Valvular Heart Disease

Question 1

Causes of Rheumatic fever

Answer 1

Rheumatic Fever: Streptococcal pyogenes infection leads to ASO antibodies that cross react with valve tissue causing damage.

Question 2

Causes of Mitral Stenosis

Answer 2

Senile Ageing - most common
Rheumatic fever
Prosthetic valves
Malignancy

Question 3

How does mitral stenosis present?

Answer 3

Dyspnoea
Fatigue
Palpitation
Chest pain
Haemoptysis

Signs: Malar flush (reduced CO)
low volume pulse
AF
Loud S1/opening snap, mid diastolic murmur(low rumbling, heard best on expiration)

Question 4

Investigations into MS

Answer 4

CXR - mitral valve calcification, left atrial enlargement.
ECG - p-mitrale, AF, RVH
Echo

Question 5

Causes Mitral Regurgitation

Answer 5

LV dilatation, annular calficiation, Rheumatic fever, IE, MI-ruptured papillary muscle, Ruptured chordae tendonae

Question 6

Signs and Symptoms of MR

Answer 6

Symptoms: Dyspnoea, Fatigue, palpitations, IE.

Signs: AF, Displaced hyperdynamic apex beat (LVH), RV heave(RVH) split S2, Pansystolic murmur (radiating the to axilla).

Question 7

Investigations into MR

Answer 7

ECG - p-mitrale, AF, LVH
CXR - cardiomegaly, mitral calcification, pulmonary oedema
Echo

Question 8

Causes of Aortic Stenosis

Answer 8

Senile calcification, Congenital disease - bicuspid valve, Rheumatic Fever, IE

Question 9

Presentation of AS, signs and symptoms.

Answer 9

Symptoms: Elderly patients, chest pain/angina, syncope, SOBOE, Heart Failure, palpitations,

Signs: Slow rising pulse, delayed carotid pulse, LV heave,
Ejection systolic murmur(crecendo-decrescendo) loudest in aortic area, Radiates to carotids, Ejection clicks,

Question 10

Tests for AS

Answer 10

ECG - p-mitral, LVH, LBBB/complete AV block, Evidence of MI,
CXR - Cardiomegaly, Calcified Aortic valve, post stenotic dilation of aorta
Echo - narrowing of the aortic opening, doppler shows increased jet velocity

Question 11

Causes of AR

Answer 11

Acute: IE, Ascending Aortic dissection, Trauma

Chronic: Congential/Marfans/Ehler Danlos, RF, Rheumatoid Arthritis, SLE, Hypertension

Question 12

Signs and Symptoms of AR

Answer 12

SOBOE, Orthopnoea, PND, Palpitations, Syncope, CCF, Angina

Signs: Collapsing pulse, Diastolic murmur, Hyperdynamic apex beats

Question 13

What is corrigans sign?

Answer 13

Carotid pulsation at rest

Question 14

What is de Mussets sign

Answer 14

Head nodding with heart beat

Question 15

What is Quincke’s sign

Answer 15

Capillary pulsation below nail bed

Question 16

What is Duroziez’s sign

Answer 16

compressing femoral pulse there is proximal femoral bruit

Question 17

What is Traube’s sign

Answer 17

Pistol shot femoral pulses on auscultation

Question 18

Tests for AR

Answer 18

ECG - LVH, p mitrale

CXR- Cardiomegaly, dilated ascending aorta (dilated annulus causes regurgitation) Pulmonary oedema

Question 19

What are the benefits of Echocardiography in valvular disease.

Answer 19

Able to assess ventricular function.
Can visualise valve compromise and assess degree of disease (Area of stenosis)
Able to use doppler to assess flow across valves in diastole and systole.

Question 20

Management of Mitral valve disease

Answer 20

Control AF, diuretics, balloon valvuloplasty, open surgery to replace valve.