Valvular Disease

Question 1

When do symptoms typically start to occur in patients with aortic stenosis? Before this point, what is the only sign?

Answer 1

When the valve area is < 1.5cm2 / Murmur

Question 2

Name 3 potential causes of aortic stenosis?

Answer 2

Age, bicuspid aortic valve, rheumatic fever

Question 3

When does degenerative aortic stenosis typically present?

Answer 3

The 6th or 7th decade of life

Question 4

When should surgery be considered for aortic stenosis?

Answer 4

When symptoms start to occur

Question 5

Describe the progression of symptoms typically seen in aortic stenosis?

Answer 5

Dyspnoea + fatigue, anginal symptoms, presyncope or syncope, heart failure symptoms

Question 6

Describe the typical murmur heard in aortic stenosis? Where is this murmur loudest? Where does it radiate to?

Answer 6

Ejection systolic murmur, loudest at the aortic area (on expiration), radiating to the carotids

Question 7

What is the most common major valve problem? What is it closely followed by?

Answer 7

Aortic stenosis, followed by mitral regurgitation

Question 8

What are the long-term consequences of untreated, left-sided valvular disease?

Answer 8

Left ventricular hypertrophy and/or pulmonary hypertension

Question 9

What is the most common cause of valvular dysfunction?

Answer 9

Age related generation

Question 10

Symptoms which occur when, are characteristic of valvular heart disease?

Answer 10

On exertion

Question 11

What is the only definitive treatment for a poorly functioning heart?

Answer 11

Surgical replacement or repair

Question 12

Describe the pulse associated with aortic stenosis?

Answer 12

Slow rising, low volume pulse

Question 13

A soft S2 is associated with what valvular abnormality?

Answer 13

Aortic stenosis

Question 14

A narrow pulse pressure is associated with what valvular abnormality?

Answer 14

Aortic stenosis

Question 15

What investigation is the gold standard for confirming and grading aortic stenosis?

Answer 15

Transthoracic ECHO

Question 16

In addition to an ECHO, what other investigations may be performed in someone with aortic stenosis?

Answer 16

ECG and coronary angiography

Question 17

What is the definitive treatment option for aortic stenosis?

Answer 17

Valve replacement

Question 18

What type of prosthetic valve is typically used in younger patients?

Answer 18

Mechanical valve

Question 19

What type of prosthetic valve is typically used in older patients?

Answer 19

Biological valve

Question 20

What anticoagulation is required with mechanical aortic valves?

Answer 20

Lifelong anticoagulation with warfarin

Question 21

What anticoagulation is required with biological aortic valves?

Answer 21

Warfarin for 3 months after surgery

Question 22

Which type of prosthetic valve is more likely to give off a ‘click’ and is therefore easier to identify?

Answer 22

Mechanical

Question 23

What is the most common cause of aortic stenosis in patients aged < 65?

Answer 23

Bicuspid aortic valve

Question 24

What procedure is a less invasive approach to aortic stenosis treatment, that is currently targeted to high-risk or inoperable patients?

Answer 24

Trans-catheter aortic valve implantation (TAVI)

Question 25

A wide pulse pressure is seen in which valvular abnormality? What clinical features may this cause?

Answer 25

Aortic regurgitation / head bobbing and nail pulsing

Question 26

A collapsing pulse is associated with which valvular abnormality?

Answer 26

Aortic regurgitation

Question 27

A bounding pulse is associated with which valvular abnormality?

Answer 27

Aortic regurgitation

Question 28

Describe the typical murmur that occurs with aortic regurgitation? When is this best heard?

Answer 28

Early diastolic murmur, loudest at the left sternal edge with the patient leaning forwards on expiration

Question 29

What is the investigation of choice for diagnosing aortic regurgitation?

Answer 29

Transthoracic ECHO

Question 30

What is the only definitive treatment for aortic regurgitation?

Answer 30

Valve replacement

Question 31

What medical management can be useful in aortic regurgitation and why?

Answer 31

ACE inhibitors / Ca channel blockers: these are vasodilators which are used to reduce the afterload

Question 32

What drugs should be used with caution in patients with aortic regurgitation and why?

Answer 32

Rate limiting drugs: these increase diastole and hence prolong the regurgitant phase

Question 33

What is the most common primary cause of aortic regurgitation?

Answer 33

Age related degeneration

Question 34

What are some processes which may accelerate the degeneration causing aortic regurgitation?

Answer 34

Infective endocarditis, bicuspid aortic valve, rheumatic fever

Question 35

What are some diseases which cause disruption of the aortic root which may predispose to aortic regurgitation?

Answer 35

Aortic aneurysm, aortic dissection

Question 36

What are some connective tissue diseases which may predispose to aortic regurgitation?

Answer 36

Marfan’s and Ehler’s Danlos syndrome, osteogenesis imperfecta