Valve Disease

Question 1

What is valve stenosis

Answer 1

The narrowing of valves

Question 2

What is valve incompetence

Answer 2

Valves becoming unable to shut properly

Question 3

Which valves are under more pressure

Answer 3

Mitral and aortic valve

Question 4

What are papillary muscles

Answer 4

Attach the valves to the heart wall and hold the valves shut during systole or diastole

Question 5

Which valve doesn’t have papillary muscles and why

Answer 5

Aortic valve

It stays shut due to the high pressure in the aorta and only opens when the pressure in the left ventricle exceeds this

Question 6

In which groups of patients is valve disease more common

Answer 6

Elderly patients

Patients with Down’s Syndrome

Question 7

What are the symptoms of valve disease

Answer 7

Rarely any symptoms and often goes undiagnosed

Question 8

What causes valve disease

Answer 8

Congenital abnormalities
MI - papillary muscle rupture
Rheumatic fever
Dilation of the aortic root

Question 9

What is rheumatic fever

Answer 9

An immune reaction to streptococci that can lead to vegetations growing on the heart valve which can become infected and cause infective endocarditis

Question 10

What is dilation of the aortic root

Answer 10

Makes the width of aortic root increase and pulls the aortic cusps apart so they no longer meet and don’t close properly

Question 11

What can cause dilation of the aortic root

Answer 11

Aneurysm formation within the aorta

Syphilis

Question 12

Give an example of a congenital abnormality that can cause valve disease

Answer 12

Bicuspid aortic valve instead of normal tricuspid appearance

Question 13

What valves are found in the heart

Answer 13

Left - aortic and mitral

Right - pulmonary and tricuspid

Question 14

Which valves fail more commonly

Answer 14

Left side valves - aortic and mitral

Question 15

What is the outcome of valve stenosis

Answer 15

Limits blood flow into the ventricle reducing the ability of the heart to maintain an adequate cardiac output and cause heart failure

Question 16

What investigations can be carried out in a patient for valve disease

Answer 16

Ultrasound scan

Doppler ultrasound scan

Question 17

Describe a Doppler ultrasound scan for valve failure

Answer 17

Doppler measures whether the blood is moving away from the probe or towards it, the computer will then colour the blood artificially to demonstrate it flowing away and towards the probe
It can be seen whether the blood can flow past the valve cusps and back into a chamber or whether the blood isn’t properly being forced into a new chamber

Question 18

When should valve replacement be carried out in a patient

Answer 18

Before evidence of heart failure as any heart failure that develops before the valve is replaced will not completely reverse after the treatment and also increases risk during the surgery

Question 19

What are the different types of replacement heart valve

Answer 19

Mechanical

Biological

Question 20

Describe a mechanical heart valve

Answer 20

Metal, long working - 20-30 years
Metal requires patient to take an anticoagulant to prevent blood clots from depositing on the surface of the valves and causing emboli and problems with stroke

Question 21

Describe a biological replacement heart valve

Answer 21

Heart of pig, coupled onto a frame which can be implanted onto the cardiac tissue
Shorter life - less than 10 years

Question 22

When is it best to use a biological heart valve

Answer 22

When known that the valve will need to be replaced in the future anyway
When the patients life expectancy is less than the life expectancy of the valve

Question 23

What major risk does heart valve replacement have

Answer 23

Infective endocarditis risk

Question 24

Which anticoagulant is currently used in patients with a metal valve

Answer 24

Warfarin

Question 25

What may some patients not like about metal valves

Answer 25

Makes a ticking noise

Question 26

How can the ticking noise of a metal valve help dentists

Answer 26

Allows dentist to recognise changes in the patients heart rate if they are becoming anxious during care

Question 27

When should antibiotic prophylaxis be considered

Answer 27

During any heart valve replacement

Question 28

How is a valve replacement carried out

Answer 28

Sutures placed through valve ring and heart tissue then valve is slid down the sutures and secured into place

Question 29

What can a dentist do to prevent endocarditis

Answer 29

Remove cases or oral sepsis
Improve patients oral hygiene
Improve prevention of oral disease