Valvular heart disease

Question 1

What are some common symptoms of valvular heart disease?

Answer 1

Crushing chest pain that radiates to the arm or jaw
Breathlessness on exertion
Ankle swelling
Orthopnoea
Paroxysmal Nocturnal Dyspnoea
Collapse

Question 2

What is a cardiac murmur?

Answer 2

The audible turbulence of blood flow

Question 3

What are the 2 main causes of murmurs?

Answer 3

Stenosis (valve too narrow)
Regurgitation (valve leaks)

Question 4

What causes the first heart sound?

Answer 4

The closure of the Mitral and Tricuspid valves

Question 5

What causes the second heart sound?

Answer 5

The closure of the aortic and pulmonary valves

Question 6

When is a systolic murmur heard?

Answer 6

Between S1 and S2

Question 7

When is a diastolic murmur heard?

Answer 7

After S2 and before the next S1

Question 8

Which conditions cause a systolic murmur?

Answer 8

Aortic stenosis
Mitral regurgitation

Question 9

Which conditions cause a diastolic murmur?

Answer 9

Mitral stenosis
Aortic regurgitation

Question 10

What is heard in patent ductus arteriosus upon auscultation?

Answer 10

A constant murmur

Question 11

What is meant by a pansystolic murmur?

Answer 11

A murmur of constant volume that stretches across the whole length of systole

Question 12

What is meant by an ejection systolic murmur?

Answer 12

A murmur that quickly gets loud and then dies down over the course of systole

Question 13

What are the 2 types of systolic murmurs?

Answer 13

Pansystolic murmur
Ejection systolic murmur

Question 14

What are the 2 types of diastolic murmurs?

Answer 14

Early diastolic murmur
Mid-diastolic murmur

Question 15

What is meant by an early diastolic murmur?

Answer 15

A murmur at the start of diastole that starts loud and descendos

Question 16

What is meany be a mid diastolic murmur?

Answer 16

A murmur that starts midway through diastole and crescendos to the end of diastole

Question 17

How are murmurs graded?

Answer 17

I - Very quiet
II - Quiet but easy to hear
III - Loud
IV - Loud with a thrill
V - Very loud with a thrill
VI - Audible without a stethoscope

Question 18

How does inspiration affect right sided murmurs?

Answer 18

Right sided murmurs are louder upon inspiration

Question 19

What are some common conditions that cause cardiac murmurs?

Answer 19

Innocent murmur
Mitral regurgitation
Aortic stenosis
Aortic regurgitation
Mitral stenosis
Continuous murmur
Tricuspid regurgitation

Question 20

What are the characteristics of an innocent murmur?

Answer 20

Soft (Less than 3/6 grading)
Early diastolic
Only heard in one location

Question 21

What are the main causes of aortic stenosis?

Answer 21

Degenerative - Age related
Congenital (e.g. bicuspid valve not tricuspid)
Rheumatic

Question 22

What are some common symptoms of aortic stenosis?

Answer 22

Breathlessness on exertion
Chest pain
Dizziness

Question 23

What causes chest pain in aortic stenosis?

Answer 23

Blood cannot flow into the coronary arteries as it is forced at high pressures
Also the increased strain on the heart increases oxygen demand

Question 24

What are the clinical signs of aortic stenosis?

Answer 24

Low volume pulse as less blood is being pumped out
Pressure build up in the left ventricle causes hypertrophy, which displaces the apex
Ejection systolic murmur
Radiation to the carotid arteries
Loudest in aortic area

Question 25

Where does the murmur of aortic stenosis radiate to?

Answer 25

The carotid arteries

Question 26

What are the 2 types of valve replacement?

Answer 26

Mechanical Bio-prosthetic

Question 27

What are the pros and cons of mechanical valves?

Answer 27

They last a very long time, however, they require lifetime warfarin treatment

Question 28

What are the pros and cons of bio-prosthetic valves?

Answer 28

They are formed of pig tissue and only last 10 years, however, they do not require warfarin treatment

Question 29

What are the treatment options for aortic stenosis?

Answer 29

Conventional valve replacement Trans-catheter Aortic Valve Implantation (TAVI) Balloon aortic valvotomy

Question 30

What are the causes of mitral regurgitation?

Answer 30

Leaflet prolapse Rheumatic Myxomatous (Floppy) valve Endocarditis Chordae rupturing Papillary muscle rupturing Annular dilatation

Question 31

What are some symptoms of mitral regurgitation?

Answer 31

Breathlessness on exertion Peripheral oedema Fatigue

Question 32

What are the clinical signs of mitral regurgitation?

Answer 32

Pansystolic murmur radiates to the axilla Loudest in the mitral area Can lead to cardiomegaly

Question 33

What are the treatment options for mitral regurgitation?

Answer 33

Diuretics Heart failure medication Repair - Prolapse Replace - Degenerative Percutaneous clipping of annulus

Question 34

What are the causes of mitral stenosis?

Answer 34

Most commonly rheumatic (Rheumatic fever) Very rarely will be congenital

Question 35

What are the symptoms of mitral stenosis?

Answer 35

Breathlessness Fatigue Palpitations (Atrial Fibrillation)

Question 36

What are the clinical signs of mitral stenosis?

Answer 36

Malar flush - Plum red cheeks Tapping apex beat Mid diastolic rumbling murmur Localised to the apex Straight left border on CXR due to left atrial hypertrophy

Question 37

What are the treatment options for mitral stenosis?

Answer 37

Diuretics Treatment for AF Valve replacement Balloon valvuloplasty

Question 38

What are some causes of aortic regurgitation?

Answer 38

Endocarditis Connective tissue damage Rheumatic Annulus dilatation Marfan's syndrome Aortic dissection

Question 39

What is the main symptom of aortic regurgitation?

Answer 39

Breathlessness

Question 40

What are the clinical signs of aortic regurgitation?

Answer 40

Collapsing pulse Displaced apex due to left ventricular dilatation Early diastolic murmur at the left sternal edge Cardiomegaly on CXR