Valvular Heart Disease

Question 1

Valvular stenosis vs insufficiency

Answer 1

• Stenosis - failure of valve to open completely

- Insufficiency, regurgitation, incompetence - failure of valve to close completely

Question 2

Causes of valvular disease (6)

Answer 2

1. Congenital abnormality
2. Degeneration with ageing
3. Myxomatous degeneration (of collagen support tissue)
4. Dilation of valve ring
5. Post inflammatory scarring - eg RHD
6. Destruction by inflammation - infection, vegetations, scarring with physical distortion, mechanical & functional abnormalities

Question 3

Features of rheumatic heart disease

Answer 3

• immune disorder following streptococcal infection in children
• antibodies cross react with self antigens in the heart - inflammation & scarring, fusion, calcification

Question 4

Causes & effects of mitral stenosis

Answer 4

• post inflammatory scarring, RHD
• elevated LA pressure - LA dilation
• increased risk of fibrillation & mural thrombus formation - irregular contraction
• pulmonary htn & edema
• RV hypertrophy & failure

Question 5

Causes & effects of aortic stenosis

Answer 5

• calcific aortic stenosis - due to age, RHD, IE, congenital bicuspid valve
• LV hypertrophy & failure
• risk of myocardial ischemia due to fibrosis
• sudden cardiac death

Question 6

Causes & effects of mitral insufficiency

Answer 6

• floppy valve syndrome - mitral valve prolapse, RHD, papillary muscle ischemia, dilation of valve ring eg heart failure, Marfan’s
• atrial fibrillation
• LV failure
• severe pulmonary congestion & edema

Question 7

Causes & effects of aortic insufficiency

Answer 7

• dilation of ascending aorta, RHD, IE, dilation of valve ring eg syphilis
• LV hypertrophy & failure
• risk of myocardial ischemia

Question 8

Features of pulmonary & tricuspid valve disease

Answer 8

• R sided valvular disease is uncommon

- RHD, post inflammatory scarring, IVDA, infective, carcinoid syndrome

Question 9

Complications of artificial heart valves (4)

Answer 9

1. Thromboembolism
2. Infective endocarditis
3. Valve deterioration with valvular insufficiency
4. Others eg mechanical hemolysis

Question 10

Non-infective valvular heart disease

Answer 10

• Marantic vegetations
• sterile, small, platelet rich
• often in chronically/severely debilitated patients
• hypercoagulability of blood due to acute phase response