Valvular Heart Disease

Question 1

What type of symptoms are characteristic of valvular heart disease?

Answer 1

Exertional symptoms

Question 2

Describe the New York heart association functional classification

Answer 2

Class I - No limitation
Class II - Slight limitation of ordinary activity
Class III - Marked limitation of less than ordinary activity
Class IV - Severe limitation of minimal activity or at rest

Question 3

What are some signs of RHF?

Answer 3

Raised JVP
Pitting oedema
Hepatic congestion

Question 4

Describe the apex beat in mitral stenosis?

Answer 4

Tapping apex beat

Question 5

Describe the apex beat in left ventricular dilation (volume overload)?

Answer 5

Displaced and diffuse

Question 6

Describe the apex beat in left ventricular hypertrophy (pressure overload)?

Answer 6

Heaving and might be displaced

Question 7

Describe where you might feel a parasternal heave and what condition might predispose it?

Answer 7

Hand left of the sternum

Right ventricular overload - cor pulmonate/pulmonary hypertension

Question 8

Describe all 4 auscultation areas?

Answer 8

Aortic valve - 2nd intercostal right sternal edge
Pulmonary valve - 2nd intercostal left sternal edge
Tricuspid valve - left sternal border 4th intercostal
Mitral valve - 5th intercostal mid clavicular

Question 9

What types of systolic murmurs do you get?

Answer 9

Pan-systolic

Ejection systolic

Question 10

What type of diastolic murmurs do you get?

Answer 10

Early diastolic

Mid diastolic

Question 11

What murmur radiates to the carotids?

Answer 11

Aortic stenosis

Question 12

What murmur radiates to the axilla?

Answer 12

Mitral regurgitation

Question 13

Roughly describe the grading of murmurs?

Answer 13

1-6
1-3 = can hear, no thrills
3-6 = can hear with thrills

Question 14

Are right of left sided murmurs louder with inspiration?

Answer 14

Right sided murmurs are louder with inspiration

Question 15

Describe valve stenosis?

Answer 15

Valve doesn’t open properly

Question 16

Describe valve regurgitation?

Answer 16

Valve doesn’t close properly

Question 17

Describe bicuspid valve in aortic stenosis?

Answer 17

Congenital condition

When you are born 2 of the aortic valve cusps, fuse together, leaving you with only 2 cusps and not 3.

Question 18

What are some of the causes of aortic stenosis?

Answer 18

Degenerative - age related
Bicuspid valve - congenital
Rheumatic

Question 19

What are some of the symptoms of aortic stenosis?

Answer 19

Breathlessness
Chest pain
Dizziness

(due to the obstruction in the left ventricle stroke volume caused by aortic stenosis)

Question 20

What are some of the signs of aortic stenosis?

Answer 20

Pulse - low volume, slow rising
Apex - heaving, not displaced 
Ejection click 
S4
LV heave

Question 21

What type of murmur is aortic stenosis?

Answer 21

Ejection systolic radiates to the carotids

Question 22

What are the treatment options for aortic stenosis?

Answer 22

Conventional valve replacement
TAVI (trans catheter aortic valve replacement)
BAV (balloon aortic valvotomy)

Question 23

What is aortic stenosis?

Answer 23

Narrowing of the aortic valve

Question 24

What is mitral regurgitation?

Answer 24

A leakage of blood backward through the mortal valve each time the left ventricle contracts

Question 25

What are some causes of mitral regurgitation?

Answer 25

``` Chordae rupture (degenerative) Leaflets - myxomatous (floppy), endocardites, rheumatic ```

Question 26

What are some symptoms of mitral regurgitation?

Answer 26

Breathlessness Peripheral oedema - due to back pressure in the pulmonary venous system Fatigue - not as much blood not getting pumped out of LV

Question 27

What are some signs of mitral regurgitation?

Answer 27

Displaced apex Pulse - sinus rhythm or AF (Soft S1 split S2)

Question 28

What type of murmur is mitral regurgitation?

Answer 28

Pan systolic murmur at the apex - radiates to the axilla

Question 29

What are the treatment options for mitral regurgitation?

Answer 29

Medication - diuretics and heart failure (ACE inhibitors) | Surgical - repair or replacements

Question 30

What is mitral stenosis?

Answer 30

Narrowing of the mitral valve. (Inflammation leads to commissural fusions and a reduction in mortal valve orifice area leading to the characteristics coming pattern seen on ECG)

Question 31

What are the causes of mitral stenosis?

Answer 31

Usually rheumatic (endocarditis) Congenital is rare

Question 32

What are the symptoms of mitral stenosis?

Answer 32

Breathlessness Fatigue Palpitations (AF)

Question 33

What are the signs of mitral stenosis?

Answer 33

Mallar flush - due to decreased CO Tapping apex beat low volume pulse

Question 34

What type of murmur is mitral stenosis?

Answer 34

Mid diastolic rumbling murmur localised at the apex

Question 35

What is the treatment for mitral stenosis?

Answer 35

Diuretics - decreased preload and pulmonary venous congestion Treat AF Surgery - valve replacement Balloon valvuloplasty

Question 36

What is aortic regurgitation?

Answer 36

A leakage of the aortic valve each time the left ventricle relaxes

Question 37

What causes aortic regurgitation?

Answer 37

Leaflets - Connective tissue diseases , infective endocarditis Annulus - Marfans syndrome

Question 38

What are the symptoms of aortic regurgitation?

Answer 38

Breathlessness

Question 39

What are the signs of aortic regurgitation?

Answer 39

Collapsing pulse | Displaced apex

Question 40

What type of murmur is aortic regurgitation?

Answer 40

high pitched early diastolic murmur heard best at the left sternal edge when the patient is sitting forward

Question 41

What treatment options are there for aortic regurgitation?

Answer 41

Medication - ACEi | Surgery - if worsening (LV dilatation + symptoms) valve replacement