Valvular dysfunction

Question 1

The main causes of valvular dysfunction.

Answer 1

Fibrosis: fusion of leaflets due to excess connective tissue.

Calcification: reduce mobility of leaflets due to deposits.

Dilatation of valve ring: prevents valve from closing and can cause prolapse.

Question 2

Epidemiology of degenerative valve disease

Answer 2

Seen to increase with age.

More present in aortic than mitral valve.

Question 3

Epidemiology of rheumatic valve disease

Answer 3

Prevalent after post Strep. rheumatic fever (not common in the West).

More common in children and young adults.

Seen in areas high with poverty due to overcrowding.

More present in mitral than aortic valve.

Question 4

Epidemiology of Infective valve disease

Answer 4

More commonly seen with already abnormal valves.

Seen in immunocompromised individuals.

Very virulent organisms (Staph/ strep) can infect normal valves.

Can affect any valve but is more common to the left heart.

Right heart more affected in intravenous drug users (IVDU)

Question 5

Aetiology of valve diseases

Answer 5

Degeneration

Rheumatic

Infective

Secondary loss of supportive tissue

Congenital causes

Question 6

Regurgitation

Answer 6

Occurs when valves do not close properly, causing blood to leak back into the previous chamber

Question 7

Stenosis

Answer 7

Narrowing of the leaflets, preventing the valve from closing properly.

Question 8

Aortic stenosis aetiology

Answer 8

Mainly caused by degenerative factors, seen in people over 60.

Congenital causes: in paediatric cases and people under 60. Very low incidence in all populations.

Post rheumatic fever- people under 60

Bicuspid valves due to fibrosis: 40-60 years old

Question 9

Symptoms of aortic stenosis

Answer 9

Low perfusion so:
Chest pain (angina)
Heart murmurs
Syncope
Dyspnea
Arrhythmia

Question 10

Consequences of aortic stenosis

Answer 10

Pressure overload:
Left ventricular compensation causes an increase in systolic pressure because of increased afterload.

Left ventricular hypertrophy

Leads to eventual decompensation and dilatation.

Question 11

Aortic stenosis heart sounds.

Answer 11

Crescendo/ descendo murmur

No distinct ‘lub-dub’

Question 12

Aetiology of aortic regurgiatation

Answer 12

Aortic dilatation:

• Degenerative
• Secondary loss of structural, supportive tissue.
• Connective tissue disease (rheumatic)
• Ventricular hypertrophy
• Aortic dissection, tear can pull the aorta and aortic valve backwards.

Valvular:

• Bicuspid valve (aortic valve should be tricuspid)
• Infective endocarditis

Acronym for causes: CREAM
C ongenital
R heumatic damage
E ndocarditis
A ortic dissection/ root dilatation
M arfan's

Question 13

Symptoms of aortic regurgitation

Answer 13

Mainly asymptomatic BUT these can occur:
Chest pain

Dyspnea

Pulmonary oedema can occur if acute decompensation is prevalent

Question 14

Heart sounds in aortic regurgitation

Answer 14

Early diastolic murmur is heard

There is still a clear systolic ‘lub’

Sometimes a systolic murmur could also occur

Question 15

Consequences of aortic regurgitation

Answer 15

Left ventricle dilatation + failure—-> Left atrium enlargement —-> Pulmonary vein hypertension —-> Pulmonary oedema

Question 16

Mitral valve regurgitation aetiology

Answer 16

Valvular causes:

• Chordal rupture/ papillary muscle failure
• Annular dilatation

Question 17

Symptoms of mitral valve regurgitation

Answer 17

Lethargy/ reduced tolerance to exercise

Dyspnea

Atrial fibrillation

Peripheral oedema

Chest pain

Question 18

Mitral valve regurgitation heart sounds

Answer 18

Pansystolic murmur, with an audible diastolic ‘dub’

Question 19

Consequences of mitral valve regurgitation

Answer 19

Potential consequences:

Volume overload in Left ventricle
Pressure overload in the right heart
Left ventricular dilatation
Potential heart decompensation

Question 20

Mitral stenosis aetiology

Answer 20

Almost always due to rheumatic fever

Other potential causes:
Congenital
Mitral valve calcification
Malignancy 
Previous endocarditis

Question 21

Symptoms of mitral stenosis

Answer 21

Dyspnea

Haemoptysis

Palpitations

Systemic emboli

Stridor

Dysphagia

Question 22

Mitral stenosis heart sounds

Answer 22

Mid-diastolic murmur, low pitched descendo-crescendo

Question 23

Consequences of mitral stenosis

Answer 23

Lung and right heart suffer due to build up of back pressure- not enough blood pumped by left atrium.

Left ventricle is compromised-
Low filling due to less blood pumped by atrium.

Question 24

Medical management of valvular dysfunctions

Answer 24

Mainly dealing with the consequences/ symptoms rather than the actual valve.

Same treatment as that of heart failure:
Diruetics
Arrhythmia control drugs

Question 25

Surgical management of valvular dysfunctions

Answer 25

Valvular repair or valvular replacement.

Valvular repair is the better option as original tissue is kept, less chance of complications.

Valve replacement: bovine or mechanical valve placed in replacement of faulty valve.

Question 26

Mitral valve heart sound

Answer 26

Mid-systolic click and late systolic murmur

Question 27

Transcutaneous valve replacement

Answer 27

Non-invasive surgery that uses a needle to get access to the valve via the artery.

Example: balloon angioplasty valve replacement- used for aortic valve dysfunctions