Valvular Heart Disease

Question 0

Causes of Mitral Stenosis

Answer 0

RHD

rarely: congenital, degenerative calcific
v. rarely: SLE, carcinoid

Question 1

Signs of Mitral Stenosis

Answer 1

Malar flush
Atrial fibrillation
JVP not raised until late
Apex beat tapping in quality
Apex beat not displaced

Question 2

Sound of Mitral Stenosis

Answer 2

Mild: Lub de de

Severe: Lub de derrrr

Question 3

C-Xray of mitral stenosis

Answer 3

Aortic knuckle
Prominent pulmonary vessels
Prominent left atrial appendage ) instead of (

Question 4

Pathophysiology of mitral stenosis

Answer 4

High LA pressure (loud HS1) -> pulmonary venous HTN (septal lines)
-> pulmonary arterial HTN (loud P2, prominent ‘a’ wave in JVP -> RVH (left para sternal heave) -> tricuspid regurgition (‘v’ wave in JVP) -> RHF (raised JVP, odema, ascites)

Question 5

Sound of Mitral regurgitation

Answer 5

Burrrr (pansystolic)
Quiet 1st heart sound
2nd HS not heard separately
Radiates loudly to the axilla

Question 6

C-Xray of Mitral regurgitation

Answer 6

Ventricular hypertrophy (volume overload) >50% of diameter taken up by the heart

Question 7

Signs of Mitral regurgitation

Answer 7

More likely to be in Sinus rhythm

Apex beat usually displaced (volume overload) determinant of severity

Question 8

Signs of Aortic regurgitation

Answer 8

Collapsing pulse
Collapsing pulse in neck
JVP not raised
Apex beat displaced

Question 9

Sound of Aortic regurgitation

Answer 9

Lub taaarr

Question 10

Causes of aortic regurgitation

Answer 10

REALM
RHD
Endocarditis
Ankylosing spondylitis/aortic dissection
Leutic heart disease (tertiary syphilis -> vasculitis)
Marfans syndrome (high ached palate, long spidery fingers)

Question 11

C-Xray Aortic regurgitation

Answer 11

Eggshell calcification of aortic knuckle

Cystic medial necrosis weakens wall of large vessels

Question 12

Signs of aortic stenosis

Answer 12

Slow rising pulse
Low volume pulse with low pressure
JVP not elevated
Apex beat forceful but not displaced (pressure overload)
Ejection systolic murmur
Radiates to carotids

Question 13

Causes of aortic stenosis

Answer 13

RHD
Degenerative calcific (affecting normal valve)
Congenitally bicuspid valve with degenerative changes

Question 14

Sound of aortic stenosis

Answer 14

Lub derrrr dub

2nd HS gets quieter with severe stenosis

Question 15

Aortic stenosis vs aortic sclerosis

Answer 15

Stenosis: fusion valve leaflets

• radiates to neck
• loud apex beat
• abnormal ECG, pulse

Sclerosis: thickened valve leaflets

• does not radiate
• no ventricular hypertrophy
• normal ECG, pulses

Question 16

Sound of aortic Starr-Edwards prosthesis

Answer 16

“Click-thud”
Opening click as ball hits cage
Ejection murmur due to turbulent flow over ball in systole
Loud closing as ball engages valve rim

Question 17

Sound of mitral Starr-Edwards prosthesis

Answer 17

“Thud click”
Closing thud as ball engages valve rim
Opening click as ball hits cage

Question 18

Sound of aortic bi-leaflet prosthesis

Answer 18

“Lub click”
Normal HS1
Soft opening click occasionally audible
Loud high pitched click as leaflets close

Question 19

Complications of prosthetic valves

Answer 19

Valve failure (acute thrombosis or mechanical failure) v. rare
Obstruction (growth of pannus)
Subacute bacterial endocarditis
Paravalvular leak (base of valve comes free -> regurgition of blood
Haemolysis (turbulence) -> hemolytic jaundice