Valvular heart disease

Question 1

What is the definition of valvular heart disease?

Answer 1

Disease of the valves of the heart (aortic, pulmonary, tricuspid, mitral)

Question 2

How common is valvular heart disease?

Answer 2

Common. Mitral prolapse is most common

Question 3

What is the pathophysiology of valvular heart disease?

Answer 3

• In rheumatic fever, body produces antibodies against M (myocardium) protein → attack the heart
• Produces Ascoff bodies (collection of macrophages and neurophils), fibrous pericarditis and vegetation
• Symptoms occur when orifice becomes <1cm squared
• Pressure ↑ in chamber → hypertrophy/dilatation
• Regurgitation occurs due to abnormalities of the valve leaflets, annulus, chrodea tendineae, papillary muscles or left ventricle

Question 4

What is the aetiology/risk factors for valvular heart disease?

Answer 4

• Rheumatic fever – mitral stenosis/regurgitation, aortic stenosis/regurgitation
• Congenital e.g. Marfan’s syndrome – mitral stenosis/regurgitation, aortic regurgitation
• ‘Senile’/age – aortic stenosis
• Mucopolysacchoridosis – metabolic disorder meaning lysosomal enzymes are absent/malfunctioning so bone, cartilage, tendons etc. cannot be formed – mitral stenosis
• Prosthatic valve – mitral stenosis
• LV dilatation – mirtal regurgitation
• Infective endocarditis – mirtal/aortic regurgitation
• Mirtal valve prolapse – mirtal regurgitation

Question 5

What are the signs and symptoms of valvular heart disease? (note: there are LOADS)

Answer 5

• Dyspnoea
• Fatigue
• Palpitations
• Chest pain
• Syncope
• Systemic emboli
• Haemoptysis
• Malar flush
• AF
• Displaced apex beat
• Oedema/ascites – right sided valve disease only
• Orthopnoea – aortic regurgitation
• Paroxysmal nocturnal dyspnoea – aortic regurgitation
• Mid diastolic murmur – mitral stenosis
• Pansystolic murmur – mitral regurgitation
• Ejection systolic murmur – aortic stenosis
• Early diastolic murmer – aortic regurgitation
• RV heave – mitral regurgitation
• LV heave – aortic stenosis
• Corrigan’s sign: carotid pulsations – aortic regurgitation
• De Musset’s sign: head nodding with each heart beat – aortic regurgitation
• Quincke’s sign: capillary pulsations in nail beds – aortic regurgitation
• Traube’s sign: pistol shot sound over femoral arteries – aortic regurgitation

Question 6

What diseases present similarly to valvular heart disease?

Answer 6

• Hypertrophic cardiomyopathy

Question 7

What investigations would be carried out for suspected valvular disease?

Answer 7

• ECG
• CXR – left atrial enlargement, pulmonary oedema, mitral valve calcification
• Echocardiogram
• Cardiac catheterisation

Question 8

What are the surgical treatments for valvular heart disease?

Answer 8

• Balloon valvuloplasty – if non calcified valve
• Open valvotomy
• Valve replacement

Question 9

What are the pharmacological treatments for valvular heart disease?

Answer 9

• Rate control – for AF
• Warfarin
• Diuretics – for ↓ preload and pulmonary congestion
• B blockers – for palpitations/chest pain
• ACE inhibitors - ↓ systolic hypertension in aortic regurgitation
• Penicillin – prophylaxis against rheumatic fever