Valvular Heart Disease

Question 1

What causes Mitral stenosis?

Answer 1

• Rheumatic Heart Disease
• Congenital MS
• Systemic conditions (Lupus-Rheumatic arthritis)

Question 2

How is stenosed mitral orifice?

Answer 2

<2cm3

Question 3

How big should mitral orifice usually be?

Answer 3

4-6cm3

Question 4

What ultimately happens with mitral stenosis?

Answer 4

Right heart dilation with tricuspid regurgitation

Question 5

What happens to the rest of the body?

Answer 5

LV Pressure and systolic function normal

Question 6

When can mitral stenosis cause tachycardia?

Answer 6

• Exercise
• Acute
• Pregnancy
• Atrial Fibrilation

Question 7

What can mitral stenosis cause?

Answer 7

• Dysponoea
• Haemoptisis
• Systemic embolisation
• Chest pain
• Hoarseness

Question 8

What does mitral stenosis cause haemoptisis?

Answer 8

-Rupture of thin walled veins

Question 9

Why does Mitral Stenosis cause haorseness?

Answer 9

-Compression of the L recurrent laryngeal nerve

Question 10

What can you find on examination with someone with Mitral Stenosis?

Answer 10

• Mitral Facies
• Pulse=Normal
• JVP=Prominent a wave
• Tapping apex beat and diastolic thrill
• RV heave
• Auscultation

Question 11

What do you find on an CXR with some one who has mitral stenosis?

Answer 11

LA enlargement

Question 12

What is the medical treatment of mitral stenosis?

Answer 12

• Diuretics and restriction of NA intake

- Anticoagulants

Question 13

What is the interventional treatment

Answer 13

Valvotomy (balloon vs Surgical)

Mitral valve replacement

Question 14

What causes mitral regurgtitation?

Answer 14

• Rheumatic heart disease

- Mitral valve prolapse

Question 15

What causes Functional Mitral regurgitation?

Answer 15

Left ventricular annular dilatation

Question 16

What does ERO mean?

Answer 16

effective regurgitant orifices

Question 17

How does the left ventricle compensate in acute MR?

Answer 17

Decreases end systolic pressure and volume

Decreases in wall tension

Question 18

How does left ventricel compensate in chronic cases of MR?

Answer 18

Increases End diastolic volume and End systolic volume returns to normal

Question 19

What does increaseing EDV do to the left ventricle?

Answer 19

makes it eccentric

Question 20

What happens to the compliance of the LA?

Answer 20

Both increased and reduced?

Question 21

Why is LA compliance reduced?

Answer 21

Marked pressure rise causing thickening of atrial myocardium

increase in pulmonary vascular resistance and remodelling of the pulmonary vasculature

Question 22

Why is LA compliance increased?

Answer 22

Marked volume enlargement , lesser changes in pulmonary asculature but develop AF

Question 23

What can be seen with acute Mitral regurgitation?

Answer 23

Breathlessness
pulm oedema
cardiogenic shock

Question 24

What can be seen with chronic MR?

Answer 24

Fatigue exhausion (low CO) Right heart failure
Dyspnoea or palpitations due to Atrial fibrillation

Question 25

What can cause valve perforation?

Answer 25

Infection

Question 26

What is pulse rate like in MR?

Answer 26

normal or reduced in heart failure

Question 27

What JVP like in MR?

Answer 27

Prominent in RH failure present

Question 28

What is the apex beat like in MR?

Answer 28

Brisk and Hyperdynamic

Question 29

What is shown in an ECG with MR?

Answer 29

LA enlargement | Prominent R wave in Right precordial leads

Question 30

What can be seen in a CXR of someone with MR?

Answer 30

Cardiomegaly, LA enlargement or calcification of mitral mitral annulus

Question 31

What causes MR?

Answer 31

Leaflet dysfunction Chordae pap muscle Annular disease

Question 32

What is the medical treatment for mitral stenosis?

Answer 32

- Acute= Preload and afterload reduction may be life saving | - Chronic : not a whole pile mostly for LV function presentation

Question 33

What is the interventional treatment for MR?

Answer 33

Mitral valve repair | Mitral valve replacement

Question 34

What can cause aortic stenoisis?

Answer 34

Rheumatic and Degenrative conditions

Question 35

How does rhuuematic disease cause aortic stenosis?

Answer 35

Adhesion, fusion of the commissures and retraction and stiffening of the free cusp margins

Question 36

How does degenerative disease cause aortic stenosis?

Answer 36

Linked atherosclerosis, a slow inflammatory process resulting in thickening and calcification of the cusps from base to free margins

Question 37

What does Aortic stenosis ultimately cause?

Answer 37

``` concentric hypertrophy Left atrial p increases Increases 02 demand Myocardial ischaemia LV failure ```

Question 38

What are the cardinal symptoms of aortic stenosis?

Answer 38

-Chest pain _syncope -Breathlessness on exertion -Heart failure

Question 39

What does the pulse look like for aortic stenosis?

Answer 39

Small volume and slowly rising

Question 40

What does the JVP look like with some who has aortic stenosis?

Answer 40

Prominent if RH failure present, low BP

Question 41

What is the apex beat like in Aortic stenosis?

Answer 41

Vigurous and sustained | Also RV heave

Question 42

How do you treat aortic stenosis?

Answer 42

Aortic vlave replacement

Question 43

What can cause aortic regurgitation?

Answer 43

Dilated arota | Or dysfunctional leaflets

Question 44

What causes the aorta itself to cause aortic regurgitation?

Answer 44

Dilated aorta | Connective tissue disorders

Question 45

What causes dysfunction in the leaflets which in turn causes aortic regurgitation

Answer 45

- Rheumatic heart disease - Endocarditis - Myxomatous degeneration

Question 46

What does aortic regurgitation?

Answer 46

Increased LV systolic pressure LV hypertrophy and Lv dilatation -Myocardial ischaemia

Question 47

What are the symptoms of chronic AR?

Answer 47

- Long asymptomatic phase | - Exertional breathlesness

Question 48

What are the symptoms of Acute AR?

Answer 48

Poorly tolerated as wall tension cannot acutely adopt

Question 49

What is pulse rate like with AR?

Answer 49

Large volume and collapsing (corrigan sign)

Question 50

What is the apex beat like for someone with AR?

Answer 50

Hyperdynamic displaced apex

Question 51

What can be seen on an ECG of someone with AR?

Answer 51

ST/T changes

Question 52

What can be seen in CXR for someone with AR?

Answer 52

If chronic cardiomegaly