Name:______________________________________

MITRAL VALVE DISEASE QUIZ CHAPTER 69

1) What affect would severe mitral valve stenosis have on the S1 heart sound?

A. Widened splitting

B. Absence of splitting

C. Increased intensity

D. Decreased intensity

2) Which of the following is the most common cause of mitral valve stenosis?

A. Severe mitral annular calcification

B. Carcinoid valve disease

C. Rheumatic valve disease

D. Congenital mitral stenosis

3) Which of the following is NOT an indication for mitral balloon valvotomy?

A. Mild mitral stenosis with the pulmonary artery systolic pressure increasing to greater than 60 mmHg
during exercise, favorable valve morphology and New York Heart Association functional class II
symptoms

B. Moderate mitral stenosis, favorable valve morphology and New York Heart Association functional
class II symptoms

C. Severe mitral stenosis with moderate mitral regurgitation, favorable valve morphology and New York
Heart Association functional class III symptoms

D. Severe mitral stenosis, unfavorable valve morphology (Wilkins score > 8), New York Heart Association
functional class III symptoms in a patient not a candidate for surgical mitral valve repair/replacement.

4) Which of the following pressure gradients across the mitral valve would indicate moderate mitral
valve stenosis?

A. 4 mmHg

B. 8 mmHg

C. 12 mmHg
D. 15 mmHg

5) True of mitral stenosis except:

A. The opening snap (OS) of the mitral valve is caused by a sudden tensing of the valve leaflets after the
valve cusps have completed their opening excursion.

B. A pansystolic murmur of TR and a S3 originating from the right ventricle may be audible in the fourth
intercostal space in the left parasternal region in patients with severe MS.

C. In patients with sinus rhythm, left atrial pressure curve shows a prominent atrial contraction (a wave),
with a rapid pressure decline after mitral valve opening (y descent).

D. Elevated left atrial pressure results in pulmonary artery hypertension, with secondary effects on the
pulmonary vasculature and right side of the heart.

6) True of Pulmonary hypertension in patients with MS:

A. Passive backward transmission of the elevated left atrial pressure

B. Pulmonary arteriolar dilatation, which presumably is triggered by left atrial and pulmonary venous
hypertension (reactive pulmonary hypertension)

C. Organic obliterative changes in the pulmonary vascular bed, which may be considered to be a
complication of longstanding and severe MS

D. A and B are correct

E. A and C are correct

F. All of the above

7) False of auscultatory findings in MS:

A. Accentuated S1 with prolongation of the Q-S1 interval, correlating with the level of the left atrial
pressure

B. Accentuation of S1 occurs when the mitral valve leaflets are flexible. It is caused in part by the rapidity
with which LV pressure rises at the time of mitral valve closure, as well as by the narrow closing
excursion of the leaflets.

C. Marked calcification and/or thickening of the mitral valve leaflets reduce the amplitude of S1,
probably because of diminished motion of the leaflets.

D. As pulmonary arterial pressure rises, P2 at first becomes accentuated and widely transmitted and
often can be readily heard at both the mitral and the aortic areas.

E. None of the above

8) True in the management of MS except:

A. Echocardiography is recommended every 3 to 5 years for mild stenosis, every 1 to 2 years for
moderate stenosis, and annually for severe stenosis.

B. Asymptomatic severe MS patients with LA thrombus with favorable valve morphology is warranted to
undergo PBMC and carries a class IIa recommendation.

C. Anticoagulation also may be considered for patients with severe MS and sinus rhythm when there is
severe left atrial enlargement (diameter >55 mm) or spontaneous contrast on echocardiography.

D. Beta blockers are particularly helpful in preventing rapid ventricular responses that develop during
exertion.

9) Which of the following is NOT well described symptom of severe mitral stenosis?

A. Hemoptysis

B. Gastrointestinal bleeding

C. Hoarseness of the voice

D. Dyspnea on exertion

10) Which of the following valves would have a Wilkin’s score in the range safe to perform percutaneous
mitral balloon valvotomy?

A. Highly mobile leaflets with little restriction, normal thickness of the valve leaflets, chordal thickening
2/3 up the chordal length and valvular calcification confined to the leaflet margins

B. There is forward movement of the valve leaflets in diastole, mild leaflet thickening, chordal thickening
2/3 up the chordal length and only a single focus of calcification

C. No forward movement of the mitral valve leaflets, total leaflet thickening (5-8 mm), chordal
thickening 2/3 up the chordal length, and calcification confined to the leaflet margins

11) True of hemodynamics in MR:

A. In acute MR, a decrease in preload and a decrease in afterload cause an increase in end-diastolic
volume (EDV) and a decrease in end-systolic volume (ESV), producing a decrease in total stroke volume
(TSV).

B. In the chronic compensated phase, eccentric hypertrophy has developed and EDV is now increased
substantially.
C. In the chronic decompensated phase, muscle dysfunction has developed, impairing ejection fraction,
diminishing both TSV and FSV.

D. A and B are correct

E. B and C are correct

F. All of the above

12) The following maneuvers will increase murmur of MR except:

A. isometric exercise

B. squatting

C. sudden standing

D. vasoconstrictors

13) Which of the following is most likely to cause acute severe mitral valve regurgitation from papillary
muscle rupture?

A. Anterior myocardial infarction (LAD)

B. Inferior myocardial infarction (RCA)

C. Lateral myocardial infarction (LCx)

14) Which of the following is the cause of mitral regurgitation in the setting of hypertrophic obstructive
cardiomyopathy?

A. Myocardial disarray of the papillary muscles causing dysfunction

B. Systolic anterior motion of the mitral valve leaflet into the left ventricular outflow tract

C. Mitral annular dilation causing functional mitral regurgitation

D. Mitral valve leaflet degeneration from the increased hemodynamic stress present in HOCM

15) Valve hemodynamics for severe MR except:

A. Rvol >/= 60mL

B.RF >/= 50%

C. ERO <0.4 cm2

D. Vena contracta </= 0.7

E. Central MR jet >40% LA or holosystolic eccentric jet MR

Matching Type:

16) At risk for MR

17) Progressive MR

18) Symptomatic severe MR

19) Asymptomatic severe MR

20) Acute MR

22) Chronic compensated MR

23) Chronic decompensated MR

A. Diminished total SV and forward SV, high ESV

B. Normal forward SV, normal afterload, high EDV

C. Increase preload and decrease afterload, high EDV and low ESV

D. Small VC <0.3, no MR or jet area <20%

E. ERO >2.0cm2; Rvol >30 ml, RF >50%; dyspnea responsive to revascularization

F. ERO <2.0cm2; Rvol <30 ml, RF <50%; exertional dyspnea

G. ERO >2.0cm2; Rvol >30 ml, RF >50%; exertional dyspnea

24-25 (Enumerate criteria for Wilkin’s score)