CVS conditions - valvular

Question 1

What is the pathology of aortic stenosis?

Answer 1

Orifice <1cm2
LV outflow obstruction leads to:
LV dilatation
Muscle hypertrophy
Increased O2 demand

Question 2

What are the causes of aortic stenosis?

Answer 2

Calcification
Rheumatic fever
Congenital bicuspid valve

Question 3

What are the signs of aortic stenosis?

Answer 3

Exertional dyspnoea
Angina
Heart failure
Syncope
Sudden death
Pulse - narrow pressure, slow rising
Heaving apex beat
Ejection systolic murmur

Question 4

What investigations would you be done if aortic stenosis was suspected?

Answer 4

ECHO
ECG - strain
CXR - LV enlargement
Cardiac catheterisation

Question 5

How is aortic stenosis treated?

Answer 5

Aortic valve replacement

Question 6

What kind of murmur is heard in aortic stenosis?

Answer 6

Ejection systolic murmur
Best heard over the aortic valve in expiration
Radiates to the carotids

Question 7

What is the pathology of aortic regurgitation?

Answer 7

Regurgitation leads to:
Increase in LV end diastolic pressure
LV dilatation
LV hypertrophy

Question 8

What are the causes of aortic regurgitation?

Answer 8

Rheumatic fever
Endocarditis
Hypertension
Atherosclerosis
Marfan's syndrome
Aortic dissection

Question 9

What are the signs of aortic regurgitation?

Answer 9

Exertional dyspnoea
Nocturnal dyspnoea
Angina
Pulse - wide pressure, collapsing water hammer
Early diastolic high-pitched murmur

Question 10

What investigations would be done if aortic regurgitation was suspected?

Answer 10

ECHO
ECG - LV hypertrophy
CXR - LV enlargement
Cardiac catheterisation

Question 11

How is aortic regurgitation treated?

Answer 11

ACEi - symptomatic
ECHO - every 6-12 months to monitor
Aortic valve replacement

Question 12

What murmur is heard during aortic regurgitation?

Answer 12

Early diastolic high-pitched murmur

Murmur best heard at the lower left sternal edge with the patient sitting forwards

Question 13

What is the pathology of mitral stenosis?

Answer 13

Orifice <2cm2
LA needs really high pressure to be able to pump blood into the LV to maintain CO
Leads to pulmonary hypertension

Question 14

What are the causes of mitral stenosis?

Answer 14

Rheumatic fever
Congenital
Endocarditis
SLE

Question 15

What are the symptoms of mitral stenosis?

Answer 15

Malar flush
Dyspnoea
Haemoptysis
Orthopnoea
Palpitations
Pulse - low volume
AF
RV heave
Loud S1, opening snap, rumbling mid/diastolic murmur

Question 16

What investigations would be done if mitral stenosis was suspected?

Answer 16

ECHO
ECG - RV hypertrophy
CXR - LA enlargement

Question 17

How is mitral stenosis treated?

Answer 17

Diuretic
AF - anticoagulant
If that doesn’t work - balloon valvuloplasty (if valve isn’t calcified)
Mitral valve replacement

Question 18

What type of murmur is heard in mitral stenosis?

Answer 18

Loud S1, opening snap, rumbling mid/diastolic murmur

Best heard with the patient lying on their left side on exertion

Question 19

What is the pathology of mitral regurgitation?

Answer 19

Backflow of blood during systole

Question 20

What are the causes of mitral regurgitation?

Answer 20

LV dilatation
Rheumatic heart disease
IHD
Calcification
Infective endocarditis
Connective tissue disorders

Question 21

What are the symptoms of mitral regurgitation?

Answer 21

Dyspnoea
Fatigue
Orthopnoea
Right sided heart failure
Pulse - jerky
Soft S1, added S3
Pansystolic murmur
Displaced apex beat
Pulmonary oedema

Question 22

What investigations would be done if mitral regurgitation was suspected?

Answer 22

ECHO
ECG - LA enlargement
CXR - LA enlarged, pulmonary oedema

Question 23

How is mitral regurgitation treated?

Answer 23

Mitral valve replacement

Question 24

What kind of murmur is heard in mitral regurgitation?

Answer 24

Soft S1, added S3

Pansystolic murmur