29 - Valvular heart disease

Question 1

Mitral valve prolapse definition

Answer 1

≥2mm systolic prolapse of 1 or both valve leaflets beyond long-axis annular plane during 2DE

Question 2

Prevalence of mitral valve prolapse

Answer 2

2-3% affecting men and women equally

Question 3

Pathology of mitral valve prolapse

Answer 3

Myxomatous degeneration

Marfan, Ehlers Danlos

Question 4

Physiology of mitral valve prolapse

Answer 4

Valve leaflet(s) prolapses back into LA during systole, sometimes producing MR (variable severity - usually trivial)

Question 5

Symptoms of MVP

Answer 5

Asymptomatic

Question 6

Signs of MVP

Answer 6

Ejection click/late systolic murmur

Question 7

Treatment of MVP

Answer 7

Not usually necessary

Question 8

Causes of aortic stenosis

Answer 8

Calcific disease
Congential bicuspid valve
Rheumatic disease

Question 9

Symptoms of aortic stenosis

Answer 9

Dyspnoea
Angina
Syncope
LVF
Sudden death

Question 10

What is the cause of dyspnoea in aortic stenosis

Answer 10

increased diastolic pressure in stiff non-compliant LV

Question 11

What is the cause of angina in aortic stenosis

Answer 11

increased demand of hypertrophied LV

Question 12

What is the cause of syncope in aortic stenosis

Answer 12

either paroxysmal ventricular arrhythmias or exertional cerebral hypoperfusion

Question 13

What is the cause of LVF in aortic stenosis

Answer 13

Contractile failure as ventricle dilates

Question 14

What is the cause of sudden death in aortic stenosis

Answer 14

Ventricular arrhythmias

Question 15

Signs of aortic stenosis

Answer 15

Slow rising carotid pulse
S4+/- ejection click
Ejection systolic murmur

Question 16

Indications of surgery in aortic stenosis

Answer 16

Any symptoms of AS

Echocardiogaphic evidence of worsening LV dilation

Question 17

Causes of aortic regurgitation

Answer 17

Aortic valve leaflet disease - calcific disease, rheumatic disease, endocarditis, congenital bicuspid valve
Aortic root dilating disease - Marfan syndrome, aortic dissection

Question 18

Symptoms of aortic regurgitation

Answer 18

Often none
Dyspnoea
Angina

Question 19

Signs of aortic regurgitation

Answer 19

Rapidly rising carotid pulse
Early diastolic murmur
Ejection murmur

Question 20

What causes Rapidly rising carotid pulse in aortic regurgitation?

Answer 20

vigorous ejection of volume loaded LV

Question 21

What causes early diastolic murmur in aortic regurgitation?

Answer 21

aortic backflow (left sternal edge

Question 22

What causes ejection murmur in aortic regurgitation

Answer 22

Turbulent ejection from volume loaded LV

Question 23

How do you investigate aortic regurgitation

Answer 23

Aortic root angiogram

2D echo doppler

Question 24

Indications for surgery for Atrial regurgitation

Answer 24

Any symptom of AR

Echocardiogram evidence of worsening LV dilation

Question 25

Cause of mitral stenosis

Answer 25

Rheumatic fever

Question 26

Symptoms of mitral stenosis

Answer 26

Dyspnoea, orthopnoea RV failure Palpitations Systemic emboli

Question 27

What causes dyspnoea in mitral stenosis

Answer 27

Increeased left atrial pressure

Question 28

What causes RV failure in mitral stenosis

Answer 28

Passive consequence of increased left atrial pressure and reactive pulmonary vasoconstriction

Question 29

What causes palpitations in mitral stenosis

Answer 29

AFib | - can cause systemic emboli as static blood within dilated fibrillating left atrium predisposes to thrombosis

Question 30

Signs of mitral stenosis

Answer 30

Pulse - AF Auscultation - Loud S1, opening snap, mid diastolic rumble, +/- pre-systolic murmur Volume overload - increased JVP, basal creps, ankle oedema

Question 31

What are the causes of mitral regurgitation

Answer 31

Mitral valve leaflet disease - prolapse, rheumatic, infective endocarditis Subvalvular disease -cordal rupture, papillary muscle dysfunction, papillary muscle rupture Functional MR - LV dilation

Question 32

Symptoms of mitral regurgitation

Answer 32

Dyspnoea, orthopnoea - increased left atrial pressure Palpitations- atrial fibrillation Systemic emboli- static blood within dilated fibrillating left atrium predisposes to thrombosis

Question 33

Signs of mitral regurgitation

Answer 33

Pulse - SR/AF Auscultation - Pansystolic murmur - S3 Volume overload - increased JVP, basal creps ,ankle oedema

Question 34

Investigations for mitral regurgitation

Answer 34

M-mode echo | LV angiogram

Question 35

Indications for surgery with mitral regurgitation

Answer 35

Symptoms that fail to respond to medical treatment Worsening CV complications Pulmonary hypertension LV dilation

Question 36

Medical treatment for valvular heart disease

Answer 36

Diuretics for fluid retention Vasodilators - low output due to regurgiant valves AF - digoxin, BB, verapamil Anticoagulants - protect against embolisation