Valve Disease

Question 1

what are the common signs?

Answer 1

exertional symptoms
chest pain
breathlessness
collapse/ dizzy spells

Question 2

describe cardiac breathlessness

Answer 2

related to activity (usually)
often associated with ankle swelling
orthopnoea
paroxysmal nocturnal dyspnoea

Question 3

describe the NY Heart Association Functional Classification

Answer 3

Class I - No limitation
Class II - Slight limitation of ordinary activity
Class III - Marked limitation of less than ordinary activity
Class IV - Severe limitation of minimal activity or at rest

Question 4

what are the signs of right side heart failure?

Answer 4

raised JVP
pitting oedema
hepatic congestion

Question 5

describe the use of the apex beat

Answer 5

normally 5th intercostal space midclavicular line
tapping apex in mitral stenosis
displaced and diffuse in left ventricular dilatation (volume overload)
heaving and may be displaced in left ventricular hypertrophy (pressure overload)

Question 6

what is a parasternal heave?

Answer 6

hand left of sternum
right ventricular overload
cor pulmonale/ pulmonary hypertension

Question 7

what is a cardiac murmur?

Answer 7

audible turbulence of blood flow

can be both innocent and pathological

Question 8

aortic valve

Answer 8

2nd- 3rd right intercostal space

Question 9

pulmonary valve

Answer 9

2-3rd left intercostal space

Question 10

tricuspid valve

Answer 10

left sternal border

Question 11

mitral valve

Answer 11

apex

Question 12

describing murmurs

Answer 12

systole or diastole?
what type of murmur?
where is it loudest?
where does it radiate to?
what grade or murmur?
influenced by respiration?

Question 13

types of systolic murmurs

Answer 13

pansystolic

ejection systolic

Question 14

types of diastolic murmurs

Answer 14

early diastolic

mid diastolic

Question 15

radiation of murmurs

Answer 15

carotids (aortic stenosis)

axilla (mitral regurgitation)

Question 16

grading of murmurs

Answer 16

I. Very quiet 
II. Quiet - easy to hear
III. Loud
IV. Loud with a thrill
V. Very loud with a thrill
VI. Loud  - audible without a 		stethoscope

Question 17

right vs left sided murmurs

Answer 17

right sided murmurs are louder with inspiration

Question 18

additional heart sounds

Answer 18

common
innocent murmur 
mitral regurgitation
aortic stenosis 
aortic regurgitation
mitral stenosis 

less common
2nd sound splitting 
3rd sound
4th sound 
systolic clicks
continuous murmur
tricuspid regurgitation 
pericardial rub

Question 19

innocent (functional) murmur

Answer 19

soft (less than 3/6 severity)
position dependant
often early systolic

Question 20

valve stenosis

Answer 20

valves which do not open properly

Question 21

valve regurgitation

Answer 21

valves which do not close properly

Question 22

mixed valve disease

Answer 22

valves which neither open properly not close properly

Question 23

reasons for aortic stenosis

Answer 23

degenerative (age related)
congenital eg bicuspid valve
rheumatic

Question 24

symptoms and signs of aortic stenosis

Answer 24

breathlessness
chest pain 
dizziness/ syncope
low volume pulse
forceful displaced apex
ejection systolic murmur than can radiate to the carotids

Question 25

treatment of aortic stenosis

Answer 25

conventional valve replacement trans catheter aortic valve replacement balloon aortic valvotomy

Question 26

mechanical heart valves

Answer 26

longevity warfarin younger patients

Question 27

bio-prosthetic heart valves

Answer 27

no warfarin 10 years older patients

Question 28

aortic valve replacement

Answer 28

preferred to TAVI long term outcomes no contra-indications CABG as well

Question 29

trans catheter aortic valve replacement

Answer 29

co-morbidity | previous sternotomy

Question 30

causes of mitral regurgitation

Answer 30

``` leaflets - prolapse - rheumatic - myxomatous (floppy) - endocarditis chordae rupture (degenerative) - prolapse/ flail leaflet papillary muscles rupture - ischaemic annular dilatation - functional ```

Question 31

symptoms and signs of mitral regurgitation

Answer 31

``` breathlessness peripheral oedema fatigue displaced apex pansystolic murmur - axilla cardiomegaly ```

Question 32

treatment of mitral regurgitation

Answer 32

``` medication - diuretics and heart failure (ACE inhibitors) surgical - repair- prolapse - replacement- degenerative percutaneous - clips in infancy ```

Question 33

causes of mitral stenosis

Answer 33

essentially rheumatic main cause | congenital rare

Question 34

symptoms and signs of mitral stenosis

Answer 34

``` breathlessness fatigue palpitations malar flush tapping apex beat mid diastolic rumbling diastolic murmur localised to apex straight left heart border ```

Question 35

treatment of mitral stenosis

Answer 35

``` medication - diuretics and treat AF surgery - valve replacement balloon valuloplasty ```

Question 36

causes of aortic regurgitation

Answer 36

``` leaflets - endocarditis - connective tissue diseases - rheumatic annulus - marfan's - aortic dissection ```

Question 37

symptoms and signs of aortic regurgitation

Answer 37

``` breathlessness collapsing pulse wide pulse pressure displaced apex early diastolic murmur left sternal edge cardiomegaly ```

Question 38

treatment of aortic regurgitation

Answer 38

``` medication - ACE inhibitors surgery - symptoms and LV dilatation - valve replacement ```