Left heart valve disease

Question 1

WHat is arotic stenosis

Answer 1

The narrowing of the aortic valve orifice

Question 2

What are the main causes of aortic stenosis

Answer 2

Age related calcific aortic stenosis, congenital bicuspicd ortic valve, rheumatic fever

Question 3

Describe the pathophysiolgogy of aortic stenosis

Answer 3

Age related degeneration involves calcification of valve leaflets. Valve orifice area lowered. Increased afterload causes left ventricular hypertrophy (initially adaptive) but then hypertrophic response decompensates, patients transition to heart failure.

Question 4

WHat are the clinical features of aortic stenosis?

Answer 4

Triad of symptoms on exertion: SAD

Syncope, angina, dyspnoea

Question 5

WHat are the examination findings of aortic stenosis including auscultation?

Answer 5

Slow rising, delayed pulse, narrow pulse pressure (not much difference between systolic and diastolic), LV heave on apex,

Auscultation: Crescendo-decrescendo ejection systolic murmur radiating to both carotids.

Question 6

What are the investigations for aortic stenosis

Answer 6

Echocardiography and doppler, ECG, Chest radiograph

Second line is cardiac MRO, cardiac catheterisation

Question 7

How is aortic stenosis managed?

Answer 7

No medical therapy really, but CAD is common in AS patients, atherosclerotic risk factor midification recommended.
Medical therapy is a bridge for intervention or surgery. ACE inhibitors, digoxin, diuretics

Aortic valve replacement is the definitive treatment.

Question 8

What is aortic regurgitation?

Answer 8

Backflow of blood though aortic valve during diastole

Question 9

What causes acute aortic regurgitation

Answer 9

IE, ascending aortic dissection, chest trauma

Question 10

WHat causes chronic aortic regurgitation

Answer 10

Rheumatic feverm congenital, CTDs, aortic dilatation, bicuspid valve disease, vasculitis, RA, SLE

Question 11

WHat is the pathophysiology of aortic regurgitation

Answer 11

Blood flows back to LV from aorta, so lv has to overcome increased volume Causes increased heartrate and contractility to overcome preload. LV hypertrophy in chronic, remodelling

In acute, LV is normal size, unable to compensate, giving SOB, Pulmonary oedema due to backwards transmission of pressure

Question 12

WHat clincial features are found in aortic regurgitation?

Answer 12

Dyspnoea, pulmonary oedema

Chronic presents with symptoms of heart failure

Question 13

What examination findings are seen in aortic regurgitation?

Answer 13

Pulsus bisiferens, collapsing pulse, laterally displaced apex, wide pulse pressure,

Auscultation: High pitched early diastolic murmur, may have third heart sound, mid diastolic murmur suggests severe

Question 14

What are the investigations of aortic regurgitation

Answer 14

CXR, ECG, echocardiogram

Second line is cardiac catheterisation

Question 15

How is acute aortic regurgitation managed

Answer 15

Immediate surgery, haemodynamic support may be needed beforehand (inotropes and nitrates)

Question 16

How is chronic aortic regurgitation managed?

Answer 16

Medical therapy - Treatment of hypertension, symptomatic patients may need surgery. WHen surgery contraindicated, ACE inhibitors and beta blockers may be needed. Definitive treatment os Aortic valve replacement.