Valvular Disease

Question 1

define aortic regurgitation

Answer 1

incompetency of valves/valve roots causing backwards flow of blood into aortic valve

Question 2

acute causes of aortic regurgitation

Answer 2

infective endocarditis
aortic dissection
traumatic rupture

Question 3

chronic causes of aortic regurgitation

Answer 3

calcification
rheumatic heart disease
Marfan’s Syndrome

Question 4

risk factors of aortic regurgitation

Answer 4

previous heart issue (e.g. Marfans, infective endocarditis or congenital bicuspid valve)

Question 5

acute presentation of aortic regurgitation

Answer 5

sudden cardiac syncope
pulmonary oedema
pallor and sweating
peripheral vasoconstriction

Question 6

chronic presentation of aortic regurgitation

Answer 6

extertional dysponea
orthopnoea
stable angina

Question 7

signs of aortic regurgitaiton

Answer 7

early diastolic murmur
pulsation of nail beds (Quincke’s Sign)
wide pulse pressure with sudden collapse (Corrigan’s Pulse)

Question 8

investigations of aortic regurgitation

Answer 8

echocardiogram
CXR
bloods (FBC, U+E, BNP, ESR, CRP and LFTs)

Question 9

management of aortic regurgitation

Answer 9

losartan +/- beta blockers

ECHO every 6-12mnths

Question 10

indications for surgery in aortic regurgitation

Answer 10

significant enlargement of ascending aorta
symptomatic AR
poor left ventricular ejection fraction
infective endocarditis refractory to medical therapy

Question 11

surgical interventions in aortic regurgitation

Answer 11

aortic valve replacement

TAVI

Question 12

define aortic stenosis

Answer 12

narrowing of aortic valve cusps occurring progressively

Question 13

clinical presentation of aortic stenosis

Answer 13

chest pain
cardiac syncope
heart failure
exertional dyspnoea

Question 14

signs of aortic stenosis

Answer 14

slow rising carotid pulse
narrow pulse pressure
S3 and S4 present
ejection-systolic high pitched murmur

Question 15

investigations of aortic stenosis

Answer 15

ECG
echocardiogram
CXR

Question 16

intervention in aortic stenosis requirements

Answer 16

symptomatic AS

asymptomatic with LVEF <50%

Question 17

surgical management of aortic stenosis

Answer 17

TAVI - those with severe comorbidities, previous heart surgery or >75yrs

SAVR - low risk and <75yrs

Question 18

medical management of aortic stenosis

Answer 18

ACE inhibitors
beta blockers
diuretics
6-12mnth follow ups

Question 19

define mitral stenosis

Answer 19

impaired opening of the mitral valve affecting blood flow from left atrium to ventricle

Question 20

causes of mitral stenosis

Answer 20

rheumatic heart disease

Question 21

clinical features of mitral stenosis

Answer 21

gradual exertional dyspnoea 
haemoptysis 
palpitations 
chest pain 
hoarseness of voice

Question 22

signs of mitral stenosis

Answer 22

malar flush 
low volume pressure 
atrial fibrillation 
⬆️ JVP 
inspiratory crepitations

Question 23

investigations in mitral stenosis

Answer 23

ECG
CXR
echocarodiogram

Question 24

management of unsymptomatic mitral stenosis

Answer 24

regular echocardiograms

Question 25

management of symptomatic mitral stenosis

Answer 25

balloon valvuloplasty
percutaneous mitral valvotomy
open valve repair/replacement