Cardiovascular: Valvular heart disease

Question 1

with reference to valve disease, what is regurgitation?

Answer 1

valve flaps don’t close properly, causing blood to leak backward

Question 2

with reference to valve disease, what is stenosis?

Answer 2

the valve flaps become thick or stiff, and they may fuse together (results in reduced blood flow)

Question 3

with reference to valve disease, what is Atresia?

Answer 3

the valve isn’t formed, and a solid sheet of tissue blocks the blood flow between the heart chambers

Question 4

with reference to valve disease, what is Vegetation?

Answer 4

The valve leaflets develop either infective or thrombotic nodules that impair normal valve mobility and can break up causing an embolism.

Question 5

what causes mitral regurgitation?

Answer 5

Dilation of mitral valve annulus, papillary muscle fibrosis + dysfunction, mitral valve prolapse (commonest cause), infective endocarditis, rheumatic valvular disease idiopathic weakening of the valve with age, ischaemic heart disease, connective tissue disorders (Ehlers Danlos syndrome or Marfan syndrome), ischaemic heart disease.

Question 6

what causes mitral stenosis?

Answer 6

Rheumatic heart disease (most common cause) + infective endocarditis.

Question 7

what causes aortic regurgitation?

Answer 7

Dilation of the aortic root, infective endocarditis, some rheumatological disorders (RA, ankylosing spondylitis). Age related weakness, connective tissues (Ehlers Danlos syndrome or Marfan syndrome).

Question 8

what causes aortic stenosis?

Answer 8

Calcific degeneration, rheumatic valvular disease.

Question 9

what is the most common type of valve disease?

Answer 9

aortic stenosis

Question 10

what are risk factors for valve disease?

Answer 10

Increasing age.
Personal or family history of CHD.
Cardiovascular risk factors e.g. smoking, diabetes, hyperlipidaemia, hypertension, obesity.
Congenital heart disease.

Question 11

what are some clinical features of valve disease?

Answer 11

Heart murmur. 
Fatigue.
SOB - particularly when the patient has been very active or lies down. 
Oedema around ankles and feet. 
Dizziness, fainting (syncope), fatigue. 
Palpitations. 
Coughing up blood stained sputum. 
Chest pains/angina.

Question 12

what signs may you find on examination in a patient with valve disease?

Answer 12

heart murmur 
oedema in legs 
SOBOE
AF 
collapsing pulse

Question 13

what is a characteristic symptom of mitral regurgitation?

Answer 13

pulmonary oedema

Question 14

what is a characteristic symptom of mitral stenosis?

Answer 14

Breathlessness (SOBOE, orthopnoea, paroxysmal nocturnal dyspnoea), AF (palpitations), systemic emboli, haemoptysis.

Question 15

what is a characteristic symptom of aortic regurgitation?

Answer 15

Collapsing pulse, diastolic murmur.

Question 16

what is a characteristic symptom of aortic stenosis?

Answer 16

SOBOE, angina, dizziness, syncope, left ventricular failure.

Question 17

a collapsing pulse is a characteristic feature of what type of valve disease?

Answer 17

aortic regurgitation

Question 18

which conditions present in a similar way to valve disease?

Answer 18

Aortic sclerosis.
Aortic regurgitation.
Bacterial endocarditis.
Atrial septal defect.

Question 19

what investigations would you conduct to confirm a diagnosis of valve disease?

Answer 19

echocardiogram

ECG / CXR

Question 20

collapsing pulse is a characteristic feature of what type of valve disease?

Answer 20

aortic regurgitation

Question 21

what is the treatment for valve disease?

Answer 21

heart valve repair

heart valve replacement (See notes)

Question 22

what medication may you prescribe for a patient with valve disease?

Answer 22

ACE inhibtiors.
Diuretics.
If AF develops: eta-blockers, calcium-channel blockers and digoxin, or anticoagulation medication.

Question 23

what are some complications of valve disease?

Answer 23

Heart failure. 
Stroke. 
Blood clots.
Atrial fibrillation: develops in about 4 in 10 cases.
Endocarditis.
Death.