Valvular Heart Disease

Question 1

What is Valvular heart disease?

Answer 1

When a heart valve becomes narrowed / insufficient

Question 2

What are the types of Valvular heart disease? (8 things)

Answer 2

Aortic / pulmonary / tricuspid / mitral Stenosis
Aortic / pulmonary / tricuspid / mitral Regurgitation

Question 3

What 2 things can Valvular Heart Disease cause the myocardium to do?

Answer 3

1. Hypertrophy
2. Dilatation

Question 4

What does Stenosis cause the myocardium to do and why?

Answer 4

Hypertrophy

Muscle has to try harder to contract through narrowed hole

Question 5

What does Regurgitation cause the myocardium to do and why?

Answer 5

Dilatation

Leaky valve allows blood to flow backwards stretching the muscle

Question 6

What does Mitral Stenosis cause?

Answer 6

Left Atrial Hypertrophy

Question 7

What does Aortic Stenosis cause?

Answer 7

Left Ventricular Hypertrophy

Question 8

What does Mitral Regurgitation cause?

Answer 8

Left Atrial Dilatation

Question 9

What does Aortic Regurgitation cause?

Answer 9

Left Ventricular Dilatation

Question 10

What causes Mitral Stenosis? (2 things)

Answer 10

1. Rheumatic Heart Disease
2. Infective Endocarditis

Question 11

What are the characteristics of the Murmur you will hear in Mitral Stenosis? Why? (2 things)

Answer 11

1. Mid-diastolic (between S2 and S1 of nxt beat nxt beat)
2. Low-pitched

Bc low velocity blood flow

Question 12

What heart sound will be different in Mitral Stenosis? Why?

Answer 12

Loud S1

Bc thick valves shutting suddenly (after needing big systolic force to shut)

Question 13

What can you palpate due to the loud S1 in Mitral Stenosis?

Answer 13

Tapping Apex beat

Question 14

What will you hear in Mitral Stenosis overall? (2 things)

Answer 14

1. Mid-diastolic, low-pitched murmur
2. Loud S1

Question 15

What is Mitral Stenosis associated with? (2 things)

Answer 15

1. AF
2. Malar flush (cheek rashes)

Question 16

Why is Mitral Stenosis associated with AF?

Answer 16

Bc L atrium struggling to push blood thru narrowed valve –> strain –> electrical disruption –> fibrillation

Question 17

Why is Mitral Stenosis associated with Malar Flush (cheek rashes)?

Answer 17

Bc back pressure of blood into pulm system –> rise in CO2 + vasodilation

Question 18

What are the causes of Mitral Regurgitation?

Answer 18

1. Rheumatic HD
2. Infective Endocarditits
3. Ischaemic HD
4. Idiopathic weakening of valve w age
5. CT disorders (e.g Ehlers Danlos / Marfan Syndromes)

Question 19

What are the characteristics of the Murmur you will hear in Mitral Regurgitation? Why? (2 things)

Answer 19

1. Pan-systolic (between S1 and S2)
2. High-pitched (whistling murmur)
   Bc high velocity blood flow thru leaky valve

Question 20

Where does the Mitral Regurgitation murmur radiate to?

Answer 20

Left Axilla

Question 21

What might you also hear in Mitral Regurgitation? (apart from murmur)

Answer 21

3rd Heart Sound

Question 22

What will you hear in Mitral Regurgitation overall? (2 things)

Answer 22

1. Pan-systolic, high pitched murmur
2. 3rd Heart Sound

Question 23

What is the most common Valvular Heart Disease?

Answer 23

Aortic stenosis

Question 24

What are the causes of Aortic Stenosis? (2 things)

Answer 24

1. Rheumatic Heart Disease
2. Idiopathic age related calcification

Question 25

What are the characteristics of the Murmur you will hear in Aortic Stenosis? Why? (3 things)

Answer 25

1. Ejection-systolic 2. High-pitched (bc high velocity of systole) 3. Crescendo-decrescendo (bc SLOW flow at start of systole and FAST flow at end)

Question 26

Where does the murmur in Aortic Stenosis radiate to?

Answer 26

Carotids (bc turbulence continues up into neck)

Question 27

What other signs can be seen in Aortic Stenosis? (apart from murmur) (3 things)

Answer 27

1. Slow rising pulse 2. Narrow pulse pressure 3. Exertional syncope (bc can’t maintain good flow to brain)

Question 28

What are the causes of Aortic Regurgitation? (2 things)

Answer 28

1. Idiopathic age related weakness 2. CT disorders (e.g Ehlers Danlos / Marfan Syndromes)

Question 29

What are the characteristics of the Murmur you will hear in Aortic Regurgitation? (2 things)

Answer 29

1. Early Diastolic 2. Soft + High pitched

Question 30

What other sign can be seen in Aortic Regurgitation? (apart from murmur)

Answer 30

Corrigan’s (collapsing) pulse = rapidly appearing + disappearing pulse carotid

Question 31

Why does Aortic Regurgitation cause a Corrigan’s (collapsing) pulse?

Answer 31

Blood pumped out by ventricles --\> immediately flows back thru aortic valve into ventricles

Question 32

What can Aortic Regurgitation lead to?

Answer 32

Heart Failure Bc back pressure of blood waiting to get to left side of heart

Question 33

What investigations should you do for sus Valvular Heart Disease? (3 things)

Answer 33

1. Echocardiography 2. ECG 3. CXR

Question 34

What does an ECG detect in Valvular Heart Disease? (2 things)

Answer 34

1. Rhythm change 2. Chamber alterations (Hypertrophy / Dilatation)

Question 35

What does a CXR detect in Valvular Heart Disease? (3 things)

Answer 35

1. Chamber alterations (Hypertrophy / Dilatation) 2. Pulmonary congestion 3. Other lung pathology

Question 36

How is a diagnosis of Valvular Heart Disease made upon? (2 things)

Answer 36

1. Clinical examination 2. Echocardiography

Question 37

What does Doppler echocardiography measure? (2 things)

Answer 37

1. Pressure gradients 2. Blood flow

Question 38

What is the management of Valvular Heart Disease?

Answer 38

Regular observation + NO active treatment

Question 39

When is intervention indicated in Valvular Heart Disease?

Answer 39

If moderate / severe lesion causes symptoms / cardiac dysfunction

Question 40

What are the intervention options for Valvular Heart Disease? (3 things)

Answer 40

1. Valvuloplasty (opening stenosed valve w catheter) 2. Valve Repair 3. Valve Replacement