Right-sided Valve Disease

Question 1

What is the most common cause of primary right-sided valve disease?

Answer 1

Rheumatic heart disease

Other causes include congenital defects, infections, and inflammatory conditions.

Question 2

Name a congenital heart defect associated with primary right-sided valve disease.

Answer 2

Ebstein anomaly

This is a structural heart defect affecting the tricuspid valve.

Question 3

List some infectious causes of primary right-sided valve disease.

Answer 3

• Endocarditis
• Infectious diseases

Endocarditis is an infection of the heart’s inner lining.

Question 4

What are some rheumatic/inflammatory causes of primary right-sided valve disease?

Answer 4

• SLE
• Antiphospholipid syndrome
• Advanced malignancy
• Collagen vascular diseases

SLE stands for Systemic Lupus Erythematosus.

Question 5

What is an iatrogenic cause of primary right-sided valve disease?

Answer 5

Scarring and adhesions due to chest radiation or pacemaker placement complications

Iatrogenic causes are those resulting from medical treatment.

Question 6

What primarily causes functional/secondary right-sided valve disease?

Answer 6

Damage to the valve ring or supporting structures

This includes damage to papillary muscles and chordae tendineae.

Question 7

Name some causes of pulmonary hypertension that can lead to secondary right-sided valve disease.

Answer 7

• Left-sided heart failure
• Fluid overloaded state
• Renal disease
• Hemodialysis
• Right ventricular infarction
• Mitral valve disease

Each of these conditions can increase pressure in the pulmonary arteries.

Question 8

What is tricuspid stenosis?

Answer 8

Narrowing of the tricuspid valve opening

This obstruction affects blood flow from the right atrium to the right ventricle.

Question 9

What are the main pathophysiological changes in tricuspid stenosis?

Answer 9

• Scarring of the tricuspid valve leaflets
• Shortening of chordae tendineae
• Commissural fusion

These changes lead to immobility of the leaflets.

Question 10

Isolated tricuspid stenosis is _______.

Answer 10

rare

It almost always occurs with mitral or aortic valve disease.

Question 11

What happens to right atrial pressure in tricuspid stenosis?

Answer 11

It increases due to increased afterload

This can lead to concentric right atrial hypertrophy.

Question 12

How does increased right atrial pressure affect pulmonary circulation?

Answer 12

It is transmitted retrograde, causing pulmonary congestion and hypertension

This can lead to symptoms such as elevated jugular venous pressure (JVP).

Question 13

What are the consequences of backflow of blood in tricuspid stenosis?

Answer 13

• Elevated JVP
• Hepatomegaly and abdominal pain
• Splenomegaly and ascites
• Pitting peripheral edema in lower limbs

This backflow leads to various systemic effects.

Question 14

What is a potential effect of backflow of blood into the alveoli?

Answer 14

Pulmonary edema

This can result from increased fluid in the lungs.

Question 15

What is tricuspid regurgitation?

Answer 15

Leaking of the tricuspid valve that causes blood to flow in the reverse direction, from the right ventricle back into the right atrium and pulmonary veins.

Question 16

What occurs during systole in tricuspid regurgitation?

Answer 16

The tricuspid valve doesn’t fully close, causing blood to be regurgitated into the right atrium from the right ventricle.

Question 17

What is the result of increased right atrial pressure in tricuspid regurgitation?

Answer 17

Increased preload leads to eccentric right atrial hypertrophy.

Question 18

How does right atrial pressure affect pulmonary circulation in tricuspid regurgitation?

Answer 18

Right atrial pressure is transmitted retrograde into pulmonary circulation, causing pulmonary congestion and hypertension.

Question 19

What are the consequences of pulmonary congestion in tricuspid regurgitation?

Answer 19

It leads to elevated JVP, hepatomegaly, abdominal pain, splenomegaly, ascites, and pitting peripheral edema in lower limbs.

Question 20

What is pulmonary stenosis?

Answer 20

Narrowing of the pulmonary valve opening, which obstructs blood flow from the right ventricle into pulmonary arteries.

Question 21

What happens to blood flow during pulmonary stenosis?

Answer 21

There is an obstruction of blood flow from the right ventricle into pulmonary arteries due to narrowing of the pulmonary valve.

Question 22

What is the effect of increased right ventricular pressure in pulmonary stenosis?

Answer 22

It causes increased afterload, leading to concentric right ventricular hypertrophy.

Question 23

What can result from eventual right ventricular failure in pulmonary stenosis?

Answer 23

It causes backflow into the right atrium and subsequently into pulmonary circulation.

Question 24

What are the consequences of backflow in pulmonary stenosis?

Answer 24

It leads to elevated JVP, hepatomegaly, abdominal pain, splenomegaly, ascites, and pitting peripheral edema in lower limbs.

Question 25

What happens to fluid due to backflow of blood in pulmonary stenosis?

Answer 25

It pushes fluid out of veins and into alveoli, causing pulmonary edema.

Question 26

What is pulmonary regurgitation?

Answer 26

Leaking of the pulmonary valve that causes blood to flow in the reverse direction, from the pulmonary arteries back into the right ventricle.

Question 27

What happens during systole in pulmonary regurgitation?

Answer 27

The pulmonary valve doesn't fully close, causing blood to be regurgitated into the right ventricle from the pulmonary arteries.

Question 28

What is the effect of increased preload in pulmonary regurgitation?

Answer 28

Right ventricular pressure increases, leading to eccentric right ventricular hypertrophy.

Question 29

What happens to right ventricular pressure in pulmonary regurgitation?

Answer 29

It is transmitted retrograde into pulmonary circulation, causing pulmonary congestion and hypertension.

Question 30

What are the consequences of pulmonary congestion in the venous system?

Answer 30

Blood goes into the superior vena cava, leading to elevated JVP, and into the inferior vena cava, causing hepatomegaly, abdominal pain, splenomegaly, ascites, and pitting peripheral edema.

Question 31

What is pulmonary edema in the context of pulmonary regurgitation?

Answer 31

Backflow of blood pushes fluid out of veins and into alveoli.

Question 32

What are the common signs of right-sided valve disease?

Answer 32

Systemic venous congestion, jugular venous distension, ascites, and peripheral edema.

Question 33

What are the symptoms of right-sided heart failure?

Answer 33

Fatigue, right upper quadrant pain due to hepatomegaly, ascites, peripheral edema, fluttering discomfort in the neck, and pulmonary edema symptoms.

Question 34

What are the ECG findings associated with right-sided valve disease?

Answer 34

• Right atrial hypertrophy • Right ventricular hypertrophy • Right axis deviation • Atrial fibrillation ## Footnote These findings indicate structural changes in the heart due to valve disease.

Question 35

What is the primary diagnostic test for right-sided valve disease?

Answer 35

Doppler echocardiography ## Footnote This test assesses the pressure gradients across valves and provides visual information about valve structure.

Question 36

What does a 2D ECHO show in cases of tricuspid stenosis?

Answer 36

Thickened leaflets with reduced movement and right atrial enlargement ## Footnote This indicates a significant obstruction to blood flow through the valve.

Question 37

What are the echocardiographic findings for pulmonary stenosis?

Answer 37

Thickened leaflets with reduced movement, right ventricular enlargement, pulmonary artery dilation ## Footnote These findings reflect the increased pressure load on the right ventricle.

Question 38

What is indicated by a dilated tricuspid annulus on echocardiography?

Answer 38

Tricuspid regurgitation ## Footnote This suggests a malfunction of the valve leading to backflow of blood.

Question 39

What does cardiac MRI provide for right-sided valve disease?

Answer 39

More accurate and reproducible findings for regurgitation ## Footnote MRI is useful for detailed assessment of heart structure and function.

Question 40

What is the initial management strategy for right-sided valve disease?

Answer 40

Treat underlying cause ## Footnote This may include addressing any conditions contributing to the valve disease.

Question 41

What is valvotomy?

Answer 41

Open up stenosed valve ## Footnote This surgical procedure aims to relieve obstruction in a narrowed valve.

Question 42

What are the main benefits and disadvantages of mechanical valves?

Answer 42

Benefit: Durable and lasts a long time Disadvantage: Patient needs to take anticoagulants ## Footnote Mechanical valves are often used in younger patients due to their longevity.

Question 43

What types of tissue valves are commonly used?

Answer 43

• Human tissue (homograft) • Animal tissue (heterograft) ## Footnote Heterografts often involve porcine or bovine tissues.

Question 44

What is a key disadvantage of tissue valves?

Answer 44

Lasts less than 15 years, even less in younger patients ## Footnote This limits their use in younger individuals who may require longer-lasting solutions.