Valve Disease - NEED DETAIL

Question 1

Causes of VHD

Answer 1

Rheumatic fever commonest

Question 2

RhF Dx

Answer 2

major

minor

Question 3

aortic stenosis symptoms

Answer 3

chest pain
exertional dyspnoea
syncope
sudden death
LVH/LVF features

Question 4

aortic stenosis signs

Answer 4

slow-rising pulse
narrow pulse pressure
systolic ejection murmur
soft SII (*normal HS II = not aortic issue)

Question 5

aortic stenosis causes and Mx

Answer 5

RhF, degeneration, congenital bicuspid

medical: diuretics +/- statins
surgical: replacement e.g. TAVI

Question 6

mitral regurg symptoms/signs

Answer 6

heart failure Sx: oedema, dyspnoea, cough, haemoptysis, fatigue

Question 7

mitral regurg signs

Answer 7

oedema, jvp, heave
pansystolic isointensity murmur
HS I normal
radiation: apex/axilla/back, heart base, none

Question 8

mitral regurg causes and Mx

Answer 8

RhF, IE
prolapse, papillary rupture (IHD)
congenital (ASD)

medical: diuretics, ACEI, BB, digoxin/warfarin
surgical: repair or replace

Question 9

Aortic regurg symptoms

Answer 9

???

Question 10

aortic regurg signs

Answer 10

bounding collapsing pulse, wide pulse pressure
soft early diastolic murmur
loudest LLSE, leant forwards, expiration
Austin Flint: Mid-DM, normal HS I

Question 11

aortic regurg causes and Mx

Answer 11

RhF, IE, degeneration,???

medical: diuretics, ACEI, ?BB + digoxin, ?CCB (non-RL)
surgical: replacement (standard vs. TAVI)

Question 12

mitral stenosis symptoms

Answer 12

hoarseness (La large compresses RLN/bronchus)
dysphagia (oesophagus compressed)
haemoptysis (alveolar capillaries
dyspnoea: ortho, PND, exertional

Question 13

mitral stenosis signs

Answer 13

MDM, soft and rumbling
EDM pre-systolic murmur (atrial knock) if sinus rhythm
loud HS I (pressure to close) and opening snap
apex tap
ECG: p mitrale (wide)

Question 14

mitral stenosis causes and Mx

Answer 14

99% RhF
congenital (chordae or leaflets)

medical: digoxin, diuretics, warfarin
surgical: percutaneous vavuloplasty or valvotomy

Question 15

summary of murmurs

Answer 15

MDM = AR
PSM = MR
ESM = AS
EDM = MS

*pig valve flow murmur: normal HS II (=not aortic issue)