valve disease (see DM for more info)

Question 1

2 mechanisms of valve disease

Answer 1

disease of the valve leaflets (e.g. stenosis); stretching if the structure the valve is attached to

Question 2

3 mechanisms of acquired valve disease

Answer 2

rheumatic, endocarditis (infective), degenerative

Question 3

what is secondary/functional regurgitation

Answer 3

regurgitation caused by dilation of the valve e.g. due to RV dilation

Question 4

conditions that can cause LV dilation - MR (3)

Answer 4

ischemic heart disease; dilation cardiomyopathy; hypertension

Question 5

Conditions that can cause aortic root dilation - AR

Answer 5

cystic medial necrosis (due to marfans, aging HTN etc.); bicuspid Aortic valve; aortic dissection

Question 6

what can high LA pressure result in?

Answer 6

pulmonary oedema (backflow of blood)

Question 7

what can high RA pressure result in?

Answer 7

increased JVP; ascites; peripheral oedema

Question 8

what is rheumatic heart disease

Answer 8

a long term consequence of recurrent rheumatic fever; inflammatory condition involving heart, skin, connective tissue; can involve all 3 heart layers (endo - valve, myo - chest pain, peri - chest pain)

Question 9

pathogenesis of rheumatic heart disease

Answer 9

strep sore throat -> acute cardiac inflammation -> chronic cardiac inflammation -> valve damage

Question 10

prevention of rheumatic heart disease (4)

Answer 10

primordial - improved living conditions; primary - penicillin for all confirmed strep cases; secondary - extended antibiotics; vaccine (not yet available)

Question 11

ways in which valve disease can present (5)

Answer 11

incidental findings - murmur, echo;
signs of heart failure - swollen legs, fatigue, SOB

Question 12

what condition is mitral valve disease associated with

Answer 12

AF

Question 13

what condition is aortic valve disease associated with

Answer 13

angina, dizziness, sudden death

Question 14

components of mitral valve (7)

Answer 14

papillary muscles; chordae tendineae; posterior leaflets; anterior leaflet; anterior annulus; anteromedial commissure; posterolateral commissure

Question 15

what is the main cause for mitral stenosis (MS)

Answer 15

rheumatic fevr

Question 16

what happens to the LA in MS

Answer 16

become dilated due to increased pressure and volume (bc blood not flowing out) - could give rise to AF

Question 17

what murmur is heard in MS

Answer 17

mid diastolic murmur with a snap (after S2), loud S1; severity directly related to volume of murmur; low rumbling sound

Question 18

where does MS murmur radiate to and how is it best heard?

Answer 18

left side, best if lying on left side, pt breathes in; use bell

Question 19

what murmur does MR have and where does it radiate to

Answer 19

pan systolic, radiates to axilla

Question 20

what causes MR

Answer 20

Mitral valve apparatus dysfunction or dilation; most commonly mitral valve prolapse

Question 21

what murmur is heard in MVP

Answer 21

mid systolic click

Question 22

what does a bicuspid aortic valve increase the likelihood of

Answer 22

aortic stenosis/regurg; aortopathy; infective endocarditis

Question 23

what murmur is heard in AS and where does it radiate to?

Answer 23

ejection systolic; radiates toward carotid artery

Question 24

wall thickness, pressure gradient equation

Answer 24

LV wall stress in ejection (afterload) ∝ (pressure in LV x radius)/wall thickness

Question 25

why is there reduced myocardial O2 supply in AS

Answer 25

coronary perfusion pressure is the driving force for pushing blood into the coronary arteries; CPP = aortic diastolic pressure - LVEDP (high as AV is stiff)

Question 26

most common cause of AS

Answer 26

calcification

Question 27

what is the AR murmur and how is it best heard

Answer 27

early diastolic murmur; lean pt forward and listen over tricuspid region, breath in/out and hold

Question 28

why is there reduced myocardial O2 supply in AR

Answer 28

in severe AR, aortic diastolic pressure is low => CPP is low ( CPP = aortic diastolic pressure - LVEDP)

Question 29

what causes a collapsing pulse

Answer 29

aortic regurgitation - sudden fall in diastolic pressure in the aorta, which is due to regurgitation of blood from the aorta, or “aortic run-off,” into the left ventricle through the leaky valve

Question 30

what can cause tricuspid regurgitation

Answer 30

RV enlargement

Question 31

TR murmur

Answer 31

systolic at LSE

Question 32

what causes tricuspid stenosis

Answer 32

rare, due to rheumatic heart disease

Question 33

what causes pulmonary stenosis

Answer 33

congential (rare)

Question 34

what causes pulmonary regurgitation

Answer 34

dilated pulmonary artery; pulmonary hypertension

Question 35

tricuspid stenosis presentation

Answer 35

fatigue, ascites and peripheral oedema; opening snap and early diastolic murmur

Question 36

pulmonary stenosis presentation

Answer 36

dyspnoea, fatigue, oedema and ascites; ejection systolic murmur that radiates to L shoulder