Valvular Heart Disease

Question 1

Tapping apex beat

Answer 1

Mitral Stenosis

Question 2

Displaced and diffused apex beat

Answer 2

LV dilatation

Question 3

Displaced and heaving

Answer 3

LV hypertrophy

Question 4

What could cause a parasternal heave?

Answer 4

Cor pulmonale or pulmonary hypertension

Question 5

Why can a parasternal heave be felt in some patients?

Answer 5

Right ventricular overload

Question 6

6 questions of murmurs?

Answer 6

1. Systole or diastole
2. Type
3. Where is it loudest
4. Radiation
5. Grade
6. Influence by respiration

Question 7

Ejection systolic murmur

Answer 7

Aortic stenosis

Question 8

Pan systolic murmur

Answer 8

Mitral regurgitation

Question 9

Early diastolic murmur

Answer 9

Aortic regurgitation

Question 10

Mid diastolic murmur

Answer 10

Mitral stenosis

Question 11

Radiation to carotids

Answer 11

Aortic stenosis

Question 12

Radiation to axilla

Answer 12

Mitral regurgitation

Question 13

How many grades of murmur are there?

Answer 13

6...
I = Very quite
III = Loud
IV = Loud + thrill
VI = Audible from end of bed

Question 14

Which murmurs are louder on inspiration?

Answer 14

Right sided i.e. tricuspid and pulmonary

Question 15

2nd sound splitting

Answer 15

Aortic stenosis or normal on inspiration

Question 16

Third heart sound

Answer 16

Aortic regurgitation

Question 17

Fourth sound

Answer 17

Mitral stenosis

Question 18

Innocent murmur

Answer 18

Tricuspid regurgitation

Question 19

Pericardial rub

Answer 19

Mitral regurgitation

Question 20

Which murmurs are always pathological?

Answer 20

Diastolic

Question 21

Causes of Aortic Stenosis?

Answer 21

Calcification of aorta due to age
Congenital bicuspid valve instead of tricuspid
Rheumatic fever

Question 22

Treatment for aortic stenosis?

Answer 22

Conventional valve replacement
TAVI - seen on hospital
Balloon aortic valvotomy

Question 23

Who should get mechanical valve replacement?

Answer 23

Younger patients - but on lifelong warfarin

Question 24

Who should get bio-prosthetic valve replacement?

Answer 24

Older patients - last for about 10 years

Question 25

What causes mitral regurgitation?

Answer 25

Rheumatic Endocarditis Papillary/chordae rupture Annular dilatation

Question 26

What does myxomatous stand for?

Answer 26

Weakening of the connective tissue

Question 27

What does mitral regurgitation do to the apex?

Answer 27

Displaces it

Question 28

Treatment for mitral regurgitation?

Answer 28

Diuretics | Surgery - repair or replacement

Question 29

What is the main cause of mitral stenosis?

Answer 29

Rheumatic fever

Question 30

Malar flush

Answer 30

Mitral stenosis

Question 31

Collapsing pulse

Answer 31

Aortic regurgitation

Question 32

Slow rising pulse

Answer 32

Aortic stenosis

Question 33

Treatment for mitral stenosis

Answer 33

Diuretics Surgery - valve replacement Balloon valvuloplasty

Question 34

Causes of aortic regurgitation

Answer 34

``` Endocarditis Connective tissue disease Rheumatic Marfans Aortic dissection ```

Question 35

Treatment for aortic regurgitation

Answer 35

ACE inhibitors | Surgery - valve replacement