L02: Valve Disease

Question 1

What are the 4 main valves in the heart

Answer 1

Pulmonary valve
Aortic valve
Mitral valve (left)
Tricuspid valve (right)

Question 2

What are the 2 things that can happen to a valve

Answer 2

Stenosis

Regurgitation

Question 3

What type of murmus is a aortic stenosis

Answer 3

Harsh crescendo decresendo systolic ejection murmur

Question 4

Where does a carotid stenosis murmur radiate to

Answer 4

To the carotids

Question 5

What type of murmus is a aortic regurgitation

Answer 5

Diastolic murmur with a decresendo

Question 6

What type of murmus is a mitral stenosis

Answer 6

Delayed diastolic murmus with a decresendo

Question 7

What is a mitral regurgitation murmur like

Answer 7

Holosytolic murmus

Question 8

Where does mitral regurgitation murmur radiate to

Answer 8

Axilla

Question 9

What type of murmus is a pulmonary stenosis murmur

Answer 9

Cresendco decresendo systolic murmur

Question 10

Where does pulmonary stenosis murmur radiate to

Answer 10

To the back

Question 11

In valvular stenosis what happens to the pressures in the upstream and downstream chamber

Answer 11

Upstream chamber pressure is higher than the downstream pressure so blood can flow through

Question 12

In valvular regurgitation what happens to the flow of blood when the valve is closed

Answer 12

There is a leak so the blood flows back to the upstream chamber

Question 13

What is the most common valvular disease in the ageing population

Answer 13

Aortic stenosis

Question 14

What are the causes of aortic stenosis

Answer 14

Congenital
Acquired: calcific degenerative aortic stenosis and rheumatic aortic stenosis (due to rheumatic fever causing inflammation and repair)

Question 15

What features can we see with aortic stenosis

Answer 15

Left ventricular hypertrophy 
Angina: due to reduced blood flow to the coronary arteries 
Breathlessness and heart failure 
Collapse/syncope
Death

Question 16

What is the management of aortic stenosis

Answer 16

Medical therapy
Valvuloplasty- put a balloon to stretch the valve
Valve replacement: mechanical valve or tissue valve from pigs
Percutaneous valve replacement: TAVR, TAVI

Question 17

How do we investigate for aortic stenosis and find out if it is severe

Answer 17

echocardiogram

Question 18

What are the signs and symptoms of aortic regurgitation

Answer 18

Wide blood pressure differnce; systolic pressure increases due to blood flowing back to the ventricle and diastolic pressure decreases
Collapsing pulse
Displaced apex beat
Early diastolic murmur/systolic murmur

Question 19

What are the causes of aortic regurgitation

Answer 19

Dilatation of the aortic root due to:
Hypertension
Marfans syndrome
Syphillis

Abnormality of aortic leaflet:
Prolpase
Fenestration

Damage to aortic leaflet:
Rheumatic fever
Endocarditis

Question 20

What is the treatment of aortic regurgitation

Answer 20

Valve replacement
Tavr
Mechanical valves: bileaflet, tilting disc, ball in cage

Question 21

What are the causes of mitral regurgitation

Answer 21

Mitral valve prolapse at birth
Rheumatic heart disease
Infecitve endocarditis
Collagen vascular disease

Secondary:
Ischaemic heart disease
Non ischaemic cardiomyopathy

Question 22

What are the symptoms of mitral valve regurgitation

Answer 22

Breathlessness
Fatigue
Right heart failure

Question 23

What are the signs of mitral valve regurgitation

Answer 23

Pan sytolic murmus radiating to the apex
Right heart failure
Pulmonary hypertension

Question 24

What is the treatment for mitral valve regurgitation

Answer 24

Medical therapy
Valve replacement
Valve repair
Mitraclip

Question 25

What are the causes of mitral stenois

Answer 25

Rheumatic fever

Congenital mitral stenosis

Question 26

What are the symptoms of mitral stenosis

Answer 26

breathlesness
Haemoptysis
Embolisatipn
Atrial fibrillation
Rv heave
Presystolic and rumbling diastolic murmur

Question 27

What is the management of mitral stenosis

Answer 27

Medical therapy- anti coagulation

Valve treatment: open mitral valvotomy, percutaneous mitral commissuoromty, valve replacement

Question 28

Do mechanical valves require anticoagulant

Answer 28

Yes

Question 29

Do tissue walves require anticoagulant

Answer 29

No but last around 10 years