Valvular heart disease

Question 2

What are some valvular heart diseases

Answer 2

Aortic stenosis
Aortic regurgutation
Mitral regurgitation
Mitral stenosis

Question 3

What is normal aortic valve area

Answer 3

3-4cm^2

Question 4

I hen do symptoms of aortic stenosis develop

Answer 4

When valve is 1/4th normal valve area of normal

Question 5

How would you investigate Aortic stenosis

Answer 5

echo
* looking for LV size and function, dilation and EF (determines severity of disease)
* Doppler derived gradient and valve area

Question 6

how is aortic stenosis graded

Answer 6

• Based on normal aortic valve area (3-4cm squared)
• Mild: >1.5
• moderate: 1-1.5
• severe: 1

Question 7

How do you manaage Aortic stenosis

Answer 7

General
* fastigious dental care
* consider infective endocarditis prophylaxis in dental procedures

Medical
* AV replacement, surgical/TAVI (TRANSCATHETER av IMPANTATION)

Question 8

In aortic stenosis when would intervention be requires

Answer 8

• Any symotomsatic patienta with severe AS
• Any patient with decreasing EF
• Any patients undergoing CABG with mod-sev AS

Question 9

Define Mitral regurgutation

Answer 9

Bsckflow of blood from left ventricle to left atrium during systole

Question 10

what causes primary mitral regurgitation

Answer 10

FINNISH

Question 11

what causes secondary mitral regurgiation

Answer 11

normal vavce architecture but impaire
FINNISH

Question 12

what are the physical sign and symptoms of Mitral regurg

Answer 12

Ascultation: pansystolic murmur at apex radiativ to axila

breathlessness

Question 13

How is Mitral regurgitation medicated

Answer 13

• Rate control for afib : B blockers, digoxin
• Anticoagulation in atrial fibrillation and flutter
• Nitrates / Diuretics in acute MR
• Chronic HF Rx if chronic MR with CCF

Question 14

What interventions can be done in mitral regurg

Answer 14

• Surgical replcements and repairs
• Transcatheter edge to edge repair (TEER)

Question 15

Define Aortic regurgutatoin

Answer 15

lelakature of blood in LV during diastole due to ineffective coaptation of the aortic cusps

Question 16

Etiology of chronic aortic regurg

Answer 16

• Bicuspid aortic valve
• Rheumatic
• Infective endocarditis

Question 17

What would you find on physical examination of aortic regurg

Answer 17

**wide pulse pressure **
hyperdynamic and displaced apical impulse

Ascultation: Diastolic blowing murmur - left sternal border
Systolic ejection murur - increased flow across aortic valce

Question 18

what are the typical presentations of Aortic regurg

Answer 18

• Dyspnoea
• Palpitations: due to increased force of contraction and ectopics

Question 19

how do you diagnose Aortic regurg

Answer 19

• Echo - Evaluation of the AV and aortic root with measurements of LV dimensions and function
• CXR (chest x ray) enlarged cardiac silhouette and aortic root enlargement

Question 20

How do you manage aortic regurg

Question 21

Define mitral stenosis

Answer 21

Obstruction of LV inflow that prevents proper filling during diastole

Question 22

what is a normal mitral valve area

Answer 22

4-6cm squared

Question 23

Discuss pathophysiology of Mitral stenosis

Answer 23

Progressive dyspnea
increase transmitral pressure