Valve Disease

Question 1

What is rheumatic fever

Answer 1

Systemic Infection that leads to destruction of heart valves

Question 2

What is pathophysiology of rheumatic fever

Answer 2

Pharyngeal infection of group A beta haemolytic strep
Antibody to cell wall of strep cross reacts with valve tissue
Cause valve damage

Question 3

How do you diagnose rheumatic fever

Answer 3

Revised Jones criteria
Evidence of GABHS: throat culture, strep antigen test, strep antibody titre

Major: carditis, arthritis, sbct nodules, erythema marginatum, chorea

Question 4

What are consequences of rheumatic fever

Answer 4

Chronic rheumatic heart disease: valve, pericarditis, CCF, conduction defects 
Mitral (70%)
Aortic (40%)
Tricuspid
Pulmonary

Question 5

What are causes of mitral valve regurgitation

Answer 5

LV dilatation 
Annular calcification 
Infective endocarditis
Rheumatic fever 
Chordae tendinae rupture
Papillary muscle rupture
Connective tissue disorders (Marfans, Ehlers Danlos)

Question 6

What are features of mitral regurgitation

Answer 6

Dyspnoea, fatigue, palpitations 
AF 
Displaced hyperdynamic apex 
Pansystolic murmur at apex, radiating to axilla 
Soft S1

Question 7

How do you manage mitral regurgitation

Answer 7

Control rate if AF
Anticoagulate if: AF, high risk of emboli, prosthetic valve
Diuretics: symptoms
Surgery replacement: severe symptoms
Transcathetor valve repair: severe symptoms but unfit for surgery

Question 8

What are causes of mitral stenosis

Answer 8

Rheumatic fever
Prosthetic valve
Congenital

Question 9

What are features of presentation of mitral valve stenosis

Answer 9

When orifice <2cm
Pulmonary HTN: dyspnoea, haemoptysis, cough
Compression by large LA: hoarseness, dysphagia, bronchial compression

AF, Malar flush
RV heave
Loud S1
mid-diastolic murmur at apex