The Heart Institute

Caridology Fellows Valve Exam

1. The principal causes of valvular AS except:

a. Congenital bicuspid valve with superimposed calcification
b. Calcification of a normal trileaflet valve
c. Rheumatic disease
d. Unicuspid valves
2. Key features of the PE in patients with AS
a. Palpaation of the carotid upstroke revealing slow rising, late peaking, low amplitude
carotid pulse
b. Pulsus parvus et tardus is not specific for severe AS
c. Normal carotid pulse excludes severe AS
d. Splitting of S1
3. Normal aortic valve area in adult
a. 1-2 cm2
b. 2-3cm2
c. 3-4cm2
d. 4-6cm2
4. True of the annual hemodynamic progression of AS
a. Decrease in the AVA of 0.3cm2/yr
b. Increase in aortic jet velocity of 0.4m/sec/yr
c. Increase in mean gradient of 7mmHg/yr
d. Serum BNP can be used in the risk stratification of symptomatic patients
5. Chronic pressure overload in AS results in
a. CLVH with increased wall thickness and chamber size
b. Afterload normalization maintaining LV contractile function
c. Decreased myocardial cell mass and increased interstitial fibrosis resulting to systolic
dysfunction
d. LV pressure pulse exhibits a rounded summit and doppler velocity curve of
progressively later peak
6. Severe obstruction to LV outflow is characterized by all except
a. Aortic jet velocity of >4m/sec
b. Mean systolic gradient of at least 60mmHg in the presence of normal cardiac output
c. An EROA of <0.6cm2/sq meter BSA or 25% of the normal aortic orifice
d. An EROA of <1cm2
7. True in the management of AS
a. All patients should be cautioned against vigorous athletic sports and physical
activities
b. Echocardiography should be conducted every 1-2 years for severe AS
c. AVR is recommended for adults with symptomatic AS even with mild symptoms
d. TAVI benefits those with STS score of >15
8. Predictor of clinical outcome of AR except
 a. LV size
b. Systolic function
c. Quantitative measures of AR
d. Age
9. Criteria for acute AR except
a. Vena contracta >06cm
b. RF >50% or more than
c. ERO >0.3cm2 or more than
d. RV > 50ml/beat or more
10. True of hemodynamics in AR
a. Immediately after valve replacement: decrease both ESV and EDV, Ef initially
increases then decreases
b. Acute AR: Total stroke volume increases, Forward SV increased
c. Chronic decompensated AR: increased in ESV, decreased in total and Forward SV,
decrease EF
d. Chronic compensated AR: increased EDV, increase in total and forward SV, ELVH
11. Management of AR except
a. Mild to moderate AR who are asymptomatic requires no therapy but needs echo
twice annually
b. RAS blocker provides vasodilatation and reduce interstitial fibrosis and remodeling
c. CMR is helpful in all patients with AR
d. Nifedipine, ACEI and BB are anti hypertensives of choice
12. Indications for surgical repair In AVR
a. Asymptomatic chronic severe AR with EF >50%, LVESD of <50mm
b. Asymptomatic chronic severe AR with EF <50%
c. Asymptomatic chronic severe AR with EF >50%, LVEDD > 65MM with high surgical
risk
d. Asymptomatic chronic severe AR with EF >50%,LVEDD <50mm, <65mm
13. Acute AR except
a. Caused commonly by IE, aortic dissection and trauma
b. Characterized by tachycardia and increase diastolic pressures
c. Forward SV is higher
d. Can cause profound hypotension and sudden CV collapse

Matching type

14. Symptomatic severe high gradient AS

15. Symptomatic severe low gradient AS with reduced LVEF
16. Symptomatic severe low gradient AS with paradoxical low flow severe AS
17. Asymptomatic severe S with LV dysfunction
18. Asymptomatic severe AS
a. AV max >= 4m/sec; AVA <1cm2, LV diastolic dysfunction, normal LVEF
b. AV max >= 4m/sec; AVA <1cm2, LV diastolic dysfunction, LVEF <50%
 c. AV max >= 4m/sec; AVA <1cm2, LV diastolic dysfunction, LVEF <50%, heart failure,
angina and syncope
d. AV max >= 4m/sec; AVA <1cm2, LV diastolic dysfunction, pulmonary HTN with
dyspnea, angina and syncope
e. AV max >= 4m/sec; AVA <1cm2, small LV chamber with low stroke volume and
restrictive filling, LVEF >50%

19. Austin flint murmur

20. Pinkish purplish cheek
21. Sharp carotid upstroke
22. Delayed carotid upstroke
a. AR
b. AS
c. MS
d. MR