Valvular heart disease

Question 1

mitral stenosis causes

Answer 1

one of the commonest, caused by rheumatic heart disease, lupus erythematosus, rheumatoid arthritis, can be congenital

Question 2

what happens in mitral stenosis

Answer 2

mitral orifice less than 2cm^2, A-V pressure gradient increases left atrium pressure increases, pulmonary venous and capillary pressure increases, pulmonary vascular resistance increases, pulmonary artery pressure increases, pulmonary hypertension develops, right heart dilatation with tricuspid regurgitation and pulmonary regurgitation. left ventricle pressures and systolic function normal

Question 3

mitral stenosis severity depends on

Answer 3

trans valvular pressure gradient, transvalvular flow rate. becomes clinically relevant when tachycardia during exercise, acute illness, pregnancy, atrial fibrillation

Question 4

clinical manifestations of mitral stenosis

Answer 4

dyspnoea (from mild exertion dyspnoea to pulmonary oedema), haemoptysis, systemic embolisation (LA and LAA enlargement), IE, chest pain, hoarseness due to (compression of the L recurrent laryngeal nerve)

Question 5

clinical examination of mitral stenosis

Answer 5

purple discolouration of cheeks and nose, pulse- normal, JVP- prominent a wave, tapping apex beat and diastolic thrill, RV heave, auscultation- quiet murmur in diastole

Question 6

investigations of mitral stenosis

Answer 6

ECG- signs of right ventricular hypertrophy or elevated P wave lasting longer than usual, cardiac catheterisation, CXR shows LA enlargement, echocardiography- thickening and scarring of leaflets, fusion of commissures, cardiac magnetic resonance

Question 7

mitral stenosis treatment

Answer 7

diuretics and restriction of Na intake, AF: SR restoration or ventricular rate control, anticoagulation: all those with AF, debatable in SR, valvotomy, mitral valve replacement

Question 8

mitral regurgitation causes

Answer 8

rheumatic heart disease, mitral valve prolapse, IE, degenerative, functional MR due to LV and annular dilatation

Question 9

mitral regurgitation pathophysiology

Answer 9

effective regurgitant orifice not fixed and is dependent on the preload, after load, LV contractility and LV compensation change. acute- ESP and ESV decreases, wall tension decreases. Chronic- EDV decreases and ESV returns to normal, eccentric left ventricular hypertrophy

Question 10

clinical manifestations of acute mitral regurgitation

Answer 10

valve perforation, chordal/papillary muscle rupture, breathlessness- pulmonary oedema, cardiogenic shock

Question 11

clinical manifestations of chronic mitral regurgitation

Answer 11

develop slowly over years, fatigue, exhaustion, right heart failure, dyspnoea or palpitations due to Afib

Question 12

clinical examination of mitral regurgitation

Answer 12

pulse normal or reduced in heart failure, brisk and hyper dynamic apex beat, prominent JVP in right heart failure, RV heave, auscultation- reduced s1 and split s2 early a2 and loud p2

Question 13

investigations mitral regurgitation

Answer 13

ECG- LA enlargement, RVH, CXR- cardiomegaly, LA enlargement, calcification of mitral annulus, cardiac catheterisation- LV angiography- obsolete, echocardiography- LV dimension, cause of MR, severity of MR and pap

Question 14

causes of MR

Answer 14

leaflet dysfunction, chordae rupture, papillary muscle rupture, annular disease

Question 15

treatment of mitral regurgitation

Answer 15

acute- preload and after load reduction by vasodilators, dobutamine, IABP
chronic- lack of evidence that any therapy is beneficial for haemodynamic improvement, LV function preservation. if necessary mitral valve replacement or apparatus repair

Question 16

aortic stenosis can be

Answer 16

degenerative, rheumatic, bicuspid (congenital)

Question 17

aortic stenosis clinical signs

Answer 17

long asymptomatic phase, chest pain, syncope/dizziness, breathlessness on exertion, heart failure

Question 18

aortic stenosis examination

Answer 18

pulse small volume and slow rising, JVP prominent if RH failure, low BP, vigorous and sustained apex beat, RV heave, auscultation- normal s1, s2 less audible A2

Question 19

aortic stenosis investigations

Answer 19

ECG- LVH voltage criteria, ST/T changes, CXR- calcification, cardiac catheterisation- peak LV peak aortic gradient- obsolete, echocardiograph- demonstrates the Av cusp mobility, LV function and hypertrophy, doppler hamody namic assessment of pressure gradient and Aortic Valve area

Question 20

aortic stenosis treatment

Answer 20

limited to those who develop heart failure, aortic valve replacement or repair if needed

Question 21

aortic regurgitation clinical signs

Answer 21

chronic- long asymptomatic phase, exertion breathlessness. acute- poorly tolerated as wall tension cannot be adapt

Question 22

aortic regurgitation examination

Answer 22

large volume and collapsing pulse, wide pulse pressure, hyper dynamic, displaced apex beat, auscultation is normal s1 and normal s2, early diastolic, decrescendo, soft murmur

Question 23

aortic regurgitation investigations

Answer 23

ECG- ST/T changes, Left axis deviation, CXR- cardiomegaly in chronic AR, cardiac catheterisation- obsolete, previously aortgram performed, echocardiogram- demonstrates the AV cusp anatomy, LV function, dilatation and hypertrophy, doppler haemodynamic assessment of regurgitant flow

Question 24

what happens in aortic stenosis

Answer 24

increased left ventricular systolic pressure, severe concentric hypertrophy and increased LVmass, increased LVEDP, increased myocardial oxygen consumption, myocardial ischaemia, LV failure

Question 25

aortic regurgitation can be due to

Answer 25

dilated aorta, connective tissue disorders, bicuspid aortic valve, rheumatic heart disease, endocarditis, myxomatous degeneration

Question 26

what happens in aortic regurgitation

Answer 26

LV accommodated both SV and regVol, increased LVEDV and Lv systolic pressure, Lv hypertrophy and Lv dilatation, increased myocardial oxygen consumption, myocardial ischaemia, Lv failure

Question 27

aortic regurgitation treatment

Answer 27

vasodilator therapy shown to delay timing for surgical intervention, aortic valve replacement or repair if needed