Valvular Heart Disease

Question 1

What are some of the CAUSES of MITRAL STENOSIS?

Answer 1

1) Rheumatic Fever
2) Congenital Defect
3) Systemic Conditions, i.e. Systemic Lupus Erythematosus and Rheumatoid Arthritis

Question 2

What are some of the SYMPTOMS of Mitral Stenosis?

Answer 2

1) Mild, Exertional Dyspnoea
2) Haemoptysis
3) Chest Pain
4) Dysphonia (Hoarseness)
5) Systemic Embolisation
6) Infective Endocarditis (IE)

Question 3

What are some of the SIGNS of Mitral Stenosis?

Answer 3

1) Rumbling Mid-Diastolic Murmur
(Heard on Expiration at Apex, with Bell; Patient on Left)
2) Malar Flush
3) Tapping Apex Beat
4) Diastolic Thrill
5) RV Heave

Question 4

What are the COMMONEST heart VALVE PROBLEMS?

Answer 4

1) Mitral and Aortic Valve Calcification
2) Mitral Valve Prolapse (MVP)
3) Bicuspid Aortic Valve
4) Aortic Sclerosis (Senile Degeneration)

Question 5

What INVESTIGATIONS would be used to DIAGNOSE VALVULAR DISEASE?

Answer 5

1) ECG
2) CXR
3) Cardiac Catheterisation
4) Echocardiography
5) Cardiac MRI

Question 6

What are the PHARMACOLOGICAL TREATMENTS for Mitral Stenosis?

Answer 6

1) Diuretics and < Na+ Intake
2) Beta-Blocker OR CCB (i.e. Verapamil or Diltiazem) - For Rate-Control
3) Anticoagulation - Particularly in AF

Question 7

What are the INTERVENTIONAL TREATMENTS for Mitral Stenosis?

Answer 7

1) Balloon Valvotomy
2) Valve Replacement

*Preserve Native Tissue for as Long as Practically Possible

Question 8

What are some of the CAUSES of MITRAL REGURGITATION (MR)?

Answer 8

1) Rheumatic Fever
2) MVP
3) IE
4) Annular Calcification
5) LV and Annular Dilatation (Functional MR)
5) Connective Tissue Disorders, i.e. Marfan’s
7) Ruptured Chordae Tendinae
8) Ruptured or Dysfunctional Papillary Muscle

Question 9

What are some of the SYMPTOMS of MR?

Answer 9

1) Dyspnoea (Due to Pulmonary Oedema or Cardiogenic Shock)
2) Fatigue
3) Palpitations (Due to AF)

Question 10

What are some of the SIGNS of MR?

Answer 10

1) Pansystolic Murmur (Heard at Apex and Axilla)
2) Dysplaced, Hyperdynamic Apex Beat
3) RV Heave
4) Distended JVP (If HF)

Question 11

What would be the POSSIBLE FINDING(S) on CXR for Mitral Stenosis?

Answer 11

1) LA Enlargement
2) Pulmonary Oedema
3) Mitral Valve Calcification

Question 12

What would be the POSSIBLE FINDING(S) on CXR for MR?

Answer 12

1) Cardiomegaly (LA and LV Enlargement)
2) Pulmonary Oedema
3) Mitral Valve Calcification

Question 13

What would be the POSSIBLE FINDING(S) on Echo for MR?

Answer 13

1) Perforation of Mitral Valve Cusp
2) Annular Disease
3) Chordae Tendinae Rupture/Dysfunction
4) Papillary Muscle Rupture/Dysfunction
5) Systolic Blood Flow Reversal in Pulmonary Veins

Question 14

What are the PHARMACOLOGICAL TREATMENTS for MR?

Answer 14

1) Diuretics
2) Rate Control (If AF)
3) Anticoagulate (If AF)

Question 15

What are the INTERVENTIONAL TREATMENTS for MR?

Answer 15

Valvular Replacement or Repair

*Repair, Where Possible, Better than Replacement

Question 16

What are the CAUSES of AORTIC STENOSIS (AS)?

Answer 16

1) Degeneration/Calcification with Age
2) Rheumatic Disease
3) Congenital Defect - Bicuspid Valve

Question 17

What are the SYMPTOMS of AS?

Answer 17

Long Asymptomatic Period

Can be:

1) Chest Pain (Tightness/Pressure)
2) Dizziness
3) Syncope
4) Exertional Dyspnoea
5) Heart Failure

Question 18

What are some of the SIGNS of AS?

Answer 18

1) Ejection Systolic Murmur (Aortic Area; Radiates to Carotids)
2) < Volume and Slow Rising Pulse
3) Distended JVP (If HF or Hypotensive)
4) RV Heave
5) Aortic Thrill
6) Vigorous and Sustained Apex Beat

Question 19

What would be the POSSIBLE FINDING(S) on CXR for AS?

Answer 19

Calcified Aortic Valve

Question 20

What would be the POSSIBLE FINDING(S) on Echo for AS?

Answer 20

Left Ventricular Hypertrophy (LVH)

Question 21

What would be the POSSIBLE FINDING(S) on ECG for AS?

Answer 21

LVH with Strain Pattern

Question 22

What are the TREATMENTS for AS?

Answer 22

Valvular Replacement or Repair

Question 23

What are the CAUSES of AORTIC REGURGITATION (AR)?

Answer 23

1) Dilated Aorta (Due to Marfan’s or HTN)
2) Connective Tissue Disorders
3) Congenital Defect (Bicuspid Aortic Valve)
4) Rheumatic Fever
5) IE
6) Myxomatous Degeneration
7) Trauma

Question 24

What are the SYMPTOMS of AR?

Answer 24

Long Asymptomatic Period

Can be:

1) Exertional Dyspnoea
2) Orthopnoea
3) Paroxysmal Nocturnal Dyspnoea

Question 25

What are some of the SIGNS of AR?

Answer 25

1) Early, Soft Diastolic Murmur
2) > Volume and Collapsing Pulse
3) Wide Pulse Pressure
4) Hyperdynamic, Displaced Apex Beat

Question 26

What would be the POSSIBLE FINDING(S) on ECG for AR?

Answer 26

1) LVH

2) Ascending Aorta Dilatation

Question 27

What would be the POSSIBLE FINDING(S) on CXR for AR?

Answer 27

Cardiomegaly

Question 28

What would be the POSSIBLE FINDING(S) on Echo for AR?

Answer 28

1) AV Cusp Deficiences (Due to Thickening or Prolapse or Vegetations)
2) LVH or Dilatation

Question 29

What are the PHARMACOLOGICAL TREATMENTS for AR?

Answer 29

Vasodilator Therapy (i.e. ACEIs)

Question 30

What are the INTERVENTIONAL TREATMENTS for AR?

Answer 30

Valvular Replacement or Repair

Question 31

What are the ADVANTAGES and DISADVANTAGES of using a BIOLOGICAL heart valve PROSTHESIS?

Answer 31

Advantage - No Anticoagulation (Warfarin) Required

Disadvantage - Becomes Inviable After 15 Years

Question 32

What are the ADVANTAGES and DISADVANTAGES of using a MECHANICAL heart valve PROSTHESIS?

Answer 32

Advantage - Valve Lasts for > 40 Years

Disadvantage - Lifetime Anticoagulation is Required