Valvular Disease

Question 1

What is the difference between aortic stenosis (AS) and aortic sclerosis?

Answer 1

Stenosis - narrowing of circumference of aortic valve, calcification
Sclerosis - deposition intraluminally reduces diameter of lumen at aortic valve

Question 2

How to differentiate between AS and aortic sclerosis ?

Answer 2

Auscultation of carotids
AS - radiation to carotids
Sclerosis no radiation

Question 3

SAD - presentation of Aortic stenosis

Answer 3

Syncope
Angina
Dyspnoea

Question 4

HOCM

Question 5

What causes an acute MR?

Answer 5

Ischaemic (papillary muscle rupture)
- inf MI

Non-ischaemic (ruptured chordae tendineae)
- myxomatous disease (mitral prolapse)
- infective endocarditis
- RHD (acute/chronic)
- trauma
- spontaneous rupture

Prosthetic valve
- tissue rupture (endocarditis, degeneration, calcification)
- paravalvular regurg (infection/suture rupture)
- impaired closure (valve thrombus/infection)

Question 6

How does an acute MR present?

Answer 6

Sudden onset:
- hypotension
- cardiogenic shock
- pulmonary oedema

Question 7

What are the causes of chronic MR?

Answer 7

Leaflets
- degenerative disease
- rheumatic fever
- IE
- systemic inflammatory (SLE, scleroderma)
- CTDs (Marfan’s, EDS)
- Congenital (clefts)
- hypertrophic cardiomyopathy
- drugs (ergomatine, bromocriptine, fen-phen)
Chordae
- myxomatous (prolapse)
- trauma
Papillary muscles
- MI/ischaemia, RWMAs
- dilated cardiomyopathy
Annular
- calcification (rheumatic fever, age)
- dilation (dilated cardiomyopathy, CTDs)
Prosthesis
- paravalvular leak
- ring/strut fracture
- leaflet deterioration
- IE
- thrombus/pannus