Cardio

Question 1

Severity of AS / MS according to the valve area

Answer 1

Mild > 1.5

Moderate 1 - 1.5

Severe < 1

Question 2

Normal aortic valve area

Answer 2

3-4

Question 3

Normal mitral valve area

Answer 3

4-6

Question 4

Signs of MS severity

Answer 4

1. Signs of pulmonary HTN
2. Signs of pulmonary congestion
3. Graham steel murmur ( pulmonary regurgitation)
4. Early opening snap ( lost with calcified leaflets)
5. Increasing length of murmur

Question 5

D.D mid diastolic rumbling murmur

Answer 5

1. Lt atrial myxoma
2. Lt atrial thrombus
3. Flow murmur ( in severe MR)
4. Austin flint murmur ( in severe AR)

Question 6

Causes of MS

Answer 6

1. Rheumatic fever
2. Degenerative
3. Congenital MS
4. CTD ( RA - SLE)
5. Carcinoid syndrome

RD 3C

Question 7

Complications of MS

Answer 7

1. AFib
2. Lt atrial enlargement
3. Lt atrial thrombus
4. Pulmonary HTN
5. Pulmonary Congestion
6. Rt heart failure

Question 8

Treatment of asymptomatic MS

Answer 8

1. Patient education as IE prophylaxis if indicated.
2. Follow up clinically & with echo ( annual if severe MS & every 2-3 years if less severe)
3. Treatment of AFib ( rate control & anticoagulation)

Question 9

Treatment of symptomatic MS

Answer 9

1. Medical treatment ( salt restriction + diuretics)
2. If worsened symptoms or developed pulmonary HTN then surgery

Question 10

What are the indications for anticoagulation in MS?

Answer 10

1. AFib
2. Lt atrial > 55 mm even if in sinus rhythm»_space; warfarin should be considered

Question 11

What are the indications of surgery in MS?

Answer 11

1. Pulmonary congestion despite adequate medical treatment
2. Pulmonary HTN
3. Hemoptysis
4. Recurrent thromboembolic events despite therapeutic anticoagulation

Question 12

What are the criteria for using valvuloplasty in MS?

Answer 12

1. Mobile valve
2. Minimal calcification of the valve
3. Absence of mitral regurgitation
4. Absence of Lt atrial thrombus on TEE echo

Question 13

Signs of severe MR

Answer 13

1.

Question 14

Signs of severe MR

Answer 14

1. Soft S1
2. S3
3. S4
4. Mid-diastolic flow murmur
5. Precordial thrill
6. Displaced apex beat ( LVH)
7. Signs of pulmonary HTN
8. Signs of pulmonary congestion

Question 15

Complications of MR

Answer 15

1. AFib
2. Thromboembolism due to AFib
3. LV dysfunction
4. Pulmonary HTN

Question 16

D.D of MR

Answer 16

1. MVP
2. TR
3. VSD

Question 17

Causes of chronic MR

Answer 17

1. Rheumatic fever
2. Degenerative ( most common)
3. CTD
4. Collagen vascular disease ( Marfan & Ehlers Danlos syndrome
5. MVP
6. Following MV surgery
7. 2ry to LV dilatation ( cardiomyopathy, ischemia)

Question 18

Causes of acute MR

Answer 18

1. IE
2. Rapture of papillary muscle due to Ischemia
3. Trauma

Question 19

Treatment of MR

Answer 19

Symptomatic MR

1. Medical treatment ( salt restriction + diuretics + dilators ACE & digoxin if in sinus rhythm )
2. If worsened symptoms or developed pulmonary HTN»_space;> surgery

Question 20

What are the indications of surgery in MR?

Answer 20

Question 21

D.D of AS

Answer 21

1. Aortic sclerosis
2. VSD
3. HOCM
4. Flow murmur
5. PS

Question 22

Causes of AS

Answer 22

1. Rheumatic fever
2. Degenerative calcification ( most common in elderly)
3. Congenital
4. Bicuspid aortic valve ( most common in young < 65 y )

Rare

5. IE
6. Hyperuricaemia

Question 23

Signs of severe AS

Answer 23

1. Low volume pulse
2. Slow rising pulse
3. Heaving apex
4. Systolic thrill
5. Soft or absent S2
6. Signs of Pulmonary HTN
7. Signs of pulmonary congestion

Question 24

Complications of AS

Answer 24

1. Sudden death
2. LVF
3. Pulmonary HTN
4. Arrhythmias
5. Heart block
6. IE
7. IDA ( heyde’s syndrome )

Question 25

Conditions associated with AS

Answer 25

1. Coarctation of aorta 2. Angiodysplasia 3. Other valvular diseases ( mitral in rheumatic valvular disease)

Question 26

Treatment of AS

Answer 26

Asymptomatic 1. Patient education 2. Follow up (6-12 monthly) for symptoms ( angina, syncope, HF) & echo 3. Avoid strenuous exercise Symptomatic 1. Surgery

Question 27

Indications of surgery in AS

Answer 27

1. Symptomatic severe aortic stenosis ( Mean gradient > 50 mmHg) 2. Moderate/ severe aortic stenosis undergoing other cardiac surgery 3. In asymptomatic aortic stenosis if Mean gradient > 40 and plus any of - LV dysfunction; EF < 50 - abnormal BP response to exercise - VT - LVH > 15 mm - valve area < 0.6 cm

Question 28

Causes of VSD

Answer 28

Congenital 1. Maternal DM 2. Maternal alcohol consumption 3. Down’s syndrome ( trisomy 21) 4. Edward’s syndrome ( trisomy 18 ) Acquired 1. Ischemia ( post MI ) 2. Iatrogenic ( complication of alcohol septal ablation)

Question 29

Complications of VSD

Answer 29

1. IE 2. Pulmonary HTN 3. LV dysfunction 4. Aortic regurgitation 5. Ventricular arrhythmias 6. Eisenmenger’s syndrome

Question 30

Management of VSD if small defects with normal pulmonary artery pressure

Answer 30

1. Re-assurance 2. IE prophylaxis

Question 31

Management of VSD if large defects with - pulmonary HTN - RVF - LVF

Answer 31

1. IE prophylaxis 2. Diuretics for congestion 3. Treatment of LV dysfunction 4. Treatment of pulmonary HTN 5. VSD closure if no contraindications

Question 32

What are the indications for VSD closure?

Answer 32

1. Increasing pulmonary: systemic blood flow ( Qp:Qs > 2:1 ) 2. LV dilatation 3. LV dysfunction 4. Recurrent endocarditis 5. Development of aortic regurgitation 6. Acute rupture of interventricular septum following myocardial infarction

Question 33

Contraindication for VSD closure

Answer 33

1. Irreversible severe pulmonary HTN

Question 34

What are the conditions that associated with HOCM?

Answer 34

1. MVP 2. WPW 3. FRIEDREICH’s Ataxia 4. Myotonic dystrophy

Question 35

Complications of HOCM

Answer 35

1. HF 2. AFib 3. Sudden Death 4. Ventricular arrhythmias 5. Angina 6. Endocarditis

Question 36

Markers of poor prognosis in HOCM

Answer 36

1. Hx of syncope 2. FHx of sudden death 3. Non-sustained VT on holter 4. Drop in BP during exercise

Question 37

Management of HOCM

Answer 37

General measures 1. IE prophylaxis 2. Patient education 3. Family screening Asymptomatic: no therapy if No LVOT obstruction Asymptomatic: B blocker if LVOT obstruction Symptomatic: A: Amiodarone for Ventricular arrhythmias B: B blocker or verapmil C: Cardioverter defibrillator (ICD) D: diuretics for congestion

Question 38

Indication of surgical myomectomy or alcohol septal ablation in HOCM if ….

Answer 38

LVOT obstruction ( LVOT gradient > 30 mmHg )

Question 39

Signs of severe AR

Answer 39

1. S3 2. Austin flint murmur 3. Signs of pulmonary HTN 4. Signs of pulmonary congestion

Question 40

Causes of collapsing pulse

Answer 40

1. AR 2. PDA 3. Pregnancy 4. Anemia 5. Thyrotoxicosis

Question 41

D.D of AR

Answer 41

1. Similar murmur: Pulmonary regurgitation 2. Causes Causes of chronic AR - bicuspid aortic valve - rheumatic fever - CTD -

Question 42

D.D of AR

Answer 42

1. Similar murmur: Pulmonary regurgitation 2. Causes Causes of chronic AR - bicuspid aortic valve - rheumatic fever - CTD - Marfan & Ehlers Danlos syndrome - syphilis - ankylosing spondylitis Acute AR - IE - aortic dissection

Question 44

Complications of AR

Answer 44

1. Endocarditis 2. Heart failure