Valvular Heart Disease

Question 1

Aetiology

Answer 1

• Rheumatic Heart Disease
• Congenital MS
• Systemic conditions SLE, RA

Question 2

Pathophysiology

Answer 2

LA pressure increases
Pulmonary venous and capillary pressure increases
Pulmonary vascular resistance increases
Pulmonary arterial pressure increases and pulmonary hypertension develops

Question 3

How is the left ventricle and systolic function in mitral stenosis

Answer 3

Normal

Question 4

Clinical Manifestation of Mitral stenosis (6)

Answer 4

Dyspnoea
Haemoptysis
Systemic embolisation
Infective endocarditis
Chest pain
Hoarseness

Question 5

Clinical Examination of Mitral Stenosis (6)

Answer 5

Mitral facies
Normal pulse
JVP-prominen wave
Tapping apex beat
Diastolic thrill
RV heave

Question 6

Investigations for Mitral Stenosis

Answer 6

ECG P> 0.12 sec
CXR0 LA enlargement
ECHO- thickening and scarring of leaflets and fusion of commissures
Imaging- cardiac magnetic resonance

Question 7

Medical Treatment (4)

Answer 7

• Diuretics and restriction of Na intake (reduce blood pressure)
• Atrial Fibrillation: Sinus rhythm restoration or ventricular rate control
Valvotomy
Mitral valve replacement

Question 8

Acute Mitral Regurgitation

Answer 8

decrease in EDP and decrease in wall tension

Question 9

Chronic Mitral Regugitation

Answer 9

Increase in EDP and ESP returns to normalEccentic LVH develops

Question 10

Normal size of ope aorta

Answer 10

3-4 cm (2)

Question 11

Aetiology of stenosis

Answer 11

• Degenerative
• Rheumatic
• Bicuspid

Question 12

Stenosed Aortic valve

Answer 12

<1.5 cm (2)

Question 13

Rheumatic pathophysiology of aortic stenosis

Answer 13

adhesion, fusion of the commissures and retraction and stiffening of the free cusp margins

Question 14

Degenerative pathophysiology of aortic stenosis

Answer 14

linked to atherosclerosis, a slow inflammatory process resulting in thickening and calcification of the cusps from base to free margin

Question 15

Stages of development of aortic stenosis (7)

Answer 15

1. Increased LV systolic pressure
2. Severe concentric hypertrophy and
3. Left ventricular pressure increases
4. Pulmonary Hypertension
5. Myocardial ischaemia
6. LV failure

Question 16

Symptoms of aortic stenosis (4)

Answer 16

Angina
Syncope/Dizziness
Breathlessness on exertion
Heart failure

Question 17

Clinical Examination of aortic stenosis (6)

Answer 17

Pulse- small volume and slowly rising
JVP- prominent
Low BP
RV heave
Normal S1
S2 less audible

Question 18

Laboratory investigations of aortic stenosis (6)

Answer 18

ECG
CXR
Cardiac catheterisation
ECHO
CMR

Question 19

What does an ECG demonstrate in aortic stenosis

Answer 19

LVH- ST/T changes

Question 20

What does a CXR demonstrate in aortic stenosis

Answer 20

Calcification of AV

Question 21

What does an ECHO demonstrate in aortic stenosis

Answer 21

• Demonstrate the AV cusp mobility
• LV function and hypertrophy
• Doppler haemodynamic assessment of pressure gradient and AVA

Question 22

Treatment of aortic stenosis

Answer 22

Aortic valve repair or replacement

Question 23

Aetiology of Aortic regurgitation (2)

Answer 23

1. Dilated aorta (Marfans, hypertension)

2. CT disorder

Question 24

What problems arise in the valves with aortic regurgitation (4)

Answer 24

Bicuspid aortic valve
Rheumatic heart disease
Endocarditis
Myxomatous degeneration

Question 25

Pathophysiology of aortic regurgitation

Answer 25

* LV accommodates both stroke volume and regurgitant volume * Increased left ventricular end-diastolic volume and LV systolic pressure * LV hypertrophy and LV dilatation * Increased MVO2 * Myocardial Ischaemia * LV failure

Question 26

Symptoms in chronic AR (2)

Answer 26

* Long asymptomatic phase | * Exertional breathlessness

Question 27

Symptoms on acute AR

Answer 27

* Poorly tolerated as wall tension cannot acutely adapt | * (LV pressure x LV radius /wall thickness)

Question 28

Clinical examination of AR

Answer 28

* Pulse- large volume and collapsing (Corrigan sign) * Wide pulse pressure * Hyperdynamic, displaced apex beat * Early diastolic, decrescendo, soft murmur

Question 29

Investigations for AR (5)

Answer 29

ECG CXR Cardiac Catheterisation ECH/CMR

Question 30

With imagine what are you looking for

Answer 30

 AV cusps anatomy (Thickening, prolapsing, number of cusps, vegetations)  LV function, dilatation and hypertrophy  Doppler haemodynamic, assessment of regurgitant flow

Question 31

Medical treatment for AR (2)

Answer 31

* Vasodilator therapy shown to delay the timing for surgical intervention * Aortic valve replacement or repair