Valves

Question 1

Risk factors for valvular disease

Answer 1

Endocarditis,
Rheumatic fever,
Bicuspid valve, 
Heart disease, 
Aneurysms,
Hypertension, 
Tumour

Question 2

Aortic stenosis presentation?

Answer 2

HF, 
Angina, 
SOB,
Harsh heart sounds, 
Right ventricular heave, 
Slow rising pulse, 
Narrow pulse pressure
Syncope, 
Vigorous, sustained apex beat

Question 3

Aortic regurgitation presentation?

Answer 3

Collapsing pulse, 
Murmur,
Displaced hyperdynamic apex beat, 
SOB, 
Wide pulse pressure,
Traube's sign (pistol shot heard over femoral artery),
De Musset's sign (Head nodding in time with heart beat),
Quincke's sign (Pulse felt in the nail)

Question 4

Mitral regurgitation presentation?

Answer 4

Brisk hyperdynamic apex beat, 
SOB,
Pansystolic murmur,
Pulmonary oedema, 
Right ventricular heave,
Palpitations, 
Fatigue

Question 5

Mitral stenosis presentation?

Answer 5

Chest pain, 
Diastolic thrill, 
SOB, 
Haemoptysis,
Hoarseness, 
Pulmonary oedema, 
Malar flush (red cheeks),
Right ventricular heave, 
Tapping apex beat

Question 6

Difference between biological and mechanical valve?

Answer 6

Biological lasts 15 years,

Mechanical last 40 years but needs warfarin

Question 7

Causes of aortic stenosis (3)

Answer 7

Atherosclerotic like calcific degeneration,
Congenital bicuspid valve,
Rheumatic Heart disease

Question 8

Causes of aortic regurgitation (h: acute and chronic causes) (3)

Answer 8

Acute:

• Cusp rupture,
• Connective tissue disorders eg Marfan’s syndrome,
• Aortic dissection,
• Perforation (secondary to infection)

Chronic:

• Rheumatoid arthritis
• Ankylosing spondylitis,
• Syphilis

Question 9

Cause of mitral stenosis?

Answer 9

Rheumatoid arthritis, 
Calcification of the valve, 
Rheumatoid arthritis, 
Ankylosing spondylitis, 
SLE, 
Malignant carcinoid

Question 10

Causes of mitral regurgitation?

Answer 10

Rheumatic heart disease,
Papillary muscle rupture,
Infective endocarditis,
Prolapse

Question 11

How does the pulse of someone with aortic stenosis appear?

Answer 11

Narrow pulse pressure,

Slow rising pulse

Question 12

How does the pulse of someone with aortic regurgitation appear?

Answer 12

Bounding pulse,
Wide pulse pressure,
pulse felt in nail,
Head bobbing to pulse

Question 13

How dies the apex beat appear in someone with mitral stenosis?

Answer 13

Tapping apex beat

Question 14

How dies the apex beat appear in someone with mitral regurgitation?

Answer 14

Displaced apex beat

Question 15

How dies the apex beat appear in someone with aortic stenosis?

Answer 15

Vigorous, sustained apex beat

Question 16

Which murmur presents with right ventricular heave?

Answer 16

Aortic stenosis,
Mitral regurgitation,
Mitral stenosis

Question 17

How dies the apex beat appear in someone with aortic regurgitation?

Answer 17

Displaced hyperdynamic apex beat