Valvular Heart Disease

Question 1

What is rheumatic heart disease?

Answer 1

inflammatory disease
caused by strep progenies
inflammation and scarring triggered by autoimmune reaction to infection
leads to mitral stenosis/ mitral regurgitation

Question 2

Define mitral prolapse

Answer 2

> 2mm systolic prop lapse of 1 or both leaflets beyond long axis annular plane during 2DE

Question 3

Identify the pathology of mitral prolapse

Answer 3

histologically normal valves
myxomatous degeneration
Marfan / Ehlers danlos

Question 4

What happens in mitral valve prolapse?

Answer 4

valve leaflets are floppy so they bow back into the left atrium during systole
sometimes produces mitral regurgitation

Question 5

What are the symptoms of mitral prolapse?

Answer 5

asymptomatic

can be associated with chest pains and arythmias

Question 6

What is the treatment of mitral prolapse?

Answer 6

antibiotic prophylaxis

Question 7

What are the signs of mitral prolapse?

Answer 7

ejection click

late systolic murmur

Question 8

What are the causes of aortic stenosis?

Answer 8

calcific disease
congenital bicuspid aortic valve
rheumatic heart disease

Question 9

What are the symptoms of aortic stenosis?

Answer 9

dyspnea 
angina 
syncope
left ventricular failure
sudden death

Question 10

How does aortic stenosis lead to dyspnea?

Answer 10

increased diastolic pressure in stiff non compliant left ventricle

Question 11

What are the signs of aortic stenosis?

Answer 11

slow rising carotid pulse
S4
ejection click
EJECTION SYSTOLIC MURMUR

Question 12

What are the investigations for aortic stenosis?

Answer 12

ECG
Lateral CXR
Echo

Question 13

What pressure signals are seen in aortic stenosis?

Answer 13

severe pressure gradient across aortic valve
increased left ventricle pressure than aortic pressure
prominent ‘a’ wave

Question 14

What are the indications for surgery in aortic stenosis?

Answer 14

any symptoms of aortic stenosis
echo showing evidence of worsening left ventricle dilation
peak systolic pressure gradient > 50mmHg
if patient is too sick do TAVI

Question 15

What is aortic regurgitation?

Answer 15

blood leaks black into left ventricle from aorta during diastole
pressure in aorta is not maintained
therefore, left ventricular filling has 2 sources: left atrium and aorta
Starling’s Law means that there is an increased systolic pressure but drops quickly when the valve closes

Question 16

What are the causes of aortic regurgitation?

Answer 16

Aortic valve leaflet disease: calcific disease, rheumatic disease, infective endocarditis, congenital bicuspid valve

Aortic root dilating disease: aortic dissection, ankylosing spondylitis, Marfan’s syndrome

Question 17

What are the symptoms of aortic regurgitation?

Answer 17

often none
angina - increased O2 demand for hypertrophied left ventricle
dyspnea - contractile failure as ventricle dilates

Question 18

What are the signs of aortic regurgitation?

Answer 18

rapidly rising pulse - vigorous ejection of volume loaded left ventricle
early diastolic murmur - aortic back flow (left sternal edge)
ejection murmur- turbulent ejection from volume loaded left ventricle (left sternal edge)

Question 19

What is mitral stenosis?

Answer 19

narrowed mortal valve leads to problems in left ventricular filling

Question 20

What are the causes of mitral stenosis?

Answer 20

rheumatic disease

Question 21

What are the symptoms of mitral stenosis?

Answer 21

dyspnoea - increased left atrial pressure leads to increased pressure in pulmonary circulation
RV failure - consequence of increase left atrial pressure and pulmonary vasoconstriction
Palpitations - AF
Systemic emboli - pooling of blood in atria due to AF. static blood within dilated fibrillating left atrium predisposes to thrombosis

Question 22

What are the signs of mitral stenosis?

Answer 22

irregularly irregular pulse due to AF
loud S1 - closure of stenotic mitral valve
opening snap of valve
MID DIASTOLIC MURMUR
elevated JVP
basal crepitations
ankle oedema

Question 23

What are the investigations for mitral stenosis?

Answer 23

ECG - huge P waves due to left atrial enlargement
Echo
X ray - blunted left border (left atrial bulge)
Valvuloplasty - fixes pressure gradient in left atria and left ventricle

Question 24

What are the causes of mitral regurgitation?

Answer 24

mitral valve leaflet disease: mitral valve prolapse, rheumatic heart disease, infective endocarditis
subvalvar disease: chordal rupture, papillary muscle dysfunction, papillary muscle rupture
functional mitral regurgitation - left ventricle dilation

Question 25

What is mitral regurgitation?

Answer 25

blood leaks back into left atrium during systole

leads to increased pressure in left atrium

Question 26

What are the symptoms of mitral regurgitation?

Answer 26

dyspnea
orthopnea
palpitations - AF
systemic emboli

Question 27

What are the signs of mitral regurgitation?

Answer 27

pulse - sinus rhythm, atrial fibrillation
pansystolic murmur
S3 - increased atrial pressure leads to rapid ventricular filling when valve opens
elevated JVP
basal crepitations
ankle oedema

Question 28

What are the investigations for mitral regurgitation?

Answer 28

echocardiogram

angiogram

Question 29

What are the indications for surgery of mitral valve disease?

Answer 29

symptoms don’t respond to medical treatment
worsening CVS complications e.g pulmonary hypertension (MS) and LV dilation (MR)
for patients too sick for surgery - mitraclip (percutaneous stitch across valve leaflets and pull them together to get less regurgitation)

Question 30

What are the medical treatments for valvular heart disease?

Answer 30

Diuretics
Vasodilators -low forward output due to regurgitant valve lesion
Digoxin, beta blockers, verapramil to help treat AF
propyhlaxis - anticoagulants and antibiotics