10. Valvular Disease

Question 1

What is mitral regurgitation?

Answer 1

back flow through the mitral valve during systole

Question 2

What can cause mitral regurgitation?

Answer 2

functional (LV dilation)
annular calcification (elderly)
Rheumatic fever
infective endocarditis
cardiomyopathy
congenital 
connective tissue disorders (post MI)

Question 3

What are the signs and symtoms of mitral regurgitiation?

Answer 3

Pan-systolic murmur radiating to the axilla
Dyspnoea, fatigue, palpitations
AF, displaced apex

Question 4

What tests can be done for mitral regurgitation?

Answer 4

ECHO- best to assess LV function + severity/aetiology

ECG

CXR

Question 5

How do you manage mitral regurgitiation?

Answer 5

Control rate and aniticoagulate if AF
anti coagulate if history of embolism
Diuretics improve symptoms
Surgery for deteriorating symptoms/ before LV is compromised

Question 6

What is the most common valvular disease?

What causes it?

Answer 6

Mitral valve prolapse

Autism, , PDA, Cardiomyopathy, turners, marfans,

Question 7

What are the signs of mitral valve prolapse?

What are the complications of a mitral valve prolapse?

Answer 7

Usually asymptomatic. Late systolic murmur

Cerebral emboli
Arrythmias
Sudden death

Question 8

How do you treat severe mitral valve disease?

Answer 8

B blockers to help palpitations/chest pain

Surgery if severe MI

Question 9

Explain the pathology of mitral stenosis?

Answer 9

Mitral valve becomes stenosed meaning less blood can come through.

This leads to pulmonary hypertension, enlarged left atrium, fatigue,

Question 10

What are the signs of mitral stenosis?

Answer 10

Pressure symptoms (Hoarse voice, dysphagia)
Malar flush
RV heave, mid diastolic murmur

Question 11

How is mitral stenosis treated?

Answer 11

If AF- rate control,
Anti-coagulate
Diuretics

If this does not control symptoms then balloon valvuplasty

Question 12

What is the Japanese octopus pot disease called?

Answer 12

Takatsubo cardiomyopathy

Question 13

How does aortic stenosis present?

Answer 13

Classic triad of angina, syncope and HF

may also have dyspnoea, syncope,

ejection systolic murmur that radiates to the carotids

Question 14

How is aortic stenosis managed?

Answer 14

Surgery- poor survival without it

usually valve replacement

Question 15

What is aortic sclerosis?

Answer 15

Senile degeneration of the valve

Ejection systolic murmur but no radiation

Question 16

What are the acute causes of aortic regurgitation?

Answer 16

Infective endocarditis
Ascending aortic dissection
Chest trauma

Question 17

What are the chronic causes of aortic regurgitation

Answer 17

Congenital
Connective tissue disorders (marfans)
Rheumatic fever
Arteritis
RA

Question 18

What are the symptoms and signs of aortic regurgitation?

Answer 18

Exertional dyspnoea
Orthopnoea
Paroxysmal nocturnal dyspnoea

Early diastolic murmur heard best when sitting forward

Question 19

What is the treatment of aortic regurgitation?

Answer 19

Reduce systolic hypertension

Only surgery when severe AR with enlarged ascending aorta

Question 20

Explain the presentation of tricuspid regurgitation?

Answer 20

Typically caused by RF, Infective endocarditits, congenital

Leads to a v heave, hepatic pain (due to congestion)

pansystolic murmur heard at the lower left sternal edge

Question 21

How do you manage tricuspid regurgitation?

Answer 21

Diuretics for systemic congestion

Valve repair of replacement

Question 22

Explain the presentation of tricsupid stenosis?

Answer 22

Typically RF may be infective endocarditits/congenital

fatigue, ascites, oedema, early diastolic murmur

Question 23

How do you treat tricuspid stenosis

Answer 23

Diuretics, surgery

Question 24

Explain the presentation of pulmonary stenosis

Answer 24

Typically a congeital condition presents with dspnoea, fatigue ascites

may be ejectio systolic murmur

Question 25

How is pulmonary stenosis investigated and treated

Answer 25

ECG, ECHO, CXR- dilated pulmonary veins.

Surgical valvoplasty or valvotomy