Knowledge Check: Rheumatic Heart Disease
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Question 1 of 10
1. Question
Rheumatic heart disease results from of which of the following?
Hint
Rheumatic Heart Disease is the result of damage to the valves from repeated episodes of untreated GAS infection.
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Question 2 of 10
2. Question
Which of the following heart valves is most commonly affected in rheumatic heart disease?
Hint
Rheumatic Heart Disease is characterized more commonly by mitral valve stenosis and mitral valve regurgitation, and more rarely aortic regurgitation.
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Question 3 of 10
3. Question
Which of the following is a symptom of rheumatic heart disease?
Hint
Rheumatic heart disease is the result of repeated episodes of acute rheumatic fever and often presents similarly to patients with congestive heart failure.
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Question 4 of 10
4. Question
You are evaluating a patient who presents with dyspnea on exertion and hepatomegaly. She was diagnosed with acute rheumatic fever on three occasions in the past. On exam, you auscultate a holosystolic murmur heard best at the apex. Based on this information, what type of valvular rheumatic heart disease does this patient most likely have?
Hint
The mitral valve is heard best at the apex. A systolic murmur at the apex is typically indicative or regurgitation.
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Question 5 of 10
5. Question
A patient presents to your office with an echocardiography report that documents mitral valve stenosis. What characteristic murmur do you expect to heart on cardiac auscultation?
Hint
The mitral valve is best auscultated at the apex.
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Question 6 of 10
6. Question
You are evaluating a patient who presents with orthopnea and peripheral edema. Given his history with multiple untreated group A streptococcal infections, you are concerned about rheumatic heart disease. On exam you note a diastolic decrescendo murmur heard at the upper left sternal border. Which of the following valve lesions do you expect to see on echocardiography?
Hint
The upper left sternal border allows for auscultation of the aortic valve. A diastolic murmur in this area is concerning for valvular regurgitation.
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Question 7 of 10
7. Question
A patient was referred to you to determine if she has rheumatic heart disease. On exam, you hear a crescendo-decrescendo systolic murmur with no S2 at the upper right sternal border. The rest of the exam is normal. Which of the following cardiac lesions is this most consistent with?
Hint
The upper left sternal border allows for auscultation of the aortic valve. A systolic murmur in this area is concerning for valve stenosis.
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Question 8 of 10
8. Question
Which of the following are indications for surgery in a patient with rheumatic heart disease?
Hint
The decision to proceed with heart surgery depends on the severity of symptoms, significant damage to heart valves (which may indirectly lead to infective endocarditis or chronic embolic events), and left ventricular size and function.
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Question 9 of 10
9. Question
In a patient who is anti-coagulated with warfarin for a mechanical heart valve, which of the following ranges represents the goal INR target?
Hint
When achieving anticoagulation for mechanical heart valves with warfarin, ranges between 2-3.5 are often targeted, but may depend on the clinical context.
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Question 10 of 10
10. Question
What is the suggested duration for anticoagulation therapy in patients with mechanical valves in order to prevent stroke?
Hint
Patients with mechanical valves are at lifelong risks of stroke.
