Valvular Heart disease

Question 1

What happens to the AV pressure gradient during mitral stenosis?

Answer 1

It increases

Question 2

What happens to the LV pressure and systolic function in mitral stenosis?

Answer 2

Stays the same

Question 3

What happens to the RHS of the heart during mitral stenosis?

Answer 3

It dilatates

Question 4

What are the main signs for mitral stenosis?

Answer 4

Malar flush (due to decreased CO)
Tapping apex beat
RV heave
Increased JVP
Rumbling mid-diastolic murmur

Question 5

What are the main symptoms of mitral stenosis?

Answer 5

Dyspnoea
Chest pain
Haemoptysis

Question 6

What are the tests used to diagnose mitral stenosis?

Answer 6

ECG (would show RVH)
CXR (left atrium enlargement)
Echocardiography (Thickening and scarring of valve leaflets shown)

Question 7

What is the management suggested for mitral stenosis?

Answer 7

Diuretic (Get rid of H2O, reduce BP)
Restrict Na+ intake
Mitral valve replacement
Valvotomy

Question 8

In acute mitral regurgitation, what happens to the end systolic pressure and volume?

Answer 8

Both decrease

Question 9

On examination in a patient with mitral regurgitation, what will be shown?

Answer 9

Prominent JVP
Hyperdynamic apex beat
RV heave
Loud systolic murmur

Question 10

What are the main investigations for mitral regurgitation?

Answer 10

ECG (LVH)
CXR (Big LA and LV, mitral valve calcification and pulmonary oedema)
Echo (assesses LV function)

Question 11

What are the main symptoms of mitral regurgitation?

Answer 11

Dyspnoea
Fatigue
Palpitations
IE

Question 12

What is the recommended management for mitral regurgitation?

Answer 12

Control rate if fast AF
Anticoagulation (If embolism, prosthetic valve)
Diuretics (Improve symptoms)
Valve replacement

Question 13

What are the main causes of aortic stenosis?

Answer 13

Calcification

Rheumatic Heart Disease

Question 14

What are the main clinical symptoms of aortic stenosis?

Answer 14

Angina
Syncope
Heart failure

Question 15

What would be found upon examination of someone with aortic stenosis?

Answer 15

Prominent JVP
Aortic thrill
Ejection systolic murmur
RV heave

Question 16

What investigations would you do for someone who you suspect has aortic stenosis?

Answer 16

ECG (ST/T changes)
CXR (Calcification of the AV node)
Cardiac catheterisation

Question 17

What is the recommended management for someone with aortic stenosis?

Answer 17

Prompt valve replacement (As prognosis not good)

Question 18

What are the 2 anatomical parts that can have a problem that could cause aortic regurgitation?

Answer 18

The aorta

The aortic valve leaflets

Question 19

As blood volume leaks back into the left ventricle in someone with aortic regurgitation, what happens to the LVEDV and LV systolic pressure?

Answer 19

Both increase

Question 20

What happens to the LV physically during aortic regurgitation?

Answer 20

Dilatation and hypertrophy occurs

Question 21

What is the main, defining feature of aortic regurgitation?

Answer 21

Breathlessness (dyspnoea, orthopnea and paroxysmal nocturnal dyspnoea)

Question 22

On examination, with someone who has aortic regurgitation, what would be found?

Answer 22

Collapsing pulse
Wide pulse pressure
Displaced and hyperdynamic apex beat
Early diastolic murmur (On expiration, patient sitting forward)

Question 23

Which investigations would you do for someone you suspect to have aortic regurgitation?

Answer 23

ECG (LVH)
Echo (LV dilatation and hypertrophy)
CXR (Cardiomegaly, dilated ascending aorta, Pulmonary oedema)

Question 24

What is the recommended management for aortic regurgitation?

Answer 24

Vasodilator therapy

Aortic valve replacement