Valvular Heart Disease

Question 1

6 common valve lesions

Answer 1

Mitral valve prolapse
Aortic stenosis/
Aortic regurgitation
Mitral regurgitation
Mitral stenosis
Right sided valve lesions

Question 2

Mitral valve prolapse

Answer 2

> /=2mm systolic prolapse of 1 or both vakve leaflets beyond long axis annular plane during 2d echo

Question 3

What histological changes occur in valves in mitral valve prolapse

Answer 3

None

Question 4

Myxomatous degeneration

Answer 4

non-inflammatory progressive disarray of the valve structure caused by a defect in the mechanical integrity of the leaflet due to the altered synthesis and/or remodeling by type VI collagen

Question 5

Where and when do mitral valve leaflets prolapse into in mitral valve prolapse

Answer 5

Left atrium during systole

Question 6

Mitral valve prolapse symptoms

Answer 6

Usually asymptomatic
Chest pain
Atrial arrhythmias

Question 7

Mitral prolapse signs

Answer 7

Ejection click
Late systolic murmur

Question 8

Aortic stenosis causes

Answer 8

Calcification disease
Congenital bicuspid valve
Rheumatic disease

Question 9

Aortic stenosis symptoms

Answer 9

Dyspnoea
Angina
Syncope
Left ventricular failure
Sudden death

Question 10

Aortic stenosis signs

Answer 10

Slow rising carotid pulse
S4
Ejection click
Ejection systolic murmur - diamond

Question 11

What causes S4 in aortic stenosis

Answer 11

Atrium trying to push blood into stiff left ventricle

Question 12

Why does aortic stenosis cause dyspnoea

Answer 12

Increased diastolic pressure in stiff non compliant left ventricle

Question 13

Why does aortic stenosis and aortic regurgitation cause angina

Answer 13

Increased oxygen demand in hypertrophied left ventricle

Question 14

Why does aortic stenosis cause syncope

Answer 14

Paroxysmal ventricular arrhythmias or exertional cerebral hypoperfusion

Question 15

Why does aortic stenosis cause left ventricular failure

Answer 15

Contractile failure as ventricle dilates

Question 16

How can aortic stenosis causes sudden death

Answer 16

Ventricular arrhythmias

Question 17

Why does aortic stenosis cause high QRS and T inversion on an ECG

Answer 17

Left ventricular strain

Question 18

What valve area shows severe aortic stenosis

Answer 18

<1cm2

Question 19

What can aortic valve leaflet disease and aortic root dilating disease cause

Answer 19

Aortic regurgitation

Question 20

What can cause aortic valve leaflet disease

Answer 20

Calcification disease
Congenital biscuspid valve
Rheumatic disease
Infective endocarditis

Question 21

What can cause aortic root dilating disease

Answer 21

Ankylosis spondylitis
Marfan syndrome
Aortic dissection

Question 22

Aortic regurgitation symptoms

Answer 22

Often none
Dyspnoea
Angina

Question 23

Aortic regurgitation signs

Answer 23

Rapidly rising carotid pulse
Early diastolic murmur
Ejection murmur - possible

Question 24

Why does aortic regurgitation cause Dyspnoea

Answer 24

Contractile failure as ventricle dilates

Question 25

What causes the early diastolic murmur in aortic regurgitation

Answer 25

Aortic backflow

Question 26

What causes the ejection murmur in aortic regurgitation

Answer 26

Turbulent ejection from volume loaded left ventricle

Question 27

What indicates surgery is needed for sortic regurgitation

Answer 27

Symptoms of aortic regurgitation Echocardiograohic evidence of worsening left ventricle dilation

Question 28

Mitral stenosis causes

Answer 28

Rheumatic fever

Question 29

Mitral stenosis symptoms

Answer 29

Dyspnoea Orthopnoea RV failure Palpitations Systemic emboli

Question 30

Mitral stenosis signs

Answer 30

Atrial fibrillation Loud s1 Opening snap Mid diastolic rumble Pre systolic murmur Incr JVP Basal creeps Ankle oedema

Question 31

WHy does mitral stenosis cause Dyspnoea and Orthopnoea

Answer 31

Incr left atrial pressure

Question 32

Why does mitral stenosis cause right ventricular failure

Answer 32

Incr left atrial pressure and reactive pulmonary vasoconstriction

Question 33

How does mitral stenosis cause palpitations

Answer 33

Atrial fibrillation

Question 34

What does static blood in dilated fibrillating left atrium due to mitral stenosis or regurgitation predispose a patient to

Answer 34

Systemic emboli

Question 35

What can be heard in chest auscultation of a patient with mitral stenosis

Answer 35

Loud s1 Opening snap Mid diastolic rumble Pre systolic murmur

Question 36

How does mitral stenosis affect left atrium pressure

Answer 36

Increase

Question 37

What operation can be used to treat mitral stenosis

Answer 37

Valvuloplasty

Question 38

What conditions can cause mitral regurgitation

Answer 38

Mitral valve leaflet disease Subvalvar disease Functional mitral regurgitation

Question 39

Mitral regurgitation symptoms

Answer 39

Dyspnoea Orthopnoea Palpitations Systemic emboli Incr left atrial pressure Atrial fibrillation Thrombosis

Question 40

Mitral regurgitation signs

Answer 40

Sinus rhythm or atrial fibrillation Pansystolic murmur S3 Incr JVP Basal creeps Ankle oedema

Question 41

How can mitral how can mitral regurgitation be investigated

Answer 41

M-mode echo M-mode phonogram M-mode Doppler Left ventricular angiogram

Question 42

What indicates a patient needs surgery for mitral valve disease

Answer 42

Symptoms don’t respond to treatment Worsening cardiovascular complications

Question 43

Which patients may a Percutaneous MitraClip be used in

Answer 43

Patients too sick for heart surgery

Question 44

Valvular heart disease treatment

Answer 44

Surgery / valvuloplasty Diuretics - fluid overload Digoxin - af Beta blockers - af Verapamil - af Anticoagulants - af