Aortic valve defects

Question 1

Describe the aortic valve

Answer 1

It has three leaflets, the orificle is smaller, 3-4 cm2

Question 2

What is aortic stenosis?

Answer 2

most common heart valve deformity, the valve is thickened and does not open properly

Question 3

What are the common causes of aortic valve stenosis ?

Answer 3

degenerative as it is exposed to large pressures, rheumatic heart disease, congenital (bicuspid aortic valve)

Question 4

Describe the degenerative causes of aortic valve stenosis

Answer 4

There is wear and tear caused by high pressures that the aortic valve is exposed to, this leads to inflammation, thickening and calcification of the cusps

Question 5

Describe the physiological changes that occur in the heart in aortic stenosis

Answer 5

There is increased L ventricular pressure, ventricular hypertrophy (the size of heart muscle increases concentrically new sarcomeres are added in parallel, size of contraction increases, the volume decreases), more prone to ischaemia, LA pressure also increases and this can lead to pulmonary hypertension

Question 6

Describe the progress of aortic stenosis

Answer 6

Slow progress, hypertrophy of LV, build up of pressure in LA, but when patients become symptomatic there is rapid deterioration, surgery needs to be performed within one month

Question 7

What are he symptoms of aortic stenosis?

Answer 7

chest pain, syncope, dizziness, SOB on exertion, heart failure

Question 8

What are the signs of aortic stenosis?

Answer 8

small volume and slow rising pulse, narrow pulse pressure, vigorous and sustained apex beat, LV heave, aortic thrill, signs of right sided heart failure , systolic murmur that radiates to carotids, crescendo descrescendo murmur

Question 9

What are the investigations for aortic stenosis ?

Answer 9

ECG, chest X ray, cardiac catherisation, echo, cardiac MRI,

Question 10

What is the treatment for aortic stenosis?

Answer 10

The treatment is limited to those who have cardiac failure, aortic valve replacement or rapid surgery

Question 11

What is aortic regurgitation?

Answer 11

The aortic valve leaflets do not close properly and the blood leaks out from aorta to ventricles

Question 12

What are the causes of aortic regurgitation?

Answer 12

aorta enlargement due to hypertension, connective tissue disorders, congenital bicuspid valves, rheumatoid arthritis, endocarditis, myxomatous degeneration

Question 13

What are the pathological changes in aortic regurgitation?

Answer 13

Ventricles needs to cope with regurgitating blood, pressure and volume overload, this leads to dilation and hypertrophy of the ventricle,, more prone to ischaemia and can lead to LVF

Question 14

What are the two types of aortic regurgitation ?

Answer 14

Acute and chronic, in chronic the patient can be asymptomatic as ventricle has time to adapt, SOB on exertion, in acute case there is no time for ventricle to adapt, it is an emergency

Question 15

What are the symptoms of aortic regurgitation?

Answer 15

exertional dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea, palpitations, angina, syncope

Question 16

What are the signs of aortic regurgitation ?

Answer 16

collapsing pulse, wide pulse pressure (high systolic and low diastolic ), hyper dynamic and displaced apex beat, strange BP, early diastolic decrescendo soft murmur

Question 17

What are the investigation for aortic regurgitation?

Answer 17

ECG (ST/T changes), chest X ray (cardiomegaly), cardiac catherisation, echo, cardiac MRI

Question 18

What is the treatment for aortic regurgitation?

Answer 18

vasodilators, more interventional treatment of repair or replacement surgery

Question 19

What are the three most common valve problems?

Answer 19

senile aortic stenosis, bicuspid aortic stenosis, degenerative mitral stenosis

Question 20

What are the two types of valves that can be used for surgery?

Answer 20

Prosthetic or animal valves

Question 21

What are the advantages and disadvantages of animal valves?

Answer 21

patients do not have to be on warfarin, but they wear out quicker, usually used in older patients

Question 22

What are the advantages and disadvantages of prosthetic valves?

Answer 22

They last longer, 3-40 years, but patients have to be on warfarin afterwards, can hear very load clicking sound

Question 23

When should be aortic valve replaced?

Answer 23

In aortic stenosis if the symptoms are present. In aortic regurgitation if there is left ventricular dilation

Question 24

When should be mitral valve replaced?

Answer 24

In mitral stenosis if the orificle is smaller than 1.5 cm2, in regurgitation based on the severity of the symptoms