Valvular Heart Disease

Question 1

What is stenosis?

Answer 1

• pressure overload
• heart chambers pumping against a higher pressure to get the same amount of blood across a smaller surface area

Question 2

What is regurgitation?

Answer 2

• volume overload
• significant of blood which is ejected moves backwards into preceding chamber

Question 3

Describe features of rheumatic valve disease

Answer 3

• causes: acute rheumatic fever (painful joints, fever, rash), strep pyogenes throat infection
• it is an antibody cross-reactivity affecting connective tissue
• cardiac injury is caused by recurrent inflammatory episodes causing fibrinous repair and scarring

Question 4

What is the pathophysiology of aortic stenosis?

Answer 4

• thickening, calcification and reduced opening of valve
• increased LV cavity pressure (pumping same amount of blood across smaller area)
• pressure overload = LV hypertrophy

Question 5

What are the symptoms and signs of aortic stenosis?

Answer 5

Symptoms: SOB, presyncope, chest pain, reduced exercise capacity

Signs: ejection systolic murmur, quiet 2nd heart sound, narrow pulse pressure, heave at apex, signs of heart failure

Question 6

What is the pathophysiology of aortic regurgitation?

Answer 6

• degeneration with fixed valves and aortic root dilation
• LV dilates to compensate for increased volume of blood

Question 7

What are the possible causes of aortic regurgitation?

Answer 7

• systemic disease (Marfans, Ehlers Danilo’s, SLE etc)
• endocarditis (perforation from infection or prevention of proper closure of valve due to embedded infection)

Question 8

What are the symptoms and signs of aortic regurgitation?

Answer 8

Symptoms: SOB, reduced exercise capacity

Signs: early diastolic murmur, increased pulse pressure, collapsing pulse, signs of heart failure, carotid/nail-bed pulsation

Question 9

What are important features of the bicuspid valve?

Answer 9

• prone to premature dysfunction (echo and CT/MRI required to look at aorta as associated with aortic abnormalities)
• genetic component (10%)

Question 10

Describe the pathophysiology of mitral regurgitation

Answer 10

• multifactorial = problem with leaflets, annulus, apparatus
• volume overload (results in LA/LV dilation)
• pulmonary hypertension - leads to secondary right heart dilation

Question 11

What are the symptoms and signs of mitral regurgitation?

Answer 11

Symptoms: SOB, palpitations, right heart failure symptoms

Signs: pan systolic murmur, quiet 1st heart sound, displaced apex beat, heart failure symptoms

Question 12

Describe the pathophysiology of mitral stenosis

Answer 12

• pressure overload from stenosis causes dilation of LA (can then progress to LV)
• pulmonary hypertension - results in secondary right heart dilation

Question 13

What are the symptoms and signs of mitral stenosis?

Answer 13

Symptoms: SOB, palpitations, chest pain, haemoptysis, right heart failure symptoms

Signs: diastolic murmur, quiet 2nd heart sound, heaving apex, signs of heart failure

Question 14

Describe the interventions that can be done to repair valvular heart disease

Answer 14

Surgical repair: valve repair or valve replacement
Procedural intervention: laparoscopic valvuloplasty, TAVI, mitral clip