Valvular Heart Disease (core)

Question 1

What is a TAVI?

Answer 1

Transcathetic aortic valve implant

Question 1

How does auscultation of AS change with increasing severity of the disease?

Answer 1

The more severe, the more widely it’s heard on the precordium

Question 1

When is the valve replaced in AS?

Answer 1

Severe AS on echo + Symptoms

Question 3

What types of hypersensitivity mediates rheumatic fever?

Answer 3

Type II

Question 4

What causes MR?

Answer 4

Myxomatous degeneration (mitral valve prolapse)

Ruptured chordae tendinae

Infective endocarditis

MI - ruptured papillary muscle

Question 5

When do you operate in AR?

Answer 5

Once the LV starts to increase in size (on echo)

Question 5

What are some signs of MS?

Answer 5

Mitral facies

Tapping apex beat

Question 6

How is rheumatic fever managed long term?

Answer 6

Long term antibiotic prophylaxis

Question 7

Describe the murmur in MR?

Answer 7

Pansystolic

Rumbling

Mostly heard at the apex (occasionally at the base too)

Question 8

What are the pros and cons of bioprosthetic valve?

Answer 8

Pros: Don’t need anticoagulants

Cons: Shorter life (10-15years)

Question 9

What is a TOE best for?

Answer 9

Mitral valve

Thombus in the LV

Endocarditis on valves or pacemaker leads

Question 11

What has happened to the LV at onset of symptoms in regurg?

Answer 11

Irreversibly damaged

Question 12

How does the LV compensate for regurgitation? What happens at decompensation?

Answer 12

Increases EDV while ESV remains the same = an increase in SV and EF

Pump failure: EDV further increases

ESV increases

EF decreases

Question 13

What causes aortic regurg?

Answer 13

Aortic leaflet damage - endocarditis, rheumatic fever

Aortic root dilated - Marfan’s syndrome, aortic dissection, syphilus

Question 14

How does the LV change in AS?

Answer 14

Concentric hypertrophy

Question 16

What are the pros and cons of mechanical valves?

Answer 16

Pros: they last forever

Cons: require anticoagulation with warfarin (INR 2-3)

Question 17

How do you decide which type of valve to use?

Answer 17

Age

>70 - Bioprosthetic

Question 18

What are some peripheral signs of AS?

Answer 18

Slow upstroke of carotid pulse

Heaving apex beat

Thrill over upper R sternal edge

Question 19

What causes TR?

Answer 19

RVF - due to pulmonary hypertension

Endocarditis

Pacemaker leads

Question 20

What are some signs of AR?

Answer 20

Collapsing pulse - fast up and down stroke

Wide pulse pressure

Early diastolic murmur

Various other signs

Question 21

What are the symptoms of AS?

Answer 21

SOB

Chest pain

Syncope

Question 22

What are the two major types of degenerative valvular disease?

Answer 22

Aortic calcification - Aortic stenosis

Mitral prolapse - Mitral regurg

Question 23

Characterise the sound of AS

Answer 23

Ejection systolic - crescendo-decrescendo

Best heard at upper R sternal edge with diaphragm

Can also be heard elsewhere on precordium

Question 24

What are some complications of MS?

Answer 24

Atrial dilatation and AF

Thrombo-embolism

Pulmonary hypertension

RHF

Question 25

How does infective endocarditis present most commonly?

Answer 25

Fever and murmur

Question 26

What are the clinical features of rheumatic fever?

Answer 26

Fever Arthritis - migratory polyarthritis, large joints Rash - erythema marginatum Subcutaneous nodules - over bones, tendons Murmur Sydenham's chorea

Question 27

What are the causes of AS?

Answer 27

Age related calcification Congenital - AS, bicuspid Rheumatic fever

Question 28

How is rheumatic fever diagnosed?

Answer 28

By clinical feature only, using the Jone's criteria

Question 29

What is the major cause of mitral stenosis?

Answer 29

Rheumatic fever

Question 30

Describe the murmur in MS?

Answer 30

Pan-diasystolic OS opening snap mitral opening

Question 31

What is the pathophysiology of rheumatic fever?

Answer 31

Type II hypersensitivity response occurs 2-3 weeks post strept pyogenes infection - typically pharyngitis or scarlett fever

Question 32

Which valvular pathologies are asymptomatic until the onset of HF?

Answer 32

AR MR

Question 33

What are some common agents of IE?

Answer 33

Strep viridans Strep bovis Staph aureas Staph epidermidis

Question 34

How do you treat IE? When do you do surgery?

Answer 34

Long term abx via PICC line If HF or uncontrolled infection

Question 35

What blood/urine results might you get with IE?

Answer 35

Anaemia Leukocytosis Elevated ESR or CRP Microhaematuria