Valvular Disease

Question 1

What is the most common valvular disease?

Answer 1

Aortic stenosis

Question 2

Aortic stenosis

Name three causes of aortic stenosis

Which causes the most common

Who does each cause affect

Answer 2

Most common cause is calcification of the aortic valve: tends to affect the elderly

Congenital bicuspid valve: tends to affect younger patients (under 65 years old) [aortic valve should be tricuspid]

Rheumatic fever: auto immune condition triggered by a Group A strep (throat) Infection

Question 3

Mitral Stenosis

Caused by?

Clinical Feature: heart and face

Complication of long-standing untreated?

Answer 3

CAUSE

• Rheumatic Heart Disease
• Infective Endocarditis

CLINICAL FEATURE

• mid-diastolic, low pitched “rumbling” murmur due to a low velocity of blood flow
• loud S1 due to thick valves requiring a large systolic force to shut, then shutting suddenly
• tapping apex beat due to loud S1.
• Malar flush due to back-pressure of blood into the pulmonary system causing a rise in CO2 and vasodilation.
• Atrial fibrillation as left atrium struggling to push blood through the stenotic valve causing strain, electrical disruption and resulting fibrillation

COMPLICATION
- Pulmonary Hemosiderosis repeated episodes of intra-alveolar bleeding that lead to abnormal accumulation of iron as hemosiderin in alveolar macrophages and subsequent development of pulmonary fibrosis and severe anemia

Question 4

Mitral Regurgitation

Causes

Clinical Features

Answer 4

Causes:

• Idiopathic weakening of the valve with age
• Ischaemic heart disease
• Infective Endocarditis
• Rheumatic Heart Disease
• Connective tissue disorders such as Ehlers Danlos syndrome or Marfan syndrome

Clinical Features:

• pan-systolic, high pitched “whistling” murmur due to high velocity blood flow through the leaky valve
• murmur radiates to left axilla
• third heart sound.

Question 5

Aortic Regurgitation

Clinical Features

Cause

Answer 5

CLINICAL FEATURES:

• Early diastolic murmur
• Severe: Austin Flint murmur = mid diastolic murmur
• Collapsing Pulse: as the blood is pumped out by the ventricles and then immediately flows back through the aortic valve back into the ventricles
• Wide pulse pressure

CAUSE

• Idiopathic age related weakness
• Connective tissue disorders such as Ehlers Danlos syndrome or Marfan syndrome
• Rheumatic Fever
• Infective endocarditis
• Ischaemic disease: aortic dissection
• Aortitis in Ankylosing Spondylarthropathy

Question 6

Aortic Stenosis

Clinical Features

Answer 6

• Ejection systolic murmur (crescendo-decrescendo) that radiates to carotids
• Narrow pulse pressure
• Slow rising pulse

Question 7

Barlow Syndrome

What is it?

Clinical Features

Answer 7

Mitral Prolapse

Clinical Features:
- Mid-diastolic click followed by late systolic murmur at apex