Master the board step 3

Cardiology
Valvular Lesion Standing/Valsalva Diuretics Indicated
Aortic stenosis (AS) Decrease Yes (replace best)
Aortic regurgitation (AR) Decrease Yes
Mitral stenosis (MS) Decrease Yes (balloon best)
Mitral regurgitation (MR) Decrease Yes
Ventricular septal defect (VSD) Decrease Yes
Hypertrophic obstructive
cardiomyopathy (HOCM)
Increase
No
Mitral valve prolapse (MVP) Increase No
Valvular Lesion Amyl Nitrate ACE Inhibitor Indicated
Aortic stenosis (AS) Increase No
Aortic regurgitation (AR) Decrease Yes
Mitral stenosis (MS) Negligible effect No
Mitral regurgitation (MR) Decrease Yes
Ventricular septal defect (VSD) Decrease Yes
Hypertrophic obstructive
cardiomyopathy (HOCM)
Increase
No
Mitral valve prolapse (MVP) Increase No
Aortic Stenosis (AS)
Aortic stenosis most commonly presents with chest pain. Syncope and CHF
are less common presentations. The patient will be older and often has a history
of hypertension. Coronary artery disease will be present in as many as
50 percent of patients.
Prognosis is as follows:
··
Coronary disease: 3- to 5-year average survival
··
Syncope: 2- to 3-year average survival
··
CHF: 1.5- to 2-year average survival
On CCS, the intensity,
radiation, and location
of the murmur will
automatically be provided
with the cardiovascular
examination. There is
no need to ask for them
separately.
Basic Science Correlate
Mechanism of Syncope/Angina in AS
In AS, a stiff valve just proximal to the entry point of coronaries blocks blood flow
into the vertebral and basilar arteries and carotids. No flow to brain = Passing
out. Thus, AS causes LV hypertrophy. LV hypertrophy = Increased demand.
AS = Blocked flow with increased demand = Chest pain
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