Valvular Heart Disease

Question 1

What valves are commonly affected by rheumatic fever (rheumatic heart disease)?

Answer 1

This infection of group A streptococci causes the inflammation of the mitral valve mainly (65%), or the mitral and aortic valves (25%), and this can lead to defects such as prolapse, stenosis or regurgitation

Question 2

What are common valve lesions?

Answer 2

Mitral valve prolapse, aortic stenosis/regurgitation, mitral regurgitation/stenosis and right-sided valve lesions

Question 3

What is the most common valve lesion?

Answer 3

Mitral valve prolapse

Question 4

What is mitral valve prolapse?

Answer 4

This is where the valve leaflets prolapse back into the left atrium during systole and are therefore non-functional

Question 5

What are the signs of mitral valve prolapse?

Answer 5

Ejection click and/or late systolic murmur

Question 6

What is aortic stenosis?

Answer 6

The narrowing of the aortic valve leaflets

Question 7

What are the causes of aortic stenosis?

Answer 7

Calcific disease associated with ageing, congenital bicuspid valve (instead of three valve leaflets there are two) and rheumatic disease

Question 8

What are the symptoms of aortic stenosis?

Answer 8

Dyspnoea due to pulmonary congestion (due to increased diastolic pressure on the stiff/non-compliant left ventricle), angina (due to increased oxygen demand as a result of left ventricular hypertrophy), left ventricular failure and sudden death (due to ventricular arrhythmia)

Question 9

What are the signs of aortic stenosis?

Answer 9

Slow, rising carotid pulse, an ejection systolic murmur and additional heart sounds

Question 10

What is aortic regurgitation?

Answer 10

When blood flow can back-track into the left ventricle from the aorta during ventricular systole

Question 11

What may cause aortic regurgitation?

Answer 11

Aortic valve leaflet disease: calcific disease, congenital bicuspid valve, rheumatic disease and infective endocarditis

Aortic root dilating disease: ankylosing spondylitis, marfan syndrome and aortic dissection

Question 12

What are the symptoms of aortic regurgitation?

Answer 12

Often there are no symptoms, but they may be dyspnoea or angina

Question 13

What are the signs of aortic regurgitation?

Answer 13

Rapidly rising carotid pulse (due to vigorous ejection of the volume-loaded left ventricle), early diastolic murmur (due to aortic back flow) and ejection murmur (turbulent ejection heard)

Question 14

What is the most common cause of mitral stenosis?

Answer 14

Rheumatic disease

Question 15

What are the symptoms of mitral stenosis?

Answer 15

Dyspnoea (due to pulmonary oedema), right ventricular failure, palpitations

Question 16

What are the signs of mitral stenosis?

Answer 16

Irregular pulse if there is atrial fibrillation, loud S1 sound, increased JVP and basal lung crepitations (oedema)

Question 17

What may cause mitral regurgitation?

Answer 17

Mitral valve leaflet disease (mitral valve prolapse, rheumatic disease and infective endocarditis), subvalvular disease or functional mitral regurgitation due to left ventricular dilatation

Question 18

What are the signs of mitral regurgitation?

Answer 18

Irregular pulse if there is atrial fibrillation, pansystolic murmur, third heart sound (S3), increased JVP, basal crepitation and ankle oedema

Question 19

What are the symptoms of mitral regurgitation?

Answer 19

Dyspnoea, palpitations

Question 20

What types of valvular disease are likely to lead to atrial fibrillation?

Answer 20

Mitral stenosis or regurgitation

Question 21

Why may beta blockers, digoxin or verapamil be used in the treatment of valvular heart disease?

Answer 21

If there are any signs of atrial fibrillation

Question 22

What drugs are commonly given in the treatment of valvular heart disease?

Answer 22

Diuretics, vasodilators, beta blockers and anticoagulants

Question 23

Why are vasodilators given in the treatment of valvular heart disease?

Answer 23

These are given to treat low forward-output lesions such as mitral/aortic regurgitation

Question 24

Why are anticoagulants given in the treatment of valvular heart disease?

Answer 24

These are given to protect against systemic emboli formation due to stagnant blood that may have occurred in atrial fibrillation