Valvular Heart Disease

Question 1

Cardiac breathlessness:

• What is it related to?
• What is it often associated with?

Answer 1

• Related to activity

- Often associated with ankle swelling, orthopnoea and paroxysmal dyspnoea

Question 2

New York heart association functional classification

Answer 2

Class I = no limitation
Class II = slight limitation of ordinary activity
Class III = marked limitation of less than ordinary activity
Class IV = severe limitation of minimal activity or rest

Question 3

Signs of right sided heart failure

Answer 3

Raised JVP, pitting oedema in ankles and sacrum, hepatic congestion

Question 4

When is there a tapping apex beat?

Answer 4

Mitral stenosis

Question 5

Apex beat in left ventricular dilatation

Answer 5

Displaced and diffuse due to volume overload

Question 6

Apex beat in left ventricular hypertrophy

Answer 6

Heaving and apex beat may be displaced

Question 7

Parasternal heave:

• When is it felt?
• What is it caused by?

Answer 7

• When the hand is over the left of the sternum

- Due to right ventricular hypertrophy - cor pulmonare/pulmonary hypertension

Question 8

What is a cardiac murmur?

Answer 8

Audible turbulence of blood flow

Question 9

Types of systolic murmur

Answer 9

Pansystolic - same volume all the way through

Ejection systolic - gets louder towards the end

Question 10

Types of diastolic murmur

Answer 10

Early diastolic - starts loud and gets quieter

Mid diastolic - gets quieter then louder

Question 11

Murmur radiating to carotids

Answer 11

Aortic stenosis

Question 12

Murmur radiating to axilla

Answer 12

Mitral regurgitation

Question 13

Grades of murmur

Answer 13

I - very quiet
II - quiet but easy to hear
III - loud
IV - loud with a thrill 
V - very loud with a thrill
VI - so loud that it is audible without a stethoscope

Question 14

What murmurs are louder with inspiration?

Answer 14

Right sided

Question 15

What murmurs are always pathological

Answer 15

Diastolic murmurs

Question 16

Valve stenosis

Answer 16

When valves don’t open properly

Question 17

Valve regurgitation

Answer 17

When valves don’t close properly

Question 18

Mixed valve disease

Answer 18

Valves which don’t open or close properly

Question 19

Symptoms of aortic stenosis

Answer 19

Breathlessness, chest pain, dizziness/syncope

Question 20

Signs of aortic stenosis

Answer 20

Low volume pulse, forceful displaced apex beat, ejection systolic murmur radiating to carotids

Question 21

Treatment of aortic stenosis

Answer 21

Conventional valve replacement, trans catheter aortic valve replacement, balloon aortic valvotomy

Question 22

Causes of mitral regurgitation

Answer 22

Prolapse of leaflets, rheumatic leaflets, myxomatous leaflets, endocarditis affecting leaflets, chordae rupture, papillary muscle rupture, annular dilatation

Question 23

Symptoms of mitral regurgitation

Answer 23

Breathlessness, peripheral oedema, fatigue

Question 24

Signs of mitral regurgitation

Answer 24

Displaced apex beat, pan systolic murmur radiating to axilla

Question 25

Treatment for mitral regurgitation

Answer 25

Medication: diuretics and ACE inhibitors Surgical: repair if prolapse, replacement if degenerative Percutaneous: clips in infancy

Question 26

Mitral stenosis causes

Answer 26

Rheumatic main cause

Question 27

Symptoms of mitral stenosis

Answer 27

Breathlessness, fatigue, palpitations (AF)

Question 28

Signs of mitral stenosis

Answer 28

Malar flush, tapping apex beat, mid diastolic murmur localised to apex

Question 29

Treatment for mitral stenosis

Answer 29

Medication: diuretics and treat AF Surgery: valve replacement Balloon valvuloplasty

Question 30

Causes of aortic regurgitation

Answer 30

Endocarditis affecting leaflets, connective tissue damage in leaflets, rheumatic leaflets, Marfan's, aortic dissection

Question 31

Symptoms of aortic regurgitation

Answer 31

Breathlessness

Question 32

Signs of aortic regurgitation

Answer 32

Collapsing pulse, wide pulse pressure, displaced apex, early diastolic murmur left sternal edge

Question 33

Treatment for aortic regurgitation

Answer 33

Medication: ACE inhibitors Surgery: Valve replacement