Valvular Heart Disease

Question 1

when do patient with valvular heart disease characteristically get symptoms?

Answer 1

on exertion

Question 2

how do you describe a murmur?

Answer 2

systole or diastole?
what type of murmur?
where is it loudest?
where does it radiate to?
what grade of murmur?
is it influenced by respiration?

Question 3

what 4 murmurs are systolic?

Answer 3

mitral regurgitaiton
tricuspic regurgitation
aortic stenosis
pulmonary stenosis

Question 4

what 4 murmurs are diastolic?

Answer 4

mitral stenosis
tricuspid stenosis
aortic regurgitaion
pulmonary regurgitation

Question 5

what is a pansystolic murmur?

Answer 5

equal throughout systole

Question 6

what are pansystolic murmurs the result of?

Answer 6

regurgitation of blood flow

mitral/tricuspid regurgitation

Question 7

what are ejection systolic murmurs?

Answer 7

during systole sound gets louder than softer

Question 8

what are ejection systolic murmurs the result of?

Answer 8

stenosis

aortic/pulmonary stenosis

Question 9

what type of murmurs radiate?

Answer 9

systolic murmurs

Question 10

what is an early diastolic murmur?

Answer 10

aortic/pulmonary regurgitation

Question 11

what is a mid diastolic murmur?

Answer 11

mitral/tricuspid stenosis

Question 12

which murmurs are always pathological?

Answer 12

diastolic murmurs

Question 13

where do aortic systolic murmurs radiate to?

aortic stenosis

Answer 13

neck

Question 14

where do pulmonary systolic murmurs radiate to?

pulmonary stenosis

Answer 14

left shoulder

Question 15

where do tricuspid systolic murmurs radiate to?

tricuspid regurgitation

Answer 15

dont radiate

Question 16

where do mitral systolic murmurs radiate to?

mitral regurgitation

Answer 16

under left axilla

Question 17

describe murmur grading?

Answer 17

1. very quiet
   2/3. loud without thrill
   4/5. loud with thrill
2. loud- audible without stethoscope

Question 18

which sided murmurs will vary with inspiration?

Answer 18

right sided murmurs will be louder on inspiration than expiration

(eg tricuspid and pulmonary murmurs will vary with inspiration)

Question 19

what are the 3 characteristics of an innocent murmur?

Answer 19

• everything else is normal
• occurs in early systole
• usually located in pulmonary area but no where else

Question 20

what is valve stenosis?

Answer 20

valves dont open properly

Question 21

what is valve regurgitation?

Answer 21

valves don’t stay closed properly

Question 22

what is mixed valve disease?

Answer 22

valves neither open properly or close properly

Question 23

what are the 3 main causes of aortic stenosis?

Answer 23

congenital bicuspid aortic valve
age-related calcification
rheumatic

Question 24

what are the symptoms of aortic stenosis?

Answer 24

breathlessness
chest pain
dizziness/syncope on exertion

Question 25

what are the signs of aortic stenosis?

Answer 25

- low volume pulse - forceful apex- LV heave - ejection systolic murmur which is maximal in aortic area and radiates to the carotids

Question 26

what are the 3 treatment options for aortic stenosis?

Answer 26

- surgery: valve replacement - balloon aortic valvotomy - transcatheter aortic valve implantation

Question 27

what are the 2 types prosthetic heart valves?

Answer 27

mechanical | bioprosthetic

Question 28

what are the advantages and disadvantages of mechanical heart valves compared to bioprosthetic?

Answer 28

mechanical have long term durability but need anticoagulants | biporsthetic dont need anticoagulants but aren;t as durable

Question 29

what are 4 problems can cause mitral regurgitation?

Answer 29

problems with mitral valve leaflets chordal rupture ischamia or infarction of papillary muscle annular dilation

Question 30

why does annular dilation cause regurgitation?

Answer 30

because valves no longer meet in the middle so are leaky

Question 31

what 3 things can cause problems with mitral valve leaflets and so cause mitral regurgitation?

Answer 31

- rheumatic heart disease - myxomatous degeneration (floppy mitral valve syndrome) - endocarditis

Question 32

what are the symptoms of mitral regurgitation?

Answer 32

breathlessness ankle swelling fatigue

Question 33

what are the signs of mitral regurgitation?

Answer 33

- displaced apex beat | - pansystolic murmur which is maximally heard at the apex and radiated to the axilla

Question 34

what is a sign of mitral regurgitation on a cxr?

Answer 34

cardiomegaly

Question 35

what are the treatment options of mitral regurgitation?

Answer 35

drugs surgery percutaneous mitral valve repair

Question 36

what are the 2 drugs that can be used for mitral regurgitation?

Answer 36

diuretics | ACE inhibitors

Question 37

what are the 2 surgery options of mitral regurgitation?

Answer 37

valve repair | valve replacement

Question 38

what are the causes of mitral stenosis?

Answer 38

rheumatic heart disease (although past history my be absent) | congenital

Question 39

what are the symptoms of mitral stenosis?

Answer 39

breathlessnes tiredness palpitations

Question 40

what are the signs of mitral stenosis?

Answer 40

- malar flush - tapping apex beat - mid diastolic murmur localised to apex - right heart failure in later stages

Question 41

what valvular heart murmur is most likely to give you palpitations?

Answer 41

mitral stenosis

Question 42

what valvular heart murmur is most likely to give you AF?

Answer 42

mitral stenosis

Question 43

what are the signs of mitral stenosis on a CXT?

Answer 43

straight left heart border | because left atrium enlarges

Question 44

what are the 3 treatment options for mitral stenosis?

Answer 44

drugs surgery mitral balloon valvuloplasty

Question 45

what drugs are given in the treatment of mitral stenosis?

Answer 45

diuretics (for oedema) betablockers, digoxin, warfarin (for AF)

Question 46

what type of surgery is used in mitral stenosis?

Answer 46

valve replacement

Question 47

when is mitral balloon valvuloplasty suitable for the treatment of mitral stenosis?

Answer 47

if there is a pliable competent valve

Question 48

what are the causes of aortic regurgitation?

Answer 48

defect with the aortic leaflets | defects with the annulus

Question 49

what can cause problems with the aortic leaflets?

Answer 49

infective endocarditis connective tissue disease rheumatic heart disease

Question 50

what can cause problems with the aortic annulus?

Answer 50

marfans syndrome | acute aortic dissection

Question 51

what are the symptoms of aortic regurgitation?

Answer 51

breathlessness chest pain dizziness

Question 52

what are the signs of aortic regurgitation?

Answer 52

collapsing pulse displaced apex early diastolic murmur heard maximally in the tricuspid area

Question 53

what are the treatment options of aortic regurgitation?

Answer 53

drugs | surgery

Question 54

what drugs are used in the treatment of aortic regurgitation?

Answer 54

ACEI ARB diuretics

Question 55

what surgery is used in the treatment of aortic regurgitation?

Answer 55

valve replacement