6.6 MTB Step 3 - Valvular Heart Disease (VSD & ASD)

Question 1

VENTRICULAR SEPTAL DEFECT (VSD)

1. Describe the Murmur of VSD in Asymptomatic patients.
2. What is (1) potential Symptom in a patient with a Larger Defect?
3. Which (3) Maneuvers Worsen (Increase the Intensity of) the Murmur of VSD?

Answer 1

1. Holosystolic Murmur
   
   • ​​Heard best at the Lower Left Sternal border.
2. Shortness of Breath (SOB)
3. Exhalation, Squatting, Leg Raise

Question 2

VENTRICULAR SEPTAL DEFECT (VSD)

1. What is the Best INITIAL Diagnostic Test for VSD?
2. What is the Most Precise Diagnostic Test is used to determine the Degree of Left-to-Right Shunting?

Answer 2

1. Echocardiography
2. Catheterization

Question 3

VENTRICULAR SEPTAL DEFECT (VSD)

1. What is the Treatment for Mild Defects?
2. What is the Treatment for More Severe Defects?

Answer 3

1. Mild Defects: can be left without closure
2. More Severe Defects: Mechanical Closure

Question 4

ATRIAL SEPTAL DEFECT (ASD)

1. What is the Clinical Manifestation of Small ASDs?
2. What is the Clinical Manifestation of Larger ASDs?

Answer 4

1. Asymptomatic
2. Shortness of Breath (SOB) or signs of Right Ventricular Failure (e.g., SOB and a Parasternal Heave)

Question 5

ATRIAL SEPTAL DEFECT (ASD)

What is the Most Frequently Tested Knowledge about ASD?

Answer 5

Fixed Splitting of S2 heart sound.

S2 Splitting is caused by Different Pressures on Different Sides of the Heart (same pressure on both sides = NO splitting)

Question 6

ATRIAL SEPTAL DEFECT (ASD)

What is the Best Diagnostic Test for ASD?

Answer 6

Echocardiogram

Question 7

ATRIAL SEPTAL DEFECT (ASD)

What are the (2) Best INITIAL Therapy Devices used for ASD?

Answer 7

Percutaneous devices

or

Catheter devices

Question 8

ATRIAL SEPTAL DEFECT (ASD)

When is Repair most often Indicated for ASD?

Answer 8

Shunt Ratio > 1.5 : 1

Question 9

ATRIAL SEPTAL DEFECT (ASD)

What are (4) Causes of Wide Splitting of S2 (P2 Delayed)?

Answer 9

1. Right Bundle Branch Block (RBBB)
2. Pulmonic Stenosis
3. Right Ventricular Hypertrophy (RVH)
4. Pulmonary Hypertension

Question 10

ATRIAL SEPTAL DEFECT (ASD)

What are (4) Causes of Paradoxical Splitting of S2 (A2 Delayed)?

Answer 10

1. Left Bundle Branch Block (LBBB)
2. Aortic Stenosis (AS)
3. Left Ventricular Hypertrophy (LVH)
4. Hypertension (HTN)