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Medicine

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Cardiology

Question
28 out of 30
 

In Rheumatic Heart Disease the least commonly involved valve is: (AIIMS May 2011)



A Tricuspid
B Pulmonary

C Mitral
D Aortic

Ans. B

Pulmonary
(Ref. Robbin’s pathology 7th ed. pg. 594)

1. The pulmonic valve is affected by rheumatic fever far less frequently than are the other valves, and it is uncommonly the seat of infective endocarditis.

2. The most common acquired abnormality affecting the pulmonic valve is regurgitation secondary to dilatation of the pulmonic valve ring as a consequence of severe pulmonary hypertension.

3. This produces the Graham Steell murmur, a high-pitched, decrescendo, diastolic blowing murmur along the left sternal border, which is difficult to differentiate from the far more common murmur produced by AR.

4. In rheumatic stenosis the valve leaflets are diffusely thickened by fibrous tissue and/or calcific deposits.

5. The mitral commissures fuse, the chordae tendineae fuse and shorten, the valvular cusps become rigid, and these changes, in turn, lead to narrowing at the apex of the funnel-shaped (“fish-mouth”) valve.

6. Calcification of the stenotic mitral valve immobilizes the leaflets and narrows the orifice further.

7. Thrombus formation and arterial embolization may arise from the calcific valve itself, but more frequently arise from the dilated left atrium (LA) in patients with atrial fibrillation (AF).

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