Valve disease

Question 1

What are the inflow valves?

Answer 1

mitral and tricuspid

Question 2

What are the outflow valves?

Answer 2

aortic and pulmonary

Question 3

What is valve stenosis?

Answer 3

valve does not open fully
not enough blood gets through

Question 4

What is valve regurgitation?

Answer 4

valve does not close fully
blood leaks backwards

Question 5

What are the 2 most common valves to be affected by valve disease?

Answer 5

aortic and mitral

Question 6

2 general causes of valve disease (related to structure)

Answer 6

disease of the valve leaflets
stretching of the structure the valve is attached to

Question 7

Congenital and acquired causes of disease of the valve leaflets

Answer 7

congenital = born with abnormal valve that wears out faster than normal (eg. bicuspid aortic valve)

acquired = degenerative, rheumatic, endocarditis

Question 8

What does stretching of the structure the valve is connected to cause?

Answer 8

leakage
called secondary/functional regurgitation

Question 9

What can cause a dilated left ventricle and what does it cause?

Answer 9

causes mitral regurgitation

ischaemic heart disease
dilated cardiomyopathy
hypertension

Question 10

What can cause a dilated aortic root and what does it cause?

Answer 10

causes aortic regurgitation

cystic medial necrosis (due to ageing, hypertension, Marfan’s)
bicuspid aortic valve
aortic dissection

Question 11

Describe rheumatic fever

Answer 11

inflammatory condition involving heart, skin and connective tissues
usually affects children/young adults
50% have cardiac involvement
heart disease development usually due to recurrent episodes

Question 12

How can rheumatic heart disease be prevented?

Answer 12

penicillin after sore throat or rheumatic fever

Question 13

What causes valve damage in rheumatic fever?

Answer 13

due to abnormal tissue response to group A strep

Question 14

How does valve disease present?

Answer 14

incidental finding (hearing a murmur, finding valve disease on an echo)

heart failure symptoms (fatigue, breathlessness, swollen legs)

Question 15

What is mitral valve disease often associated with?

Answer 15

atrial fibrillation

Question 16

What can aortic valve disease be associated with?

Answer 16

angina
dizziness
sudden death

Question 17

Status of aortic and mitral valves in systole

Answer 17

mitral valve closed
aortic valve open

Question 18

Status of aortic and mitral valves in diastole

Answer 18

mitral valve open
aortic valve closed

Question 19

Anatomical cause of mitral stenosis

Answer 19

commisural fusion and leaflet thickening

Question 20

Most common cause of mitral stenosis

Answer 20

rheumatic heart disease

Question 21

What position accentuates the mitral stenosis murmur?

Answer 21

left lateral
place bell lightly at apex

heard as low frequency rumbling heard in mid diastole

Question 22

Mitral stenosis treatment

Answer 22

anticoagulation (if AF present)
balloon valvotomy

Question 23

Mitral regurgitation treatment

Answer 23

surgery if severe and symptomatic or asymptomatic with left ventricular impairment
mitral valve repair is treatment of choice

Question 24

What is the commonest congenital heart defect?

Answer 24

bicuspid aortic valve

Question 25

Describe the pathophysiology of aortic stenosis

Answer 25

thickening of aortic valve causes obstruction to outflow pressure gradient develops across the valve and turbulent flow causes a loud murmur in systole left ventricle is pressure loaded because of obstruction to flow and hypertrophies

Question 26

Aortic stenosis symptoms

Answer 26

heart murmur angina pectoris syncope air hunger (difficult breathing)

Question 27

Signs of aortic regurgitation

Answer 27

collapsing pulse wide pulse pressure prominent carotid pulsation laterally displaced apex beat

Question 28

Symptoms of aortic regurgitation

Answer 28

asymptomatic for many years develop left ventricular failure (dyspnoea, orthopnoea, fatigue) chest pain

Question 29

What signs can be seen in aortic regurgitation?

Answer 29

Corrigan's sign De Musset's sign Quincke's sign Traube's sign Austin Flint murmur Duroziez's sign

Question 30

What is Corrigan's sign?

Answer 30

carotid pulsation

Question 31

What is De Musset's sign?

Answer 31

head nodding with each heartbeat

Question 32

What is Quincke's sign?

Answer 32

capillary pulsations in nail bed

Question 33

What is Traube's sign?

Answer 33

'pistol shot' sound over the femoral arteries

Question 34

What is Austin Flint murmur?

Answer 34

mid diastolic murmur over cardiac apex

Question 35

What is Duroziez's sign?

Answer 35

systolic and diastolic bruit over femoral arteries on gentle compression by stethoscope

Question 36

What position can accentuate the sound of aortic regurgitation?

Answer 36

sit up lean forward exhale completely hold breath in full expiration press diaphragm firmly at left sternal edge

Question 37

Describe tricuspid valve disease

Answer 37

mild tricuspid regurgitation = so common it's a normal variant significant TR usually functional and due to right ventricle enlargement

Question 38

What causes tricuspid stenosis?

Answer 38

rare rheumatic heart disease

Question 39

Describe pulmonary valve diseases

Answer 39

pulmonary stenosis = rare and usually congenital pulmonary regurgitation = usually functional due to dilated pulmonary artery caused by pulmonary hypertension

Question 40

What is the key investigation for valve disease and what can it tell you?

Answer 40

echocardiography - severity of stenosis - degree of regurgitation - ventricular size and function - atrial size - estimated pulmonary artery pressure

Question 41

Medical therapy for valve disease

Answer 41

treat heart failure AF: - prevent embolism = anticoagulate (warfarin) - rate control = beta blockers and digoxin

Question 42

Surgical/interventional options for valve disease

Answer 42

valvotomy (open valve up) - mainly for mitral stenosis, can be for aortic temporarily/palliative tricuspid valve repair (surgical/percutaneous with balloon) repair valve surgically - almost always mitral valve valve replacement: - mechanical valve - tissue valve (animal/human) - TAVI (transcatheter aortic valve implantation)

Question 43

Compare mechanical vs tissue vs repair vs catheter implanted for valve disease treatment

Answer 43

mechanical = durable but must anticoagulate tissue = lasts less time, no anticoags unless AF repair = best if can be done but only mitral, long-lasting, no anticoags, better function percutaneous implant = only aortic TAVI = good alternative to standard surgical aortic valve replacement

Question 44

Factors that increase the risk of valve surgery

Answer 44

age general physical state and comorbidities damage already done to the heart - particularly to LV in chronic cases renal function cerebral and carotid arteries - these determine risk of stroke