Valvular Heart Disease

Question 1

Name the 3 leaflets of the aortic valve

Answer 1

• Right, left and non-coronary

Question 2

Name some pathological mechanisms that can affect the valve leaflets

Answer 2

• Calcification,
• Thickening,
• Degenerations,
• Infections,
• Prolapse

Question 3

Name some of the pathological mechanisms that can affect the apparatus/annulus of the valves

Answer 3

• Annular dilatation,
• Annular calcification,
• Apparatus thickening, tethering or rupture,
• Regional wall motion abnormality

Question 4

Describe features of Rheumatic valve disease

Answer 4

• Acute rheumatic fever can cause painful joints, fever and rash.
• Antibody cross reactivity affects the connective tissue. Recurrent inflammation and fibrinous repair and scarring can lead to cardiac injury.

Question 5

What can occur as a result of aortic stenosis/regurgitation

Answer 5

Stenosis - Increased left ventricular cavity pressure, and pressure overload leading to left ventricular hypertrophy.
Regurgitation - Volume overload leading to left ventricular dilitation.

Question 6

What are the signs and symptoms of aortic stenosis?

Answer 6

Symptoms - SAD (Syncope, angina and dyspnoea) SOB, presyncope, syncope, chest pain and reduced exercise tolerance.
Signs - Ejection systolic murmur, quiet second heart sound, narrow pulse pressure, heaving apex beat due to LV hypertrophy and signs of heart failure.

Question 7

What are some causes of aortic stenosis?

Answer 7

• Thickening,
• Calcification,
• Congenital valve defects,
• Rheumatic valve disease

Question 8

What are some causes of aortic regurgitation?

Answer 8

• Degeneration,
• Rheumatic valve disease,
• Aortic root dilation,
• Systemic diseases: Marfan’s syndrome, Ehlers Danlos syndrome, Ankylosing Spondylitis and SLE.
• Endocarditis

Question 9

What are the signs and symptoms of aortic regurgitation

Answer 9

Symptoms - SOB and reduced exercise capacity.
Signs - Early diastolic murmour, increased pulse pressure, collapsing pulse, signs of heart failure and eponymous signs.

Question 10

What are the eponymous signs of aortic regurgitation?

Answer 10

Corrigan’s - Carotid pulsation.
Quinke’s - Nail bed pulsation,
De Musset’s - Head bobbing

Question 11

Describe features of an aortic bicuspid valve

Answer 11

Genetic abnormality prone to premature dysfunction and associated with aortic abnormalities

Question 12

What can occur due to mitral regurgitation

Answer 12

Volume overload which can lead to left atrial and ventricular dilitation. This can can lead to atrial fibrillation, pulmonary hypertension and secondary right heart failure

Question 13

What are the signs and symptoms of mitral regurgitation?

Answer 13

Symptoms - SOB, palpitation and right heart failure symptoms.
Signs - Pansystolic murmur, quiet first heart sound, displaces apex beat, signs of heart failure

Question 14

What are some potential causes of mitral stenosis and what can it result in?

Answer 14

Causes - congenital or rheumatic valve disease.
Can result in a pressure overload leading to a dilated left atrium. This can cause atrial fibrillation, pulmonary hypertension and secondary right heart failure.

Question 15

What are the signs and symptoms of mitral stenosis

Answer 15

Symptoms - SOB, palpitations, chest pain, haemoptysis, right heart failure symptoms.
Signs - Diastolic murmur (occurs just after S2- LUB Dub-derrr), quiet second heart sound, apex heave and signs of heart failure

Question 16

How do you assess someone with a suspected valvular disease?

Answer 16

• History, examination, BP, ECG, ECHO, CT/MRI, exercise tolerance test, CPET, stress echo, catheterisation

Question 17

What are some possible treatments for valvular disease

Answer 17

Medication
Surgical - Valve repair, valve replacement (mechanical or tissue)
Procedural - Transcatheter aortic valve implantation, mitraclip, meoldy valve or valvuloplasty