Valvular disease

Question 1

Describe what can be heard in the heart

Answer 1

Opening and closing of heart valves
Turbulent flow through the heart and valves
Filling of the heart
Valvular pathology
Structural heart disease

Question 2

Where can heart murmurs be heard?

Answer 2

Between the two heart sounds during systole

Question 3

List the 4 ways valve disease can be caused describing the epidemiology of each

Answer 3

Degenerative- reflects aging population
Rheumatic- post streptococcal infection common in areas of poverty and overcrowding
Infective- common in IV drug abusers and immunocompromised patients
Congenital- Low incidence in all populations

Question 4

Which valve is affected in degenerative valvular disease?

Answer 4

Aortic > Mitral

Question 5

Which valve is affected in congenital valvular disease?

Answer 5

Any valve

Question 6

Which valve is affected in infective valvular disease?

Answer 6

Any valve however more commonly the right if the person is an intravenous drug user

Question 7

Which valve is affected in Rheumatic valvular disease?

Answer 7

Mitral>Aortic

Question 8

List the 3 main pathologies behind valvular heart disease

Answer 8

Fibrosis- fusion of leaflets
Calcification- immobility of leaflets
Dilation- of the valve ring

Question 9

What do the pathologies of valvular heart disease result in?

Answer 9

Either stenosis or regurgitation

Question 10

Describe stenosis

Answer 10

The narrowing of the leaflets so the leaflets fail to open completely leading to a build up of back pressure and loss of volume

Question 11

Describe Regurgitation

Answer 11

The leaflets do not meet in systole. The leaflets fail to close completely allowing to reverse flow of blood during the relaxation of the heart

Question 12

In valvular disease the valves can either be…

Answer 12

Tight or leaky

Question 13

Give the age of presentation of congenital syndromes causing aortic stenosis

Answer 13

Paediatrics, <60

Question 14

Give the age of presentation of Bicuspid valves causing aortic stenosis

Answer 14

40-60

Question 15

Give the age of presentation of degenerative aortic stenosis

Answer 15

> 60

Question 16

Give the age of presentation of rheumatic aortic stenosis

Answer 16

< 60

Question 17

Describe the features of aortic stenosis

Answer 17

Symptoms due to obstruction of flow- if severe then fatigue, breathlessness, syncope on exertion, chest pain, palpitations and murmur. If early then no symptoms may be present. The patient may adapt themselves to cope with symptoms and therefore may not notice any.
Pressure overload- Generation of high left ventricular systolic pressure causing left ventricular hypertrophy and eventually left ventricle decompensation/dilation

Question 18

Describe the heart sounds of aortic stenosis

Answer 18

Crescendo-decrescendo murmur- Turbulent flow of blood since the aortic valve fails to open. At the beginning of systole the pressure gradually rises and as a result the amount of blood and therefore turbulence increases , peaks and then falls as the ventricles begin to relax
Soft second heart sound

Question 19

What is the cause of most arrhythmias?

Answer 19

Pressure overload

Question 20

List the symptoms of aortic stenosis

Answer 20

The SAD triad

Fatigue

Question 21

If aortic stenosis is symptomatic what is more likely to occur?

Answer 21

Sudden death

Question 22

State the aetiology of aortic regurgitation

Answer 22

Aortic dilatation- loss of support, connective tissue disease, hypertension, aortic dissection, degenerative, cystic medial necrosis and syphilis
Valvular- Bicuspid valve and infective endocarditis
CREAM- congenital, rheumatic, endocarditis, aortic dissection and marfan’s

Question 23

List the consequences of aortic regurgitation

Answer 23

Volume overload- blood falls back into left ventricle during diastole
LV dilatation- to accomodate greater volume
Late decompensation of LV function
High volume circulation

Question 24

Describe the pathophysiology of aortic regurgitation

Answer 24

Increase dilatation of the heart and left ventricle never returns to its original state. Therefore lose contractility. Less blood volume going forward. Overtime the volume overload causes pressure overload into the lungs. Manifests as fluid within the lungs

Question 25

Name the two heart sounds of aortic regurgitation

Answer 25

Early diastolic murmur

Concomitant systolic murmur

Question 26

Name the symptoms of aortic regurgitation

Answer 26

Often asymptomatic
Breathlessness
Chest pain
Sudden onset pulmonary oedema if acute

Question 27

Give the aetiology of mitral regurgitation

Answer 27

Valvular- prolapse, infective, degenerative
Chordal rupture/papillary muscle failure
Annular dilation

Question 28

List the consequences of mitral regurgitation

Answer 28

Decompensation- pulmonary oedema
Left ventricular dilatation
Volume overload in left ventricle
Pressure overload of right heart leading to right ventricular hypertrophy and right heart failure

Question 29

State the differences between acute and chronic mitral regurgitation

Answer 29

Acute- No dilatation of left ventricle, high LA pressure, pulmonary oedema
Chronic- dilatation of left ventricle and left atrium- pressure dissipated to a degree. No pulmonary odema

Question 30

Which heart sound is heard when mitral regurgitation is present?

Answer 30

Pan-systolic murmur

Question 31

State the symptoms of mitral regurgitation

Answer 31

Breathlessness
Lethargy
Palpitations
Peripheral oedema
Chest pain

Question 32

What happens during a mitral prolapse?

Answer 32

Initially valve shuts during the early part of systole but then, either because the leaflet is too ‘baggy’ or because of abnormal subvalvular apparatus the leaflet prolapses back into the left atrium potentially allowing through a jet of regurgitation

Question 33

Give the names of the two heart sounds heard during a mitral prolapse

Answer 33

Mid systolic click

Late systolic murmur

Question 34

List the aetiology of mitral stenosis

Answer 34

Rheumatic 
Congenital- more commonly seen
Storage diseases
Malignancy
Previous endocarditis
Mitral valve calcification 
Systemic disease

Question 35

What are the consequences of mitral stenosis

Answer 35

Lung/right heart consequences
Breathlessness, congestion, etc
Due to pressure back up because of failure of ejection of left atrial volume
Left ventricle physiology usually preserved

Question 36

State the heart sounds of a mitral stenosis

Answer 36

Mid-diastolic rumbling murmur
Opening snap
Loud first heart sound

Question 37

List the symptoms of mitral stenosis

Answer 37

Breathlessness
Peripheral oedema
Haemoptysis – coughing up blood
Palpitations – atrial fibrillation 
Systemic emboli
Fatigue
Compressive symptoms: 
Stridor- vibrating noise when breathing, 
Dysphagia- difficulty swallowing

Question 38

Name the medical treatments for valvular disease

Answer 38

Diuresis for heart failure and drugs to slow down the heart for Arrhythmias

Question 39

Name the percutanous treatments for valvular disease

Answer 39

TAVI

BAV

Question 40

Name the surgical treatments for valvular disease

Answer 40

Valve replacement

Valve repair

Question 41

In terms of prosthetic valves, If the first heart sound is metallic which valve could this be?

Answer 41

Mitral or tricuspid

Question 42

In terms of prosthetic valves, If the second heart sound is metallic which valve could this be?

Answer 42

Aortic or pulmonary

Question 43

When are heart murmurs from prosthetic valves pathological?

Answer 43

If diastolic