(MHD) Clinical Valvular Heart Disease

Question 1

What is the primary cause of mitral stenosis?

Answer 1

Rheumatic fever (rare in the US)

Question 2

How does rheumatic fever lead to mitral stenosis?

Answer 2

It results in “melting” and fusing of the mitral valve apparatus. The leaflets become so rigid that they cannot open or shut

Question 3

What effect can rheumatic fever have that leads to Mitral Regurgitation?

Answer 3

When rheumatic fever results exclusively or predominantly in contraction and fusion of the chordae tendineae, with little fusion of the valvular commissures, dominant MR results

Question 4

Name the clinical presentations which may result from chronic MS (8)

Answer 4

1. Enlargement of the left atrium and resultant elevation of the left main stem bronchus
2. Calcification of the left atrial wall
3. Mural thrombi
4. Obliterative changes in the pulmonary vascular bed
5. Dyspnea
6. Pulmonary Edema
7. Endocarditis
8. Compression of the left recurrent laryngeal nerve

Question 5

A “Hockey-stick” deformity on ultrasound is associated with what cardiac issue?

Answer 5

Mitral Stenosis

Question 6

What operation is the key for mitral stenosis treatment?

Answer 6

Balloon valvulopasty

Carried out in symptomatic patients with moderate to severe MS

Question 7

What is the most common valvular issue?

Answer 7

Mitral Valve regurgitation

Question 8

Degenerate vs Functional Mitral Regurgitation

Answer 8

Degenerate: The valve itself has broken down in a way that can be fixed

Functional: The issue is not with the valve itself so much so as with the ventricle. Much tougher fix.

Question 9

How can ischemia/infarction lead to mitral regurg?

Answer 9

Ischemia/Infarction can lead to a failure of papillary muscle contraction, thus allowing for prolapse into the atria and associated insufficiency.

Question 10

Why might atrial dilation or left ventricular hypertrophy be seen with mitral regurgitation?

Answer 10

1. If the left atrium doesn’t expand in size, you will see RV hypertrophy because blood which is regurgitated into the left atrium backs up and causes a pressure increase for the right ventricle to push through.
2. Sometimes the atria simply dilates and there are no pressure changes.

Question 11

Symptoms usually do not develop in patients with chronic MR until __________________. Because of this….

Answer 11

The left ventricle fails.

Because of this, we cannot wait for symptoms

Question 12

_______________ reduction is of particular benefit in the management of mitral valve regurgitation– both the acute and the chronic forms.

Answer 12

Afterload reduction

Question 13

What window defines the optimal timing of valve replacement surgery?

Answer 13

If the surgery is done too early, the patient will have a valve for a longer time and as such will have greater risk for longterm prosthetic complications.

If surgery is done too late, the Left Ventricle gets too stretched out and ventricular function is too deteriated.

Question 14

The patient’s _______ prior to surgery is a good predictor of surgical outcome

Answer 14

EF

Question 15

What kind of valve is normally given to younger patients? Elderly?

Answer 15

Younger: mechanical valve

Elder: tissue based valve (porcine, bovine, etc.)

Question 16

What percentage of patients with mitral valve prolapse show symptoms?

Answer 16

Only 5%

Question 17

What is the most common cause of aortic stenosis in adults?

Answer 17

Degenerative (senile) calcific AS. The cuspos are immobilized by a deposit of calcium along their flexion lines. Comes with aging.

Question 18

What is a key point regarding the progress of symptoms of aortic stenosis?

Answer 18

Aortic stenosis can occur for a very long time without symptoms clearly appearing. Often times, the onset of significant symptoms occurs just prior to a rapid decline and death.

Question 19

Why might patients with aortic stenosis sometimes have a single S2 sound?

Answer 19

The calcification and immobility of the aortic valve make it inaudible

Question 20

What sound might a systolic murmur make when aortic stenosis becomes severe?

Answer 20

It may make a cooing/musical sound that is associated with a precordial thrill.

Question 21

What is the treatment for an aortic valve stenosis? What treatment will not work as a long term fix?

Answer 21

Aortic Valve Replacement is the only true treatment. Balloon aortic valvuloplasty risk restonisis due to scarring in more than half the patients.

Question 22

What causes aortic regurgitation?

Answer 22

Aortic regurgitation (AR) may be caused by primary disease of either the aortic valve leaflets (rheumatic fever) or the wall of the aortic root or both.

Question 23

The ability to hear aortic regurgitation indicates that it is at what stage?

Answer 23

Moderate to severe

Question 24

Treatment of aortic regurgitation (symptomatic patients? asymptomatic patients?)

Answer 24

symptomatic patients: AVR

asymptomatic patients: usually drugs (nifedipine)

Question 25

What is the most commonly used aortic valve replacement type?

Answer 25

Bi-leaflet tilting disc

Question 26

The most common cause of tricuspid regurgitation is...

Answer 26

Dilatation of the right ventricle and of the tricuspid annulus, which may be complications of right ventricular failure of any cause.

Question 27

The response of a murmor to __________ helps aid in establishing it as tricuspid regurgitation.

Answer 27

Respiration

Question 28

Tricuspid Regurgitation in the abscence of ____________ \_\_\_\_\_\_\_\_\_\_\_\_\_\_ usually does **not** require surgical treatment

Answer 28

the absence of **pulmonary hypertension**

Question 29

What type of aortic valves are more likely to become stenosed?

Answer 29

Bicuspid aortic valve

Question 30

What are the (3) concerning symptoms of aortic stenosis?

Answer 30

1. Angina 2. Syncope 3. HF