Valve disease

Question 1

Causes of acute AR

Answer 1

Infective endocarditis
Type A aortic dissection

Question 2

Causes of chronic AR

Answer 2

Congenital - bicuspid aortic valve
Rheumatic heart disease
Connective tissue - Marfan’s
Autoimmune - Ank Spond, RA

Question 3

Symptoms of AR

Answer 3

LVF
Arrhythmias
Angina

Question 4

Sx of LVF

Answer 4

SOB

Orthopnoea

PND

Question 5

Signs of AR

Answer 5

Collapsing pulse
Wide pulse pressure
Apex displaced
HS: Soft S2 +/- S3
Early Diastolic Murmur

Question 6

Ix for AR

Answer 6

Bloods
ECG
CXR - pulmonary oedema, cardiomegaly
Echo

Question 7

Mx of AR

Answer 7

Optimise RFs - statins, antihypertensives, DM
Aortic valve replacement

Question 8

Causes of mitral stenosis (MS)

Answer 8

Rheumatic fever
Prosthetic valve
Congenital

Question 9

Symptoms of MS

Answer 9

Dyspnoea
Chest pain
AF - atrial hypertrophy
Haemoptysis

Question 10

Cause of haemoptysis with MS

Answer 10

Rupture of bronchial veins

Question 11

Signs of MS

Answer 11

AF
Malar flush
Raised JVP
HS: Loud S1
Mid Diastolic Murmur

Question 12

When does MS manifest

Answer 12

Manifest when orifice < 2 square cm

Question 13

Complications of MS

Answer 13

Pulmonary HTN
Emboli
Recurrent laryngeal nerve palsy
Dysphagia - oesophageal compression

Question 14

Sign of recurrent laryngeal nerve palsy

Answer 14

Hoarse voice

Question 15

Mx of MS

Answer 15

Optimise RFs
Percutaneous ballon valvuloplasty
Surgical valvotomy
Valve replacement

Question 16

Causes of MR

Answer 16

Mitral valve prolapse
LV dilatation
Post MI
Rheumatic fever
Connective tissue - Marfan’s

Question 17

Symptoms of MR

Answer 17

Dyspnoea
AF
Pulmonary HTN
Pulmonary Oedema

Question 18

Signs of MR

Answer 18

AF
Apex displaced
HS: Soft S1
Pan Systolic Murmur

Question 19

Mx of MR

Answer 19

Optimise RFs
Valve repair
Valve replacement

Question 20

Barlow syndrome

Answer 20

Mitral valve prolapse

Question 21

Causes of mitral valve prolapse

Answer 21

MI
Marfan’s
Turner’s

Question 22

Signs of mitral valve prolapse

Answer 22

Mid Systolic click
+/- Late Systolic Murmur

Question 23

AR murmur

Answer 23

Early Diastolic Murmur

Question 24

MS murmur

Answer 24

Mid Diastolic Murmur

Question 25

MR murmur

Answer 25

Pan Systolic murmur

Question 26

AS murmur

Answer 26

Ejection Systolic murmur

Question 27

AS causes

Answer 27

Senile calcification (60yrs +): commonest
Congenital
Rheumatic fever

Question 28

Congenital causes of AS

Answer 28

Bicuspid valve

William’s syndrome

Question 29

Symptoms of AS

Answer 29

Angina

Dyspnoea

Syncope (on exertion)

LVF

Question 30

Signs of AS

Answer 30

Slow rising pulse
Ejection systolic murmur

Radiates to carotids

Question 31

Severe AS signs

Answer 31

Narrow pulse pressure
Decompensation: LVF

Question 32

Medical treatment of AS

Answer 32

Optimise RFs
Monitor with echo
Angina: β-Blocker
Heart failure: ACEi and diuretics
Avoid nitrates

Question 33

Surgery for AS

Answer 33

Replacement
Balloon valvuplasty
TAVI

Question 34

Different types of valves for replacement

Answer 34

Mechanical valves
Bioprosthetic valves

Question 35

Who get mechanical valves

Answer 35

Young pts

Question 36

Problem with mechanical valves

Answer 36

Last longer but require anticoagulation

Question 37

Problem with bioprosthetic valves

Answer 37

Fail 10-15 yrs

Question 38

TAVI

Answer 38

Transcatheter Aortic Valve Implantation