Valvular disease

Question 1

What causes aortic stenosis?

Answer 1

• calcification disease

- congenital bicuspid valve

Question 2

What are the S+S of aortic stenosis? (also explain the S+S that occur)

Answer 2

Symptoms:

• dyspnoea: increased diastolic pressure in non-complaint LV
• angina: increased O2 demand of hypertrophied LV
• syncope: paroxysmal ventricular arrhythmia or exertion cerebral hypoperfusion
• LVF: contractile failure due to ventricular distribution
• Sudden death: ventricular arrhythmia

Signs:

• slow rising carotid pulse
• 4th heart sound (with/without ejection click)
• ejection systolic murmur

Question 3

How is aortic stenosis diagnosed?

Answer 3

CXR (lateral): calcification, enlarged LV and LA

also an ‘a’ wave on apexcardiogram as there is severe pressure gradient across aortic valve

Question 4

When is surgery indicated in aortic stenosis?

Answer 4

If there is LV dilatation or systolic pressure gradient >50 mmHg

Question 5

What causes aortic regurgitation?

Answer 5

1. aortic valve leaflet disease:
   - calcification disease
   - congenital bicuspid valve
   - rheumatic disease
   - infective endocarditis
2. Aortic root dilating disease:
   - ankylosing spondylitis
   - marfan syndrome
   - aortic dissection

Question 6

What are the S+S of aortic regurgitation? (also explain the S+S that occur)

Answer 6

Symptoms:

• dyspnoea: contractile failure as ventricle dilates
• angina: increases O2 demand of hypertrophies LV

Signs:

• rapidly rising carotid pulse
• early diastolic murmur - aortic backflow
• ejection murmur - turbulent ejection from volume-loaded LV

Question 7

How is aortic regurgitation diagnosed?

Answer 7

aortic root angiogram

Question 8

What is mitral valve prolapse?

Answer 8

> /= 2mm systolic prolapse of 1/both valve leaflets

valve leaflets prolapse back into LA during systole, sometimes produces mitral regurgitation

Question 9

What causes mitral valve prolapse?

Answer 9

Marfans

Ehlers danlos

Question 10

What are the S+S of mitral valve prolapse?

Answer 10

Usually asymptomatic (sometimes chest pain, atrial arrhythmias)
Signs:
- ejection click with/without late systolic murmur

Question 11

What is the main cause of mitral stenosis?

Answer 11

rheumatic fever

Question 12

What are the S+S of mitral stenosis?

Answer 12

Symptoms:

• dyspnoea, orthopnoea: increased LA pressure
• RV failure: consequence of LA pressure and active pulmonary vasoconstriction
• Palpitations: AF
• Systemic emboli: static blood within dilated fibrillating LA –> increased risk of thrombosis

Signs:

• pulse: AF (irregularly, irregular)
• auscultation: loud S1, opening snap mid-diastolic rumble with/without pre-systolic murmur
• volume overload: increased JVP and ankle oedema

Question 13

How is mitral stenosis diagnosed?

Answer 13

• ECG: notched p wave

- CXR: LA enlargement

Question 14

How is mitral stenosis treated?

Answer 14

• valvuloplasty: widening of mitral valve

* *there must be no calcification, no MR and no LA thrombus

Question 15

What causes mitral regurgitation?

Answer 15

1. mitral valve leaflet disease:
   - mitral valve prolapse
   - rheumatic disease
   - infective endocarditis
2. subvavular disease:
   - chordal rupture
   - papillary muscle dysfunction/rupture
3. functional MR:
   - LV dilatation

Question 16

What are the S+S of mitral regurgitation?

Answer 16

symptoms:

• dyspnoea, orthopnoea
• palpitations
• systemic emboli

signs:

• pulse: AF
• auscultation: Pan-systolic murmur (S3)
• volume overload: increased JVP and ankle oedema

Question 17

How is mitral regurgitation diagnosed?

Answer 17

Echo, phono and doppler

Question 18

When is surgery indicated in mitral regurgitation?

Answer 18

worsening CV complications (pulmonary hypertension - mitral stenosis and LV dilatation)

Question 19

How should low forward output/regurgitant valve lesions be treated?

Answer 19

digoxins
BBs
verapamil

Question 20

How should AF be treated?

Answer 20

anticoagulants (protect against systemic emboli)