Valvular Heart Disease

Question 1

Infective endocarditis
- pathophysiology
- causative organisms
- risk factors

Answer 1

Endocardium infected, damages valves => vegetation formation
-can dislodge and cause infarcts

Saureus - most common in developed countries
- acute
- IVDU, piercings

Sviridans - most common in developing countries
-poor dental hygiene

Sepidermidis - most common post valve surgery

Sbovis - colorectal cancer link

Question 2

Infective endocarditis
- presentation
- diagnosis and investigations
- management

Answer 2

Fevers, chills
MR -
TR - IVDU
Oslers - immune complex deposition in hands
Splinter hemorrhages, Janeway - microinfarcts
Organ infarcts

Blood culture + echo

1st line - ABx (fluclox)
2nd line - surgery to repair/replace valve if
-ABx not effective
-abscess/fistula
-HF
-emboli

Question 3

Main cause and presentation of
- mitral stenosis
- mitral regurgitation
- aortic stenosis
- aortic regurgitation

Answer 3

ALL CAN PRESENT WITH SOB, MURMURS, HF
Mitral stenosis - rheumatic heart disease => palpitations

Mitral regurgitation - old age, LH dilation/HF, post MI (papillary muscle rupture), rheumatic fever

Aortic stenosis - old age => chest pain

Aortic regurgitation - idiopathic, Marfans, EDS

Question 4

Main cause and presentation of
- tricuspid stenosis
- tricuspid regurgitation
- pulmonary stenosis
- pulmonary insufficiency

Answer 4

GENERALLY RARER

ALL CAN PRESENT WITH ASCITIES, PERIPHERAL EDEMA, HEPATOMEGALY, HIGH JVP, MURMUR

Tricuspid stenosis - RARE (rheumatic heart disease, congenital)

Tricuspid regurgitation -

• mild => no treatment needed
• severe - RV dilation, VSD, congenital

Pulmonary stenosis - congenital

Pulmonary regurgitation - RARE, treatment not needed

Question 5

Valvulopathies
- presentation
- diagnosis
- management

Answer 5

Chest pain
SOB, SOBOE

Echo

AS
Low risk of complications - surgical aortic valve repair
Elderly/frail - TAVI

MR
Severe - surgical repair/replace