Valvular Disease

Question 1

Causes

Answer 1

The leading cause of valvular heart disease in the united states is mechanical degeneration.
In the devloping world rheumatic fever is the most common eitiology

Question 2

Types

Answer 2

Aortic Stenosis
Aortic Regurgitation
Mitral Stenosis
Mitral Regurgitation

Question 2

Aortic Regurgitation

Answer 2

May appear acutely or as a chronic condition

Question 2

Aortic Regurgitation
Chronic Cases

Answer 2

Birth Defects
Rheumatic Fever
Connective Tissue Disorders

Question 2

Aortic Regurgitation
Symptoms

Answer 2

Dyspnea on exertion
Paroxysmal Nocturnal Dyspnea
Lightheadedness on standing or changing positions too quickly

Question 3

Aortic Regurgitation
Physical Exam

Answer 3

Chest ausculation characterized by three distinct murmurs
Blowing diastolic murmur at LSB
Midsystolic murmur at the apex
Mid-diastolic rumble

Other signs
Head-bobbing with heart beats caused by caudal venous outflow obstruction
Water hammer pulse
Femoral bruits on compression of femoral pulse

Question 4

Aortic Regurgitation
Evaluation

Answer 4

Echocardiography is diagnostic
Doppler imaging shows back-flow across the aortic valve during diastole
EKG may show signs of dilated ventricles

Question 5

Aortic Regurgitation
Differential

Answer 5

Other valvular disease, including aortic stenosis or mitral regurgitation , CHF

Question 6

Aortic Regurgitation
Treatment

Answer 6

Medical management until symptoms warrant intervention
Vasodilator therapy: CCBs and ACEIs

Question 7

Aortic Regurgitation
Prevention, Prevention and Complications

Answer 7

Acute cases rapidly progress to pulmonary congestion, shock, and death if not
treated

Question 8

Mitral Valve Stenosis
Etiology

Answer 8

Rheumatic Fever

Question 9

Mitral Valve Stenosis
Symptoms

Answer 9

Presents with wide range of symptoms
Dyspnea on exertion
Arrhythmias
Orthopnea
Infective endocarditis
Paroxysmal nocturnal dyspnea

Question 10

Mitral Valve Stenosis
Physical Exam

Answer 10

Chest auscultation may reveal opening snap

Other signs include
Crackles and rales indicative of pulmonary edema

Question 11

Mitral Valve Stenosis
Evaluation

Answer 11

Doppler echocardiography is diagnostic
CXR will likely demonstrate mild to severe pulmonary edema

Question 12

Mitral Valve Stenosos
Differential

Answer 12

Other valvular disease, CHF

Question 13

Mitral Valve Stenosis
Treatment

Answer 13

Antiarrhythmics for symptom relief
Beta blockers, digoxin

Severe cases require surgical intervention.
Repair by commissurotomy preferred over replacement
Balloon valvotomy
Valve Replacement

Question 14

Mitral Valve Stenosis
Prognosis , Prevention and Complications

Answer 14

If left untreated, can progress to severe CHF and ultimately death

Question 15

Mitral Valve Regurgitation
Causes

Answer 15

Rheumatic Fever
Chordae Tamponade Rupture

Question 16

Mitral Valve Regurgitation
Symptoms and Physical Exam

Answer 16

Presents with a range of symptoms including
Dyspnea
Orthopnea
Fatigue

Chest auscultation reveals holosystolic murmur that radiates to the axillae

Question 17

Mitral Valve Regurgitation Evaluation

Answer 17

Doppler echocardiography is diagnostic - shows regurgitant flow

CXR may show enlarged left atrium

Angiography used to assess severity of disease

Question 18

Mitral Valve Regurgitation
Differential Diagnosis

Answer 18

Other valvular diseases, CHF

Question 19

Mitral Valve Regurgitation
Treatment

Answer 19

Decrease afterload: ACE inhibitors and ARBs

Antiarrythmics may be necessary if AF or others develop

Question 20

Prevention, Prognosis, and Complications

Answer 20

At increased risk of developing atrial fibrillation due to enlargement

Question 21

Cardiac Auscultation in Valvular Disease

Answer 21

Aortic Stenosis
Loud crescendo-decrescendo systolic ejection murmur in right 2nd intercostal space

Mitral Regurgitation
High pitched holosystolic loudest at apex radiating to axilla

Tricuspid Regurgitation
Soft holosystolic at right sternal border

Mitral Prolapse
Crisp midsystolic click and a delayed or late systolic regurgitation murmur.

Aortic Regurgitation
High pitched blowing early diastolic decrescendo murmur at left sternal border

Mitral Stenosis
Rumbling mid-diastolic murmur with accentuated S1. S2, best heard on expiration or when the patient is squating or exercising because venous return is increased