Valvular Heart Disease, Murmurs & Structural Disease
Use history, examination and echocardiography to identify major valve lesions and recognize when urgent or specialist intervention is required.
Module format: each study session covers what to learn, how the presentation appears clinically, investigation/management priorities, safety issues and common MCCQE traps.
Module 6 — Topic map
- Approach to systolic and diastolic murmurs and bedside maneuvers
- Aortic stenosis: classic symptoms, examination, echo severity and intervention concepts
- Aortic regurgitation: acute versus chronic presentation and management principles
- Mitral stenosis: rheumatic disease, atrial fibrillation and thromboembolic complications
- Mitral regurgitation: primary/secondary causes, acute MR and chronic management
- Tricuspid and pulmonic valve disease
- Prosthetic valves and anticoagulation considerations
- Infective endocarditis: risk factors, blood cultures, echocardiography, major complications and when to suspect surgical disease
- Endocarditis prevention principles in high-risk cardiac conditions
Chronic + Acute CarePhysical diagnosisInvestigationReferral / management
Study Session 6.1 — Murmur Approach & Aortic Valve Disease
Focused MCCQE cardiovascular study session
Core topics & learning goals
- Use timing, location, radiation, intensity and maneuvers to classify murmurs.
- Recognize aortic stenosis symptoms and classic examination findings.
- Differentiate acute and chronic aortic regurgitation.
- Use echocardiography to confirm valve anatomy/severity.
Clinical recognition & investigation
- Recognize syncope, angina and dyspnea as high-risk symptoms in severe AS.
- Consider bicuspid valve and associated aortopathy in younger patients.
Management & patient-safety priorities
- Refer symptomatic severe valve disease for intervention assessment.
- Treat acute severe AR as an emergency.
MCCQE exam traps
- Murmur intensity does not always track severity, particularly in low-flow states.
- Do not reassure exertional syncope with a harsh systolic murmur.
Study Session 6.2 — Mitral / Tricuspid Valve Disease & Prosthetic Valves
Focused MCCQE cardiovascular study session
Core topics & learning goals
- Recognize mitral stenosis, primary/secondary MR and tricuspid regurgitation.
- Understand AF and embolic risk in mitral stenosis.
- Recognize acute MR after MI or endocarditis.
- Know basic prosthetic-valve complications and anticoagulation considerations.
Clinical recognition & investigation
- Use JVP, pulmonary findings, murmur changes and echo to assess severity.
- Distinguish functional MR/TR caused by chamber dilation from primary leaflet disease.
Management & patient-safety priorities
- Control congestion/rhythm when appropriate and refer significant symptomatic disease.
- Urgently assess acute severe MR with pulmonary edema or shock.
MCCQE exam traps
- New MR after MI can reflect papillary muscle rupture and demands urgent action.
- Mechanical prosthetic valves require special anticoagulation management.
Study Session 6.3 — Infective Endocarditis & Structural Complications
Focused MCCQE cardiovascular study session
Core topics & learning goals
- Recognize risk factors, persistent bacteremia, embolic/immunologic findings and new regurgitation.
- Obtain appropriate blood cultures before antibiotics when the patient is stable enough.
- Use TTE/TEE appropriately.
- Recognize abscess, HF, emboli and persistent infection as major complications.
- Know broad prophylaxis principles for highest-risk patients/procedures.
Clinical recognition & investigation
- Suspect endocarditis with unexplained fever plus prosthetic valve, prior IE, injection drug use or new murmur.
- Evaluate neurologic and systemic embolic complications.
Management & patient-safety priorities
- Start targeted empiric therapy after cultures when indicated and involve specialists early.
- Recognize when surgical evaluation is urgent.
MCCQE exam traps
- A negative TTE does not always exclude IE when clinical suspicion is high.
- Do not give prophylaxis for every murmur or routine dental procedure.