Heart Valve Diseases

Question 1

Mitral stenosis: definition

Answer 1

Narrowing of the mitral valve resulting in obstructed forward blood flow

Question 2

Mitral stenosis: etiology

Answer 2

#Rheumatic heart disease
#Calcification
#Pulmonary hypertension
#Atrial fib

Question 3

Mitral stenosis: what’s it sound like?

Answer 3

#Mid-diastolic rumbling murmur with crescendo toward S2
#Loud S1 with opening snap

Question 4

Mitral stenosis: Clinical features

Answer 4

#Exertional dyspnea
#PND
#Acute pulmonary edema 
#Orthopnea 
#PACs 
#Palpitations

Question 5

Mitral stenosis: diagnosis

Answer 5

#Echocardiogram: most valuable. L atrial enlarged.
#ECG: biphasic or notched p-waves
#CXR: Straight L heart border, pulmonary congestion
#Cardiac catheterization

Question 6

Mitral stenosis: treatment

Answer 6

#If atrial fib: beta-blockers, non-dihydropyridine CCBs, or digoxin for rate control
#Diuretics
#Anticoags for atrial fib (INR goal: 2-3)
#Surgical repair

Question 7

Mitral stenosis: when to schedule surgery

Answer 7

If the patient is symptomatic (NYHA Functional Class II-IV) with isolated MS, whose valve area is < 1 cm squared per square meter of body surface area.That’s < 1.5 cm square in a normal sized adult.

Question 8

Mitral regurgitation: definition

Answer 8

Backflow of blood into the L atrium because the mitral valve doesn’t close properly

Question 9

Mitral regurgitation: etiology

Answer 9

#Rheumatic heart disease
#Floppy valve
#Papillary muscle dysfunction
#Endocarditis
#Ruptured chordae tendon
#Hypertrophic cardiomyopathy
#SLE

Question 10

Mitral regurgitation: what’s it sound like?

Answer 10

#S3 heart sound with systolic murmur at the apex
#May radiate to base or L axilla
#Blowing, musical, or high pitched quality
#May be palpable apical thrill

Question 11

Mitral regurgitation: clinical features

Answer 11

#Fatigue
#Weakness
#Dyspnea

Question 12

Mitral regurgitation: diagnosis

Answer 12

#Echo or TEE: thickened valve with or without flail leaflets or vegetation
#Doppler echo: regurg flow into L atrium
#ECG: Notched or broad P-waves, L axis deviation
#CXR: enlarged LA/LV
#Cardiac catheterization

Question 13

Mitral regurgitation: Treatment

Answer 13

#Vasodilators to decrease afterload
#Digoxin
#Diuretics
#Anticoag for atrial fib (INR goal: 2-3)
#Surgery for severe or refractory

Question 14

Mitral regurgitation: when to schedule surgery

Answer 14

Surgery for chronic, non-ischemic, severe MR is indicated once symptoms occur, ESPECIALLY if repair (as opposed to replacement) is feasible.

Question 15

Aortic stenosis: definition

Answer 15

Narrowing of the aortic valve resulting in obstructed forward blood flow. The blood can’t get out the door fast enough!

Question 16

Aortic stenosis: etiology

Answer 16

Most common valve disorder in the US
#Rheumatic disease
#Aging
#Idiopathic (calcification of the valve)
#Congenital

Question 17

Aortic stenosis: what does it sound like?

Answer 17

#Systolic "blowing" murmur
#Harsh at the 2nd R ICS
#Usually radiates to neck

Question 18

Aortic stenosis: Clinical features (it’s so very SAD)

Answer 18

THREE MAJOR SIGNS
#Syncope
#Angina
#Dyspnea

Question 19

Aortic stenosis: diagnosis

Answer 19

#Echo
#CXR: check for concentric hypertrophy of the LV with calcified valve

Question 20

Aortic stenosis: treatment

Answer 20

#SURGERY! High mortality rate if valve not replaced
#Symptomatic tx: Na+ restriction & diuretics for CHF
#IMPORTANT: ACEi will decrease SVR & cause hypotension, syncope. CONTRAINDICATED.

Question 21

Aortic stenosis: when to schedule surgery

Answer 21

When your patient has symptoms of aortic stenosis. :)

Question 22

Aortic regurgitation: definition

Answer 22

Backflow of blood into the LV re: deficient aortic valve leaflets or the aorta

Question 23

Aortic regurgitation: etiology

Answer 23

#MOST COMMON ACUTE CAUSE: infectious endocarditis
#Rheumatic fever (boy that will mess up your whole heart)
#RA
#Idiopathic valve calcification

Question 24

Aortic regurgitation: What does it sound like?

Answer 24

#S3 heart sound
#Diastolic "blowing" murmur at the 3rd L ICS

Question 25

Aortic regurgitation: clinical features

Answer 25

#Fatigue
#Dyspnea
#Syncope
#CHF signs/symptoms
#Increased pulse pressure

Question 26

Aortic regurgitation: diagnosis

Answer 26

#Echo
#CXR: check for LV enlargement (mod to severe)

Question 27

Aortic regurgitation: treatment

Answer 27

#Surgery
#Vasodilators (ACEi or nifedipine in asymptomatic)
#Nitroprusside for acute management
#Treatment of CHF symptoms: Na+ restrict, diuretics, digoxin

Question 28

Aortic regurgitation: when to schedule surgery

Answer 28

Optimal time: AFTER the onset of LV dysfunction, but PRIOR to the development of severe symptoms. Why?

1) Patients usually not symptomatic until after development of myocardial dysfunction
2) When delayed too long, surgery often doesn’t restore normal LV function.