Vascular Heart Diseases MCQs

Syndromes with MVP as a feature Marfan syndrome Ehler Danlos syndrome Klinefelter syndrome Osteogenesis imperfecta Autosomal dominant Polycystic kidney disease Pseudoxanthoma elasticum Barlow syndrome is synonymous with Mitral valve prolapse Noonan syndrome is associated with peripheral pulmonary artery stenosis, hypertrophic cardiomyopathy and atrial septal defect. Reference : Harrison's Principles of Internal Medicine 21 st edition Page 2000

From the options above, For renal artery stenosis, MRA remains the best investigation with high sensitivities and specificities. MRI is not effective for detecting stent thrombosis. CT angiography provides excellent imaging of the vessels and is less affected by stents. Risk of contrast nephropathy in renal impairment. Though Intra Arterial angiography remains Gold standard for diagnosis of Large vessel diseases. Doppler is very less expensive but is operator dependent and not useful for distal renal arteries and Fibromuscular dysplasia. Captopril renography has strong negative predictive value. Reference: Harrison's Principles of Internal Medicine, 21 st ed, Ch: 278, Pg: 2088-2089.

Typically, a small VSD generates a pansystolic murmur at the left sternal border(LSB) accompanied by a thrill. The murmur may be heard at the apex but is usually loudest at the LSB . Very small defects may generate an early/late systolic murmur. Reference: Harrison's Principles of Internal Principles, 20 th edition, ch:234,264 pg:1673,1833

The patient is a IV drug abuser, who was presumed to be not well for the past few weeks. IV drug abuse increases the risk of Infective endocarditis. So the patient probably died of an untreated Infective endocarditis. The appearance of kidneys in IE is 'Flea Bitten' and microscopy shows immune complex deposition. It is more common in Sub Acute Bacterial endocarditis than Acute, since acute will be more symptomatic and the patient would have got treated. SLE presents with varying degrees of proliferation. Moreover, the history of drug abuse cant be ignored. Reference: Harrison's Principles of Internal Medicine, 21 st ed, Pg: 2337.

Causes of continuous murmur These murmurs persist throughout systole and diastole . Causes include : Patent ductus arteriosus Coronary arteriovenous fistula Rupture sinus of Valsalva aneurysm Aortopulmonary window ASD with MS Anomalous left coronary artery Reference : Harrison's Principles of Internal Medicine 21 st edition Page 2012

Bicuspid aortic valve is perhaps the most common form of congenital heart disease in adults (0.5-1.4% of population). Bicuspid aortic valve (BAV) tends to occur sporadically although it can also be inherited in an autosomal dominant pattern. The prevalence of BAV disease among first-degree relatives of an affected individual is ~10%. Complications that can occur in BAV include aortic stenosis, aortic regurgitation and increased risk of aortic dissection. Aortic aneurysm may also be coexistent with BAV. Bicuspid valves have a propensity to wear out and calcify with aging . So an aortic valve replacement is eventually likely to be required in the 5th and 6th decades of life. BAV is seen in association with turner's syndrome . Reference: Harrison's Principles of Internal Principles, 20 th edition, ch:256 pg:1803,1804,1807

Warfarin is the anticoagulant of choice in valvular AF, For patients with AF or atrial flutter and an elevated CHA2DS2-VASc score of 2 or greater in men or 3 or greater in women, anticoagulation with warfarin (INR 2.0-3.0), is recommended.

Up to half of patients presenting with Streptococcus bovis endocarditis have colorectal tumors. Reference: Harrison's Principles of Internal Medicine, 21 st ed, Ch: 81 Pg: 638