Valvular Disease

Question 1

Aortic Stenosis
- Causes
- Presentation + O/e
- Ix
- Mx

Answer 1

Causes: calcification, rheumatic heart disease

Syx
- SAD = syncope (exertional), angina, dyspnoea

O/e
- Ejection systolic murmur
- High pitched murmur
- Radiates to carotids

Features of severe AS
- Slow rising pulse and narrow pulse pressure
- S4
- Thrill
- LVF or failure

Ix:
- ECG, CXR, ECHO

Mx
- If Asyx: WW
- If Syx: valve replacement (AVR or Balloon valvuloplasty)

Question 2

Aortic Regurgitation
- Causes
- Presentation + O/e
- Ix
- Mx

Answer 2

Leaking of aortic valve causes reverse blood flow during ventricular diastole. Complications: HF

Caused by valve disease or distortion
- Rheumatic fever. IE
- Marfans, EDS
- Bicuspid aortic valve
- Aortic dissection
- HTN
- Syphilis

Presentation
(1.) Exertional dyspnoea
(2.) Orthopnoea
o/e
- early diastolic murmur
- collapsing/corrigan’s pulse (rapid appearing + disappearing pulse)
- wide pulse pressure
- Quincke’s sign (nailbed pulsation)
- De Musset’s sign (head bobbing)

Management
(1.) Medical Mx of associated HF, reduce systolic HTN with ACEi, Bb
(2.) Surgery indicated in
- Syx with severe AR
- Asyx with severe AR who have LV systolic dysfunction

Question 3

Mitral Stenosis
- Causes
- Presentation + O/e
- Ix
- Mx

Answer 3

Causes: RHEUMATIC FEVER
Presentation
(1.) Pulmonary HTN from inc left atrial pressure: dyspnoea, pink frothy sputum
(2.) Malar flush - rise in CO2 + vasodilation from pulmonary htn
(3.) AF - due to inc atrial pressure + enlargement
O/e
- mid-diastolic, low pitched “rumbling” murmur
- loud S1

Ix
- ECG
- CXR: left atrial enlargement
- ECHO

Management
- Anitcoag if AF
- Ayx - monitor with ECHO
- Syx - balloon valvoplasty or valve replacement

Question 4

Mitral Regurgitation
- Causes
- Presentation + O/e
- Ix
- Mx

Answer 4

Incompetent mitral valve allows blood to leak back into LA during systole. Complications: CCF

Causes:
- age
- IHD e.g. post MI papillary rupture, mitral valve prolapse,
- IE, rheumatic heart disease,
- Marfan, EDS.

Presentation
- asyx
- pan-systolic murmur
- radiates to left axilla

Ix:
- ECG: P-mitrale (due to left atrial enlargement), left ventricular hypertrophy, left axis deviation.
- CXR
- ECHO (dx)

Mx
- Syx: mitral valvuloplasty or valve replacement
- Post-mi/acute MR: emergency valve replacement

Question 5

Tricuspid stenosis
- causes
- syx
- mx

Answer 5

Causes: rheumatic fever

Syx
- Fatigue
- Ascites
- Oedema
- JVP
- Early diastolic murmur

Mx
- Diuretic
- Surgical repair

Question 6

Tricuspid regurg
- causes
- syx
- mx

Answer 6

Causes
- RV dilation
- Pulmonary HTN
- Rheumatic fever
- IE
- Drugs

Syx
(1.) Signs of RSHF: Pulsatile hepatomegaly, Ascites, Oedema
(2.) HS
- Pansystolic murmur
- Parasternal heave
(3.) Other signs: JVP, prominent V waves, jaundice

Mx
- Rx underlying cause
- Rx HF/fluid overload: diuretics
- Valve repair/replacement

Question 7

Pulmonary stenosis
- causes
- syx
- mx

Answer 7

Causes:
- Congenital: ToF, Williams syndrome, Rubella infection, Carcinoid syndrome

Syx
- Dyspnoea
- Fatigue
- Oedema
- Ascites
- JVP
- Parasternal heave

Mx
Pulmonary valvulopasty or valvotomy

Question 8

Pulmonary regurg
- causes
- syx
- mx

Answer 8

Causes: IE, ToF, Carcinoid tumour, Rheumatic fever

Syx
- CP/discomfort
- Fatigue
- Light headed

Mx
valve replacement

Question 9

Mitral Valve prolapse: RF, Syx, Ix, Mx

Answer 9

MVP is a common cause of mitral regurgitation
- RF: Marfans, EDS, turner’s syndrome

Presentation
- ASyx
- CP
- Palpitations
- Dyspnoea
- exercise intolerance
- dizziness
- o/e: MR murmur (pan-systolic)

Ix
- ECG
- ECHO show abnormal displacement of one or both leaflets

Mx
- Bb - relax blood vessels and slow HR which reduced BP
- Surgery if severe