Valve Disease

Question 1

Name the two systolic murmurs

Answer 1

Mitral Regurgitation

Aortic Stenosis

Question 2

Name the two diastolic murmurs

Answer 2

Mitral Stenosis

Aortic Regurgitation

Question 3

What are the most common causes of Mitral Stenosis?

Answer 3

• Rheumatic Heart disease, secondary to rheumatic fever

- could also be congenital or arthritic

Question 4

How much is the valve narrowed in stenosis?

Answer 4

From 4-6cm to <2cm

Question 5

Consequences of Aortic Stenosis?

Answer 5

Increased pressure in Left atrium

• increased pressure in pulmonary veins
• tricuspid and pulmonary valve become incompetent under pressure.

Question 6

What two factors affect the severity?

Answer 6

Flow rate (dependent on CO, HR)
Pressure Gradient

Question 7

SIGNS of MS

Answer 7

dyspnoea
stroke
Haemoptosis
chest pain
infective endocarditis
hoarse voice
mitral facies
JVP- prominent a wave
tapping apex beat
diastolic thrill
RV heave

Question 8

Investigations for MS

Answer 8

ECG catheterisation
CXR
Echo- ** best for looking at leaflets.
Cardiac MRI

Question 9

Treatment for ms

Answer 9

meds- diuretics, control AF, anticoagulation

Surgery- valve replacement or valvotomy

Question 10

Mitral Regurgitation- causes

Answer 10

Rheumatic Heart Disease
Mitral Valve prolapse
Degenerative
change in LV- hypertrophy

Question 11

MR- consequences?

Answer 11

Chronic- LV will compensate

Acute- LV doesn’t have a chance to compensate- v bad

Question 12

SIGNS OF MR

Answer 12

Acute- SOB, Pulmonary Oedema, Cardiogenic Shock
Chronic- Fatigue, exhaustion, RH failure, dyspnoea, palpitations
Loud systolic murmur
Hyper dynamic Apex Beat
JVP- elevated in Heart failure`

Question 13

Investigation in MR

Answer 13

ECG- tall p wave
CXR- oedema
Echo- look at valve **

Question 14

Treatment of MR

Answer 14

Medical- reduce afterload and preload in acute= diuretics.

Surgery- replace or repair.

Question 15

Aortic Valve Stenosis causes

Answer 15

Degenerative- due to high stresses on aortic valve

Congenital - bicuspid aortic valve

Question 16

Consequences of AS

Answer 16

High LV systolic pressure
LVH
High ED pressure
High O2 demand= more susceptible to ischaemia.

Question 17

SIGNS of AS

Answer 17

Long period will be asymptomatic
Symptoms = bad
Chest Pain
Syncope
SOB on exertion
Heart Failure
Pulse- small and slow rising
JVP- prominent in Heart failure
Vigorous and hyper dynamic apex beat
harsh systolic murmur- carotid

Question 18

Investigations for AS

Answer 18

ECG- tall r wave
CXR- calcification if valve
ECHO- look at valve and LV function

Question 19

Treatment of AS

Answer 19

• Only for those with heart failure

- Valve replacement

Question 20

Aortic Regurgitation- causes?

Answer 20

Dilated Aorta
Bicuspid Aortic Valve
Connective Tissue Disorder- Marfans

Question 21

Consequences of AR

Answer 21

High EDV and Stroke Volume

Hypertrophy and Dilation= increased demand for O2= MI= Heart Failure

Question 22

Clinical signs of AR

Answer 22

Chronic- long asymptomatic phase
Acute- pulse, large and collapsing
quiet diastolic murmur
wide pulse pressure
hyper dynamic misplaced apex beat.

Question 23

Investigations of AR

Answer 23

ECG
CXR
ECHO-

Question 24

Treatment of AR

Answer 24

Medical - vasodilators - delay surgery for 2-3 years.

Surgery - replacement or repair