Valve disease overview

Question 1

Define:

Stenosis
Regurgitation
What valves are usually affected?

Answer 1

Can’t open fully

Can’t close fully aka incompetence

Left sided valves (atrial stenosis, mitral regurgitation)

Question 2

S+S

• What would you hear?
• Why could they have fatigue or dizziness?
• Why may valve disease cause angina?

Answer 2

Murmur

Low CO

The thickened heart muscle must pump against high pressure to push blood through the narrowed aortic valve. This increases heart muscle oxygen demand in excess of the supply delivered in the blood, causing chest pain (angina).

Question 3

Investigations:

An echocardiogram is used for valve disease.

What are the 2 types of echo’s?

What does the echo look at?

ECG and CXR - what could you find that would correlate with valve disease?

Answer 3

Transthoracic
Transoesophageal

Valve diameter
Valve anatomy (leaflets/calcification)
Jet velocity and pressure
Gradient across valve

Co-morbid ischaemia
LVF
AF

Question 4

Investigations:

What other scan can be done if echo unclear?

Answer 4

Cardiac MRI if echo unclear

Question 5

Surgery:

At what point is this done?

What 2 things could they do?

Answer 5

Severe symptomatic patients

Repair or replacement

Question 6

Surgery:

Mechanical valves:

• Why are they better for younger patients?
• What do they carry a higher risk of?

Bioprosthetic valves:

-Above what age are they usually used in and why?

What needs to be prescribed in any patient with a valve replacement?

Answer 6

It is more durable

Thrombus formation

> 65 as they are less durable

Anticoagulation such as aspirin