgitation Diagnosis
Aortic Regurgitation Diagnosis
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Medical Management Aortic Regurgitation
Medical Management Aortic Regurgitation
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When to consider surgical intervention for Aortic Regurgitation
When to consider surgical intervention for Aortic Regurgitation
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Mitral Stenosis
Mitral Stenosis
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Mitral Stenosis Etiology
Mitral Stenosis Etiology
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Mitral Stenosis Symptoms
Mitral Stenosis Symptoms
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Mitral Stenosis Murmur
Mitral Stenosis Murmur
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Mitral Stenosis Diagnosis
Mitral Stenosis Diagnosis
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Mitral Stenosis Treatment
Mitral Stenosis Treatment
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Mitral Regurgitation
Mitral Regurgitation
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Acute Mitral Regurgitation
Acute Mitral Regurgitation
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Chronic Mitral Regurgitation
Chronic Mitral Regurgitation
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Mitral Regurgitation Murmur
Mitral Regurgitation Murmur
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Mitral Regurgitation Diagnosis
Mitral Regurgitation Diagnosis
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Mitral Regurgitation Treatment
Mitral Regurgitation Treatment
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Mitral Valve Prolapse
Mitral Valve Prolapse
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Mitral Valve Prolapse Etiology
Mitral Valve Prolapse Etiology
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Mitral Valve Prolapse
Mitral Valve Prolapse
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Treatment for Mitral Valve Prolapse
Treatment for Mitral Valve Prolapse
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Tricuspid Valve Stenosis
Tricuspid Valve Stenosis
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Murmurs related to the Tricuspid Valve Stenosis.
Murmurs related to the Tricuspid Valve Stenosis.
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Tricuspid Valve Regurgitation
Tricuspid Valve Regurgitation
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With the murmurs associated TR try and consider what this means.
With the murmurs associated TR try and consider what this means.
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Pulmonary issues and TVR
Pulmonary issues and TVR
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To find out if those are indeed serious issues try and ask.
To find out if those are indeed serious issues try and ask.
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What could this mean and how to differate?
What could this mean and how to differate?
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Usually for all these conditions the symptoms and treatment involve.
Usually for all these conditions the symptoms and treatment involve.
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What causes Rheumatic Fever?
What causes Rheumatic Fever?
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What are the Jones Criteria?
What are the Jones Criteria?
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What is Aortic Stenosis (AS)?
What is Aortic Stenosis (AS)?
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What is Concentric LVH?
What is Concentric LVH?
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What should AS patients avoid?
What should AS patients avoid?
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Aortic Insufficiency (AI)
Aortic Insufficiency (AI)
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Classic AI signs?
Classic AI signs?
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Critical AI treatment?
Critical AI treatment?
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What can be seen on CXR if a person has Mitral Senosis?
What can be seen on CXR if a person has Mitral Senosis?
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What changes if any if patient has MS during lung exam and a opening of heart?
What changes if any if patient has MS during lung exam and a opening of heart?
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What does severe MS mean?
What does severe MS mean?
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Aortic Stenosis hallmark
Aortic Stenosis hallmark
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Acute AI urgency
Acute AI urgency
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AR physical exam exclusion
AR physical exam exclusion
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AI medication to avoid
AI medication to avoid
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Mitral stenosis consequence
Mitral stenosis consequence
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Chronic AI Surgical Indication
Chronic AI Surgical Indication
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MVP hallmark
MVP hallmark
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Mitral Stenosis Progression
Mitral Stenosis Progression
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Acute MR
Acute MR
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Tricuspid regurgitation
Tricuspid regurgitation
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Common Aortic Stenosis Cause
Common Aortic Stenosis Cause
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Infective Endocarditis
Infective Endocarditis
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Rheumatic MS
Rheumatic MS
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AS contraindication
AS contraindication
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Post-MI papillary rupture
Post-MI papillary rupture
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Pathological Murmurs
Pathological Murmurs
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AS Surgical Indication
AS Surgical Indication
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Carvallo's Sign
Carvallo's Sign
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MR maneuver
MR maneuver
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Mitral Stenosis risks
Mitral Stenosis risks
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Study Notes
Aortic Stenosis (AS)
- The classic symptoms of LV outflow obstruction are heart failure, angina, and syncope, indicating advanced disease.
- Physical exam may reveal pulsus parvus et tardus (weak/slow rising carotid pulse).
- Severe AS (valve area <1.0 cm²) is a contraindication to treadmill stress testing due to the risk of syncope or sudden death.
- Degenerative calcification is a common cause of AS in patients >70 years old.
- In the absence of symptoms, avoid strenuous activity.
- Severe AS with reduced EF is a surgical indication, even if asymptomatic.
Aortic Insufficiency (AI) or Aortic Regurgitation (AR)
- Acute AI due to endocarditis is a surgical emergency due to hemodynamic instability. Urgent aortic valve replacement (AVR) is indicated.
- In chronic AI, beta-blockers should be avoided as they prolong diastole and worsen aortic regurgitation.
- Surgical intervention for chronic AI is indicated if EF < 55% or LVESD > 55 mm.
- In chronic AR shows a diastolic murmur, Austin Flint, and bounding pulses.
Mitral Stenosis (MS)
- Advanced MS can lead to pulmonary hypertension, RV strain, and loud P2 with RV heave.
- Physical exam may reveal a diastolic murmur with an opening snap, best heard in the left lateral decubitus position.
- Longer diastolic rumble duration indicates longer pressure gradient/more severe MS.
Mitral Regurgitation (MR)
- Acute MR is poorly tolerated because there is no time for LA/LV remodeling, leading to a rapid rise in pressure, pulmonary edema, and collapse.
- Treatment of acute MR consists of emergent valve repair or replacement.
- A surgical trigger in severe MR is the new onset of atrial fibrillation, even with normal EF.
- Dyspnea and a holosystolic murmur at the apex radiating to axilla is indicative of MR.
- Increased regurgitant murmurs with handgrip.
Mitral Valve Prolapse (MVP)
- Physical exam may reveal a mid-systolic click and a late systolic murmur, best heard at apex in LDD.
Tricuspid Regurgitation (TR)
- IV drug use with a systolic murmur that increases with inspiration should be suspected.
- Murmur intensity which increases with inspiration (Carvallo's sign) distinguishes TR from MR.
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