Valvular Heart Disease

Question 1

In aortic stenosis describe the common triad associated?

Answer 1

SOB on exertion
Syncope
Chest pain
(+palpitations)

Question 2

What two clinical findings may be found in a patient with AS O/E?

Answer 2

Slow rising pulse
Ejection systolic murmur - radiating to the carotid (A)
(Crescendo-Decrescendo)

Question 3

Severe AS can be asymptomatic, however patients can deteriorate quick. Which 5 circumstances are an indication to operate?

Answer 3

LV dysfunction
Abnormal exercise test
Fast progression
Severe LV hypertrophy
Recurrent ventricular arrhythmias

Question 4

What is the major cause of AS?

Answer 4

Age related calcification of the heart (increased stiffness)

Question 5

Describe the symptoms of mitral stenosis?

Answer 5

Exertional SOB
Tachycardia - exaggerates the trans-mitral gradient and therefore = frank pulmonary oedema
Heamoptysis
Systemic emobolisms (increased stroke risk)

Question 6

Describe the clinical findings O/E of MS?

Answer 6

LATE diastolic murmur 
Prominent 1st heart sound with low pitched diastolic murmur - better heard on inspiration
Mallar flush
Tachycardia
?Basal crepitations

Question 7

What is the major cause of MS and which groups are most affected?

Answer 7

Rheumatic valve disease secondary to rheumatic fever (Group A streptococcus (pyogenes) found in the mouth) causes vegetations on the heart along with inflammation and scarring
3rd world and pregnant young women

Question 8

On CXR what features are to note of a patient with MS?

Answer 8

Atrial enlargement with cardiomegaly

Patients may complain of swallowing difficulties as the atrium presses on the oesophagus

Question 9

Describe aortic regurgitation?

Answer 9

EARLY diastolic murmur

Question 10

Describe the symptoms associated with aortic regurgitation?

Answer 10

Asymptomatic on presentation
SOB on exertion
Palpitations (regular)
Angina = late manifestation

Question 11

O/E of a patient with aortic regurgitation describe five clinical findings?

Answer 11

De Musset's sign
Corrigan's pulse (collapsing)
Pistol shot femoral pulse
De Quincke's sign
Early diastolic murmur - best heard in inspiration

Question 12

What is De Musset’s sign?

Answer 12

Rhythmic head bobbing with heart beat

Question 13

What is pistol shot femoral pulses?

Answer 13

Loud cracking sound on auscultation over the femoral area

Question 14

What is De Quincke’s sign?

Answer 14

Alternating flashing of the finger nails from pink to white

Question 15

Name five causes for the development of AR?

Answer 15

Infective endocarditis 
Rheumatic fever
Dilated aortic aneurysm (Marfan's)
VSD
Bicuspid valve prolapse

Question 16

Name five causes of mitral regurgitation?

Answer 16

Post MI (dilation of LV)
Dilated cardiomyopathy (dilation of LV)
Rheumatic fever (early presentation)
Infective endocarditis
Mitral valve prolapse

Question 17

Name three causes of mitral valve prolapse?

Answer 17

Idiopathic
Marfan’s syndrome (CT disorder)
Ehler’s Danlos syndrome (CT disorder)

Question 18

What presentation and under what circumstances, would you get with acute mitral regurgitation?

Answer 18

Papillary muscle rupture (or chordae tendoneae) leading to frank pulmonary oedema

Question 19

Describe the murmur of MR?

Answer 19

Pansystolic = radiates to the axilla

Question 20

What symptoms and signs would you get with mitral valve prolapse syndrome?

Answer 20

SOB
Syncope
Atypical chest pain
Palpitations 
MID-systolic click

Question 21

Name the major causative agents for infective endocarditis?

Answer 21

Staphylococcus aureus

Streptococcus viridens

Question 22

Name the major causative agents for rheumatic fever?

Answer 22

Streptococcus pyogenes (group A)