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Category: Cardiology--->Valvular heart disease and Endocarditis
Page: 16

Question 76# Print Question

A 42-year-old woman, who underwent mitral valve replacement with a bileaflet tilting disk valve for rheumatic disease, presents to the emergency room with complaints of severe dyspnea. On examination, she has a BP of 120/60 mmHg. Heart rate is 83 bpm. Chest reveals bilateral crackles, one-third up. Cardiac examination reveals a nondisplaced PMI. Prosthetic clicks are muffled. A long diastolic rumble is heard at the apex. Her past medical history is otherwise unremarkable.

An echocardiogram is ordered on the above patient.

Which of the following would you expect to see?

A. Severe MR
B. Mean gradient across the mitral prosthesis of 17 mmHg
C. Pressure half-time of 80 milliseconds
D. Ejection fraction of 20%


Question 77# Print Question

A 26-year-old woman presents to your office for evaluation. She was told she had a murmur many years ago. She has a history of palpitations, but is otherwise asymptomatic. On examination, she is in no acute distress. Prominent v waves are noted in the JVP. Carotid upstrokes are normal. Chest is clear to auscultation. Cardiac examination reveals a nondisplaced PMI. Auscultation reveals a widely split first heart sound, with a loud second component that sounds like a click. A holosystolic murmur is heard at the right sternal border, which increases with inspiration. Hepatomegaly is present. An echocardiogram is performed (Fig. below).

What is the most likely cause for her palpitations?

A. Arrhythmias secondary to an accessory pathway
B. AV nodal reentrant tachycardia
C. Ventricular tachycardia
D. Atrial fibrillation
E. Anxiety


Question 78# Print Question

A 26-year-old woman presents to your office for evaluation. She was told she had a murmur many years ago. She has a history of palpitations, but is otherwise asymptomatic. On examination, she is in no acute distress. Prominent v waves are noted in the JVP. Carotid upstrokes are normal. Chest is clear to auscultation. Cardiac examination reveals a nondisplaced PMI. Auscultation reveals a widely split first heart sound, with a loud second component that sounds like a click. A holosystolic murmur is heard at the right sternal border, which increases with inspiration. Hepatomegaly is present. An echocardiogram is performed (Fig. below).

No intervention is performed for the patient. She returns to your clinic 3 months later. She describes an episode of transient word-finding difficulty, which lasted for a number of seconds. This occurred while she was recovering from a fractured tibia. A CT scan was performed, which was negative. She is concerned that she may have a recurrence.

What is the most appropriate next test for her?

A. Echocardiography with saline contrast study
B. Carotid Dopplers
C. 24-hour ambulatory electrocardiographic monitoring
D. Right heart catheterization with oxygen saturation run


Question 79# Print Question

A 21-year-old man presents to your office for evaluation. He tells you that a murmur was noted a few days after birth. He is presently asymptomatic. On examination, he is normotensive. Pulse is 65 bpm and regular. Carotid upstrokes are normal. Chest is clear. Cardiac examination reveals a nondisplaced PMI. An RV lift is present. A systolic thrill is present in the suprasternal notch. A highpitched sound is heard after S1 . A crescendo–decrescendo systolic murmur is heard at the left second intercostal space. A2 is normal.

Which of the following would you expect to find on echocardiography?

A. Vmax across the aortic valve of 4 m/s
B. Vmax across the pulmonic valve of 4 m/s
C. A wide jet of mitral insufficiency
D. Flow reversal in the hepatic veins


Question 80# Print Question

A 21-year-old man presents to your office for evaluation. He tells you that a murmur was noted a few days after birth. He is presently asymptomatic. On examination, he is normotensive. Pulse is 65 bpm and regular. Carotid upstrokes are normal. Chest is clear. Cardiac examination reveals a nondisplaced PMI. An RV lift is present. A systolic thrill is present in the suprasternal notch. A highpitched sound is heard after S1 . A crescendo–decrescendo systolic murmur is heard at the left second intercostal space. A2 is normal.

The patient returns 1 year later for follow-up.

Which of the following is a definite indication for intervention?

A. He tells you of an episode of syncope
B. No symptoms, but RV to PA peak gradient of 30 to 39 mmHg
C. No symptoms, but RV to PA peak gradient of 20 to 29 mmHg
D. He has occasional feelings that his heart has extra beats




Category: Cardiology--->Valvular heart disease and Endocarditis
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