Valvular disease

Question 1

What is aortic stenosis?

Answer 1

Obstruction of blood flow across the aortic valve due to pathological narrowing.

Question 2

Causes of aortic stenosis

Answer 2

Calcification of normal trileaflet valves (80%)
Congenital bicuspid valves
Coarctation of the aorta and Turner’s syndrome
Rheumatic heart disease

Question 3

Diagnosis of valvular disease

Answer 3

Echocardiography- 1st line
Cardiac MRI- 2nd line
ECG- shows LVH (rules out other conditions)

Question 4

What is pulmonary stenosis?

Answer 4

Obstructs the blood flow from the right ventricle to the pulmonary bed. 
Causes: 
Mostly congenital 
Acquired causes are rare but include:
Carcinoid syndrome
Infectious endocarditis
Myocardial tumours 
External compression

Question 5

What is aortic regurgitation?

Answer 5

Diastolic leakage of blood from the aorta into the LV. 
-Valvular causes: 
Congenital 
Ankylosing spondylitis 
IE 
Rheumatic fever 
Rheumatoid arthritis 
-Non-valvular causes: 
Aortic dissection 
Marfan's syndrome 
Chest trauma 
Systemic HTN 
Ehlers-Danlos syndrome 
Behcet's disease 
Reiter's syndrome
Takayasu's arteritis

Question 6

What is mitral regurgitation?

Answer 6

Systolic leakage of blood from the left ventricle into the right atrium.
Causes include:
IE
Ischaemic papillary muscle dysfunction
Acute rheumatic fever
Acute dilation of the LV due to myocarditis or ischaemia

Question 7

What is mitral stenosis?

Answer 7

This is the narrowing of the mitral valve orifice.
Causes:
Rheumatic heart disease (95%)
Congenital
Carcinoid syndrome
Use of ergot and/or serotogenic drugs such as fenfluramine.
Amyloidosis

Question 8

Which cardiac murmurs are always abnormal?

Answer 8

New murmur
Loud murmur with thrill
Diastolic murmurs
A soft ESM may not signify organic pathology