Valvular Heart Disease

Question 1

in the mitral valve which leaflet is larger?

Answer 1

the anterior leaflet

Question 2

what can cause mitral stenosis?

Answer 2

> rheumatic heart disease
congenital MS
systemic

Question 3

what is the affect of mitral stenosis on the left atrium pressure?

Answer 3

it increases

Question 4

how is the pulmonary venous and capillary pressure affected by mitral stenosis?

Answer 4

> it is increased

Question 5

what is the effect of mitral stenosis on left ventricular pressure and systolic function?

Answer 5

they are normal

Question 6

describe the clinical manifestations of mitral stenosis

Answer 6

> dyspnoea
> haemoptysis
> systemic embolisation
> chest pain
> hoarseness ( compression of the left laryngeal nerve by the left atrium)
> infective endocarditis

Question 7

what would you expect to find on examination of someone with mitral stenosis?

Answer 7

> mitral facies
> normal pulse
> prominent jugular venous pressure
> tapping apex beat and diastolic thrill
> right ventricular heave
> auscultation

Question 8

what investigations would you carry out for mitral stenosis?

Answer 8

> ECG
chest x-ray
echocardiology
cardiac magnetic resonance

Question 9

if a patient has mitral stenosis what abnormality would you expect to see on their chest x-ray

Answer 9

left atrium enlargment

Question 10

what would you expect to see on a cardiac magnetic resonance if the patient has mitral stenosis?

Answer 10

large left atrium, only the extrinsic flap opening

Question 11

what medical treatment can be given to treat mitral stenosis?

Answer 11

> diuretics
restriction of sodium intake
atrial fibrillation: sinus rhythm restoration and ventricular rate control
anti-coagulation (atrial fibrillation)

Question 12

what is the aetiology for mitral regurgitation?

Answer 12

> rheumatic heart disease
> mitral valve prolapse
> infective endocarditis
> degenerative due to age
> functional: left ventricular and annular dilation

Question 13

what is mitral regurgitation?

Answer 13

this is when the mitral valve is leaky or incompetent allowing blood to flow back into the left atrium

Question 14

how does the left ventricle compensate in chronic mitral regurgitation?

Answer 14

it increases it contractibility and end diastolic volume by dilating to accommodate the extra blood. left ventricular hypertrophy develops.

Question 15

describe the effects of acute mitral regurgitation on the heart

Answer 15

increased preload and decreases afterload causes an increase in end diastolic volume and a decrease in end systolic volume. all of this creates an increased stoke volume and an overall increase in left arterial pressure.

Question 16

what is the clinical manifestations of an acute mitral regurgitation?

Answer 16

breathlessness
pulmonary oedema
cardiogenic shock

Question 17

what are the clinical manifestations of mitral regurgitation?

Answer 17

> fatigue
> exhaustion
> right heart failure
> dyspnoea
> palpitations

Question 18

what would you expect to find on clinical examination of a patient with mitral regurgitation?

Answer 18

Pulse: normal or reduced in heart failure
JVP: prominent if right heat failure is present
Apex beat: brisk and hyper-dynamic
Right ventricular heave
Auscultations: reduced s1, split s2 with early a 2 and loud p3

Question 19

what investigations would you carry out in a patient with a mitral regurgitation?

Answer 19

> ECG
chest x-ray
cardiac catheterisation

Question 20

what would you expect to see on a patients ECG who has a mitral regurgitation?

Answer 20

prominent P wave in r precordial leads due to right ventricular hypertrophy

Question 21

what would you expect to see on a patients chest x-ray if they have a mitral regurgitation?

Answer 21

left atrial enlargement
calcification of the mitral annulus
cardiomeggaly

Question 22

how could an acute mitral regurgitation be treated?

Answer 22

reduce preload and afterload with sodium nitroprusside, dobutamine and IABP.

Question 23

how would you treat chronic mitral regurgitation?

Answer 23

there is no therapeutic benefit for haemodynamic improvement but left ventricle function preservation

Question 24

what surgical intervention can be used to treat mitral regurgitation?

Answer 24

> mitral valve apparatus repair

> mitral valve replacement

Question 25

what is the aetiology of aortic stenosis?

Answer 25

> degenerative > rheumatic > bicuspid

Question 26

how does rheumatic disease lead to aortic stenosis?

Answer 26

there is adhesion and fusion of the commissures and retraction and stiffening of the free cusp margins

Question 27

how can aortic stenosis occur degenerately?

Answer 27

this is linked to atherosclerosis. it is a slow inflammatory process resulting in thickening and calcification of the cusps from base to free margins

Question 28

what are the effects of aortic stenosis?

Answer 28

there is increased left ventricular systolic pressure leading to severe concentric hypertrophy and left ventricular mass. this leads to increased left ventricular end diastolic pressure. this creates myocardial ischemia and results in left ventricular ischemia

Question 29

what symptoms can be caused by aortic stenosis?

Answer 29

``` > there is a long asymptomatic phase > chest pain > syncope > breathlessness of exertion > heart failure ```

Question 30

what would be seen upon clinical examination of a patient with aortic stenosis?

Answer 30

``` pulse: small volume and slowly rising JVP: prominent if right heart failure is present. low blood pressure apex beat: vigorous and sustained right ventricle heave ```

Question 31

what would you expect to hear during auscultation of a patient with aortic stenosis?

Answer 31

``` > normal s1. > less audible s2 with a2. > there is late peaking > it is loud at the base > harsh > radiates to the carotids ```

Question 32

what would you expect to see on an ECG of an aortic stenosis?

Answer 32

left ventricular strain and hypertrophy | Doppler haemodynamic assessment of pressure gradient and AVA

Question 33

what would you expect to see on the chest xray of someone with an aortic stenosis?

Answer 33

calcification of the aortic valve

Question 34

describe what an aortic stenosis would look like in cardiac magnetic resonance

Answer 34

a fish mouth opening

Question 35

what medical treatment is available for patients with aortic stenosis?

Answer 35

it is limited for those that develop heart failure but you can replace or repair the aortic valve

Question 36

what aortic causes are there for aortic regurgitation?

Answer 36

> dilated aorta | > connective tissue disorders

Question 37

what problems with the leaflets of aortic valve causes regurgitation?

Answer 37

> bicuspid aortic valve > rheumatic heart disease > endocarditis > myxomatous degeneration

Question 38

what is the effect of aortic regurgitation on the heart?

Answer 38

the left ventricle is now accommodating both the stroke volume and the regurgitated volume. this increases left ventricular diastolic volume and systolic pressure. this causes left ventricular hypertrophy and dilatation. resulting in myocardial ischaemia and left ventricular failure

Question 39

what are the symptoms of chronic aortic regurgitation?

Answer 39

there is a long term asymptomatic phase and then exertional breathlessness

Question 40

why is acute aortic regurgitation worse than chronic?

Answer 40

the wall tension cannot adapt in such a short space of time

Question 41

what would you expect to see on clinical examination of a patient with aortic regurgitation?

Answer 41

pulse: large volume and collapsing wide pulse pressure apex beat: hyperdynamic and displaced

Question 42

what would you hear on auscultation on a patient with aortic regurgitation?

Answer 42

normal s1 normal s2 early diastolic, decrescendo soft murmur

Question 43

what would ECG show for aortic regurgitation?

Answer 43

> it would demonstrate aortic valve cusp anatomy, thickening and vegetation's > left ventricular function, dilation and hypertrophy > Doppler haemodynamic assessment of regurgitant flow

Question 44

what would you see on a chest xray of a patient with chronic aortic regurgitation?

Answer 44

cardiomegaly

Question 45

what medical treatment is used for aortic regurgitation?

Answer 45

vasodilator therapy has been shown to delay the timing for surgical intervention, aortic valve replacement or repair