Valvular Heart Disease

Question 1

What percentage of heart failure involves valve disease?

Answer 1

10%

Question 2

What is essentially the function of the valves?

Answer 2

To allow forward flow, but to prevent back flow

Question 3

What are the 4 components of the mitral and tricuspid valves?

Answer 3

Cusps
Papillary muscles
Chordae tendinieae
Valve ring

Question 4

There are 8 types of failure in valves, 2 potentials for each valve. List all 8, stating which are more likely to occur.

Answer 4

Mitral stenosis
Mitral incompetence
Aortic stenosis
Aortic incompetence

(above are more likely and more severe than those below)

Tricuspid stenosis
Tricuspid incompetence
Pulmonary stenosis
Pulmonary incompetence

Question 5

Define stenosis in reference to valvular heart disease.

Answer 5

Narrowing of the valve outlet caused by thickening of valve cusps, or increased rigidity or scarring

Question 6

Define incompetence in reference to valvular heart disease.

Answer 6

Aka insufficiency or regurgitation (which is what happens).

Caused by incomplete seal when vales close, allowing blood to flow backwards.

Question 7

What is a direct result of stenosis?

Answer 7

Hypertrophy, but not hypertension (due to reduced blood flow)

Question 8

What is a direct result of incompetence?

Answer 8

Higher systolic pressure, but lower diastolic pressure

Question 9

What is a vegetation?

Answer 9

Arterial thrombus (platelets, fibrin and more platelets)

Question 10

What causes the first heart sound?

Answer 10

Both mitral and tricuspid valves closing (start of systole)

Question 11

What causes the second heart sound?

Answer 11

Both aortic and pulmonary valves closing (start of diastole)

Question 12

What are some common causes of valvular stenosis and incompetence?

Answer 12

Congenital heart disease
Cardiomyopathy
Acquired:
- Rheumatic fever
- MI
- Age related
- Endocarditis

Question 13

What are 3 causes of aortic stenosis?

Answer 13

Calcification of congenital mitral valve
Senile calcific degeneration
Rheumatic fever

Question 14

What are some consequences of aortic stenosis?

Answer 14

o Increases work of the heart
o Ventricular hypertrophy
o Causes cardiac failure late in the clinical course
o Fibrous tissue calcification
o Can lead to right ventricular hypertrophy

Question 15

What are some associated clinical symptoms and signs of aortic stenosis?

Answer 15

o	Dyspnoea (breathlessness)
o	Angina (cardiac chest pain)
o	Syncope (collapse)

Question 16

What are 3 causes of aortic incompetence?

Answer 16

Marfan’s syndrome
Rheumatic fever
Infective endocarditis

Question 17

Why can aortic incompetence or regurgitation lead to cardiac hypertrophy or even cardiac failure?

Answer 17

There is an increase in the volume of blood that needs to be pumped (to compensate for blood leaking back into the ventricle) –> increased workload of the heart –> left ventricular hypertrophy –> left cardiac failure

Question 18

What can cause mitral incompetence?

Answer 18

Rheumatic fever
Infective endocarditis
Floppy valve & Marfan’s syndrome

Question 19

How might the papillary muscles be damaged?

Answer 19

Post MI

Question 20

What can mitral incompetence cause?

Answer 20

Pulmonary hypertension

Right ventricular hypertrophy

Question 21

What clinical CVS conditions can mitral stenosis lead to?

Answer 21

AF
Right heart failure
Pulmonary hypertension (due to back pressure)
Left atrial and right ventricular hypertrophy

Question 22

When does mitral stenosis commonly occur?

Answer 22

Post-rheumatic fever

Question 23

What is an problem concerning the heart blood flow that arises due to mitral stenosis?

Answer 23

Restriction of blood flow to left ventricle

Question 24

What type of murmur is associated with mitral stenosis?

Answer 24

Opening snap and diastolic murmur

Question 25

What type of murmur is associated with mitral incompetence?

Answer 25

Mid-systolic click and late systolic murmur in mitral prolapse

Question 26

What type of murmur is associated with aortic stenosis?

Answer 26

Ejection systolic murmur

Question 27

What type of murmur is associated with aortic incompetence?

Answer 27

Diastolic murmur

Question 28

What is infective endocarditis?

Answer 28

The infection of a valve with formation of thrombotic vegetations

Question 29

What determines the damage caused and the severity of the infective endocarditis?

Answer 29

Virulence of organisms

Question 30

What is bacteraemia?

Answer 30

The presence of bacteria in the blood

Question 31

Why are antibiotics used in a dental examination if the patient has had rheumatic fever in the past?

Answer 31

Since rheumatic fever is a predisposing factor to valvular disease, antibiotics are used to prevent bacteraemia and hence potential set up of bacteria in the valvular vegetations that may be present in resultant infective endocarditis

Question 32

What are the three major risk factors associated with infective endocarditis?

Answer 32

Valve damage Bacteraemia (dental & catheterisation) Immunosuppression

Question 33

What is rheumatic fever?

Answer 33

Acute multi-system disease - heart, (pericarditis, myocarditis & valvulitis) joints & connective tissue

Question 34

What type of infection normally precedes rheumatic fever?

Answer 34

Streptococcal (usually pharyngitis)

Question 35

What age group does rheumatic fever affect?

Answer 35

Children - 4-16 years old

Question 36

What is the composition of a vegetation?

Answer 36

``` Group D streptococcus Gut commensals (bacteria) Skin strep (coxiella, fungi, candida) ```

Question 37

What are the two main parts of infective endocarditis that must be carried out?

Answer 37

Blood culture | Intravenous antibiotics

Question 38

What factors are part of the infective endocarditis diagnosis, treatment and prevention plan?

Answer 38

``` Treat strep infection with antibiotics Prophylactic cover for invasive procedures (e.g. dental work) Replace damaged valves Imaging BLOOD CULTURE INTRAVENOUS ANTIBIOTICS ```