Valvular Heart Disease

Question 1

What is valvular heart disease

Answer 1

Any cardiovascular disease process involving one or more of the four valves of the heart

Question 2

What are the four valvular diseases

Answer 2

Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation

Question 3

What does one valve abnormality have the potential to do to the other valves

Answer 3

It can damage them and cause further valvular disease

Question 4

What is mitral stenosis

Answer 4

Narrowing of the mitral valve

Question 5

What is the threshold diameter for mitral stenosis

Answer 5

2cm

Anything less than 2cm is mitral stenosis

Question 6

Is mitral stenosis common in the UK

Answer 6

NO (But it used to be)

Question 7

What is the most common cause of mitral stenosis

Answer 7

Rheumatic heart disease

Question 8

What is a rarer cause of mitral stenosis

Answer 8

Systemic lupus erythematosus (SLE)

Question 9

What is Systematic lupus erythematosus (SLE)

Answer 9

An autoimmune disease. In this disease, the immune system of the body mistakenly attacks healthy tissue. It can affect the skin, joints, kidneys, brain, and other organs.

Question 10

What is Rheumatic heart disease

Answer 10

Antibodies that are created from strep throat infection attack the heart valve/tissue.
Causes adhesion and fusion of the commissures and retraction and stiffening of the free cusp margins.

Question 11

Whats the pathophysiology for mitral stenosis causing heart problems

Answer 11

Left atrial pressure increases
Pulmonary venous and capillary pressure increases
Pulmonary hypertension develops 
RIGHT HEART DILATION
TRICUSPID REGURGITATION 
PULMONARY REGURGITATION

Question 12

Why is mitral stenosis difficult to detect

Answer 12

Pulse is fine

The left ventricle works fine

Question 13

What are the presenting symptoms of mitral stenosis

Answer 13

S.O.B
Haemoptosis 
Palpitations 
Stroke 
Chest pain 
Hoarse voice

Question 14

What might be found on examination with mitral stenosis

Answer 14

Mitral facies (rosy cheeks) 
Normal pulse
Prominent JVP 
Diastolic thrill
RV heave
Tapping apex beat

Question 15

What the best investigation to use for diagnosing mitral stenosis

Answer 15

Echocardiography

Question 16

What features does echocardiography show in mitral stenosis

Answer 16

Thickening and scarred leaflets

Fusion of the commissures

Question 17

What other investigation (apart from echo) is always done when investigating heart disease

Answer 17

CXR

Question 18

What can a chest XRAY show when investigating mitral stenosis

Answer 18

Pulmonary oedema

LA enlargement

Question 19

What is the treatment for mitral stenosis

Answer 19

Manage cardiovascular risk eg smoking
diuretics and restriction of Na intake
mitral valve replacement (MVR) (valvotomy)

Question 20

If patient is in AF due to their mitral stenosis then what drugs should be given and why

Answer 20

anti coagulants - to prevent a stroke

Question 21

What is mitral regurgitation

Answer 21

When blood is pushed back into the left atrium, the the mitral valve on sytole

Question 22

What are common causes of mitral regurgitation

Answer 22

Rheumatic heart disease
Mitral valve prolapse (common in men)
Age degeneration

Question 23

What is a less common causes of mitral regurgitation

Answer 23

Infective endocarditis

Question 24

What does the degree of regurgitation depend on in mitral regurgitation

Answer 24

The effective regurgitation Orrifice (ERO)

Question 25

What are the two ways that mitral regurgitation can manifest

Answer 25

Acute | Chronic

Question 26

What happens in acute mitral regurgation

Answer 26

The change is rapid (eg chordae tendenae breaks) The ventricle takes control and the ventricle contracts rapidly. Myocardium thickens

Question 27

What happens to EDV in acute mitral regurgitation

Answer 27

It decreases

Question 28

What happens in the chronic mitral regurgitation

Answer 28

Changes are slow and the ventricle has time to adapt and compensate Myocardium thickens

Question 29

What happens to EDV in chronic mitral regurgitation

Answer 29

It increases

Question 30

What are presenting symptoms of acute mitral regurgitation

Answer 30

Breathlessness Pulmonary oedema Cardiogenic shock

Question 31

What are presenting symptoms of chronic mitral regurgitation

Answer 31

Fatigue Exhaustion Right heart failure Dyspnoea due to AF palpitations

Question 32

What can be found on examination of mitral regurgitation

Answer 32

Normal or reduced pulse JVP prominent hyperdynamic apex beat RV heave

Question 33

What investigations are done for mitral regurgitation

Answer 33

ECG CXR ECHO

Question 34

What treatment is used for acute mitral regurgitation

Answer 34

Need to reduce pre load and after load sodium nitroprusside dobutamine intra aortic balloon pump

Question 35

What treatment is used for chronic mitral regurgitation

Answer 35

Can be left alone until valve needs replaced | No emergency

Question 36

What shape is the aortic valve

Answer 36

Tricuspid | Inverse mercedes benz sign

Question 37

What causes aortic valve disease

Answer 37

degenerative (atherosclerosis) rheumatic bicuspid

Question 38

What percentage of people have a bicuspid aortic valve

Answer 38

1.5-2%

Question 39

What is aortic stenosis

Answer 39

Narrowing of the aortic valve

Question 40

How common is Aortic stenosis

Answer 40

It is the leader for cardiac valve disease worldwide

Question 41

What the pathophysiology of how aortic stenosis causes heart problems

Answer 41

Increased LV systolic pressure severse concentric hypertrophy increased Left ventricular end diastolic pressure and left atrial increased myocardial oxygen consumption and myocardial ischaemia

Question 42

Discuss the phases of aortic stenosis progression

Answer 42

Long asymptomatic phase - progression is slow | When symptomatic - life expectancy drops rapidly

Question 43

What is observed in clinical exam of aortic stenosis

Answer 43

pulse has small volume and is slow rising prominent JVP if RH failure is present Vigorous and sustained apex beat (visible)

Question 44

What investigation should be done for aortic stenosis

Answer 44

ECG | ECHO

Question 45

What is treatment for aortic stenosis

Answer 45

Medical - only for those who have heart failure | Interventional - Aortic valve replacement or repair

Question 46

What causes aortic regurgitation

Answer 46

Dilated aorta (aortic problem) Connective tissue disorders (aortic problem) Bicuspid valve Rheumatic heart disease endocarditis Myxomatous degeneration (5th decade of life)

Question 47

What the pathophysiology of how aortic regurgitation causes heart problems

Answer 47

Increased Left ventricular end diastolic volume and left ventricular systolic pressure LV hypertrophy and LV dilation Increased oxygen demand Ischaemia

Question 48

What are features of chronic aortic regurgitation

Answer 48

VERY slow progressing and asymptomatic

Question 49

What are features of acute aortic regurgitation

Answer 49

Pulmonary oedema and cardiogenic shock | MEDICAL EMERGENCY

Question 50

What can be found in clinical exam of aortic regurgitation

Answer 50

Pulse has large volume and is collapsing (Corrigans) Apex beat is hyperdynamic and displaced SYSTOLIC PRESSURE IS HIGH AND DIASTOLIC IS VERY LOW (RED FLAG)

Question 51

What investigation should be done for aortic regurgitation

Answer 51

ECG | ECHO

Question 52

What can ECG show in both aortic regurgitation and stenosis

Answer 52

ST changes due to LV strain

Question 53

What is Medical treatment for aortic regurgitation

Answer 53

Vasodilator therapy which has been shown to delay the time needed until surgical intervention

Question 54

What is surgical treatment for aortic regurgitation

Answer 54

Aortic valve replacement/repair