Valvular heart disease exam elabrations
1.The most common etiology of mitral stenosis in adult is?: Rheumatic
fever (99%)
-Congenital (parachute mitral valve)
2.The cardiac valves listed in decreasing order as they are affected
by rheumatic heart disease?: Mitral valve (most common)
-rheumatic fever results in four forms of fusion of the mitral valve
apparatus. Com- missural, cuspal, chordal and combined
Aortic valve
Tricuspid valve
Rarely pulmonic valve
3.Signs and symptoms of mitral stenosis secondary to rheumatic heart dis-
ease include?: 1. Passive backward transmission of the elevated left
atrial pressure 2.Arteriolar constriction
3.Organic obliterative changes in the pulmonary vascular bed, RV
pressure increase to to right ventricular failure
4.Pts with mitral stenosis, left atrial enlargement and atrial fibrillation are
at increased risk for the development of?: Thromboembolism is an
important complication of mitral stenosis.
5.Conditions that may lead to clinical symptoms that mimic those
associated with rheumatic mitral stenosis include?: Left atrial myxoma
-mobile left atrial mysoma may prolapse into the mitral valve orifice
during ventricular diastole and obstruct flow into the LV mimicking mitra
stenosis
6.The equation used in the cardiac catherization laboratory to determine
mitral valve area is?: Gorlin
-Cardiac cath may not be necessary to evluate mitral stenosis
hemodynamics including mitral valve area. It's used for CAD
7.85. The M-mode being demonstrated below is an example of?:Mitral
-Thickened mitral valve leaflet stenosis
-decreased mitral valve E-F slope
-Anterior motion of the posterior mitral valve leaflet
8.A strong indication for mitral stenosis on 2D echo is an anaterior mitral
valve leaflet that exhibit?: Diastolic doming, caused by commisure fusion
9.2D echo findings for rheumatic mitral stenosis include all of the
following except:: Reverse doming of the anterior mitral valve may be
seen in patients with sever AI
Include all of the following:
-Hockey stick appearance of the anterior mitral valve leaflet
, Valvular heart disease exam elabrations
-Increased left atrial dimension
-Thickened mitral valve leaflets and subvalvular apparatus
10.The most accurate method for determining the severity of mitral valve
stenosis is?: Performing planimetry of the mitral valve orifice by two
dimensional echo
11.Critical mitral valve stenosis is said to be present if the mitral valve
area is reduced to: < 1.0cm^2
12.Typical echo findings in a pt with isolated rheumatic mitral stenosis
in- clude all of the following except?: Dilated left ventricle
-D-shaped left ventricle with persist throughout ventricular systole and
diastole suggest a RV pressure overload
-D shaped left ventricle during ventricular diastole which become
circular in shaped during ventricular systole suggest a right ventricular
volume overload
-Left atrial enlargment
-left atrial thrombus
13.Secondary echo/doppler findings in pt with rheumatic mitral stenosis
include all of the following except?: Except: Left ventricular dilation
-Abnormal interventricular septal wall motion
-Increase right heart dimensions
-Increase tricuspid regurgitation jet
14.The classic cardiac doppler feature of mitral valve stenosis include all
of the following except:: Except: mitral valve area
-increase E velocity
-increase pressure half time
-turbulent flow
15.The abnormal mitral valve pressure half time for patients with mitral
valve stenosis is?: D. 60-90 sec
MVA (cm^2)= 220/ PHT(msec)
The abnormal range for PHT in a patient with mitral valve stenosis is 90
to 400msec
16.A deceleration time of 800 msec was obtained by CW in a pt with
rheumatic mitral valve stenosis. The pressure half time is?: Pressure half
time (msec)= Deceleration time x0.29
800msec x 0.29 = 232
17.A doppler mean pressure gradient across a stenotic mitral valve
of 22mmHg is obtained. The severity of the mitral stenosis is?:
Severe
, Valvular heart disease exam elabrations
18.Mitral stenosis is considered to be severe by all of the following criteria
except?: Except: Mitral valve doppler A wave peak velocity >1.3m/s.
Mitral stenosis, A wave ignore
, Valvular heart disease exam elabrations
-Mean pressure gradient >10mmHg
-MItral valve area <1.0cm
-Pressure half time >220msec
19.2D echo examination reveals thin mobile mitral valve leaflet tips and a
Doppler E velocity of 1.8 m/s with a pressure half time of 180msec in an
elderly pt. The most likely diagnosis is: Ms due to severe mitral
calcification, funcitonal mitral stenosis
20.All of the following are possible etiologies of anatomic mitral
regurgitation except?: Except: dilated cardiomyopathy. Functional MR is
commonly seen in pt with dilated cardiomyopathy or ischemic
cardiomyopathy
-mitral annular calcification
-mitral valve prolapse
-ruptured chordae tendinea
21.All of the following are causes for chronic mitral regurgitation except::
Ex- cept: ruptured papillary muscle, rare complication of acute MI.
Rheumatic heart disease
Cleft mitral valve
Mitral annular calcification
22.The most common cause of acute MR is?q: rupture of the chordae
tendinea due to mitral valve prolapse
23.The most common presenting symptom of significant chronic mitral
regur- gitation is: Dyspnea, orthopnea similar to CHF
24.CHF in a patient with significant chronic mitral regurgitation occurs
be- cause of increase pressure in the?: LA: increase LA pressure
25.Possible signs and symptoms associated with acute severe mitral
regurgi- tation include:: Pulmonary edema: accumulation of fluid in the
lung. PT with severe MR, LA pressure is reflected back into the
pulmonary circuit. There is rapid rise
in pulmonary pressures at the venous level, fluid is forced out of the
pulmonary capillaries and veins into the lung
26.chronic significant mitral regurgitation may result in all of the
following except:: Except: Mitral annular calcification
-LA enlargement
-LV enlargement
1.The most common etiology of mitral stenosis in adult is?: Rheumatic
fever (99%)
-Congenital (parachute mitral valve)
2.The cardiac valves listed in decreasing order as they are affected
by rheumatic heart disease?: Mitral valve (most common)
-rheumatic fever results in four forms of fusion of the mitral valve
apparatus. Com- missural, cuspal, chordal and combined
Aortic valve
Tricuspid valve
Rarely pulmonic valve
3.Signs and symptoms of mitral stenosis secondary to rheumatic heart dis-
ease include?: 1. Passive backward transmission of the elevated left
atrial pressure 2.Arteriolar constriction
3.Organic obliterative changes in the pulmonary vascular bed, RV
pressure increase to to right ventricular failure
4.Pts with mitral stenosis, left atrial enlargement and atrial fibrillation are
at increased risk for the development of?: Thromboembolism is an
important complication of mitral stenosis.
5.Conditions that may lead to clinical symptoms that mimic those
associated with rheumatic mitral stenosis include?: Left atrial myxoma
-mobile left atrial mysoma may prolapse into the mitral valve orifice
during ventricular diastole and obstruct flow into the LV mimicking mitra
stenosis
6.The equation used in the cardiac catherization laboratory to determine
mitral valve area is?: Gorlin
-Cardiac cath may not be necessary to evluate mitral stenosis
hemodynamics including mitral valve area. It's used for CAD
7.85. The M-mode being demonstrated below is an example of?:Mitral
-Thickened mitral valve leaflet stenosis
-decreased mitral valve E-F slope
-Anterior motion of the posterior mitral valve leaflet
8.A strong indication for mitral stenosis on 2D echo is an anaterior mitral
valve leaflet that exhibit?: Diastolic doming, caused by commisure fusion
9.2D echo findings for rheumatic mitral stenosis include all of the
following except:: Reverse doming of the anterior mitral valve may be
seen in patients with sever AI
Include all of the following:
-Hockey stick appearance of the anterior mitral valve leaflet
, Valvular heart disease exam elabrations
-Increased left atrial dimension
-Thickened mitral valve leaflets and subvalvular apparatus
10.The most accurate method for determining the severity of mitral valve
stenosis is?: Performing planimetry of the mitral valve orifice by two
dimensional echo
11.Critical mitral valve stenosis is said to be present if the mitral valve
area is reduced to: < 1.0cm^2
12.Typical echo findings in a pt with isolated rheumatic mitral stenosis
in- clude all of the following except?: Dilated left ventricle
-D-shaped left ventricle with persist throughout ventricular systole and
diastole suggest a RV pressure overload
-D shaped left ventricle during ventricular diastole which become
circular in shaped during ventricular systole suggest a right ventricular
volume overload
-Left atrial enlargment
-left atrial thrombus
13.Secondary echo/doppler findings in pt with rheumatic mitral stenosis
include all of the following except?: Except: Left ventricular dilation
-Abnormal interventricular septal wall motion
-Increase right heart dimensions
-Increase tricuspid regurgitation jet
14.The classic cardiac doppler feature of mitral valve stenosis include all
of the following except:: Except: mitral valve area
-increase E velocity
-increase pressure half time
-turbulent flow
15.The abnormal mitral valve pressure half time for patients with mitral
valve stenosis is?: D. 60-90 sec
MVA (cm^2)= 220/ PHT(msec)
The abnormal range for PHT in a patient with mitral valve stenosis is 90
to 400msec
16.A deceleration time of 800 msec was obtained by CW in a pt with
rheumatic mitral valve stenosis. The pressure half time is?: Pressure half
time (msec)= Deceleration time x0.29
800msec x 0.29 = 232
17.A doppler mean pressure gradient across a stenotic mitral valve
of 22mmHg is obtained. The severity of the mitral stenosis is?:
Severe
, Valvular heart disease exam elabrations
18.Mitral stenosis is considered to be severe by all of the following criteria
except?: Except: Mitral valve doppler A wave peak velocity >1.3m/s.
Mitral stenosis, A wave ignore
, Valvular heart disease exam elabrations
-Mean pressure gradient >10mmHg
-MItral valve area <1.0cm
-Pressure half time >220msec
19.2D echo examination reveals thin mobile mitral valve leaflet tips and a
Doppler E velocity of 1.8 m/s with a pressure half time of 180msec in an
elderly pt. The most likely diagnosis is: Ms due to severe mitral
calcification, funcitonal mitral stenosis
20.All of the following are possible etiologies of anatomic mitral
regurgitation except?: Except: dilated cardiomyopathy. Functional MR is
commonly seen in pt with dilated cardiomyopathy or ischemic
cardiomyopathy
-mitral annular calcification
-mitral valve prolapse
-ruptured chordae tendinea
21.All of the following are causes for chronic mitral regurgitation except::
Ex- cept: ruptured papillary muscle, rare complication of acute MI.
Rheumatic heart disease
Cleft mitral valve
Mitral annular calcification
22.The most common cause of acute MR is?q: rupture of the chordae
tendinea due to mitral valve prolapse
23.The most common presenting symptom of significant chronic mitral
regur- gitation is: Dyspnea, orthopnea similar to CHF
24.CHF in a patient with significant chronic mitral regurgitation occurs
be- cause of increase pressure in the?: LA: increase LA pressure
25.Possible signs and symptoms associated with acute severe mitral
regurgi- tation include:: Pulmonary edema: accumulation of fluid in the
lung. PT with severe MR, LA pressure is reflected back into the
pulmonary circuit. There is rapid rise
in pulmonary pressures at the venous level, fluid is forced out of the
pulmonary capillaries and veins into the lung
26.chronic significant mitral regurgitation may result in all of the
following except:: Except: Mitral annular calcification
-LA enlargement
-LV enlargement
