Valvular heart disease

Question 1

What are the signs of right heart failure?

Answer 1

Raised JVP
Pitting oedema
Hepatic congestion

Question 2

What happens to the apex beat in mitral stenosis?

Answer 2

Tapping apex beat

Question 3

What happens to the apex bear in left ventricular dilatation?

Answer 3

Displaced and diffuse

Question 4

What happens to the apex beat in left ventricular hypertrophy?

Answer 4

Heaving and may be displaced

Question 5

What does a left parasternal heave indicate?

Answer 5

Right ventricular overload

Cor pulmonale/pulmonary hypertension

Question 6

What is a cardiac murmur?

Answer 6

Audible turbulence of blood flow

Question 7

What is the first heart sound?

Answer 7

Mitral and tricuspid valve closing

Start of systole

Question 8

What is the second heart sound?

Answer 8

Aortic and Pulmonary valve closing

Start of diastole

Question 9

What are diastolic murmurs always?

Answer 9

Pathological

Question 10

What are the types of systolic murmur?

Answer 10

Pansystolic

Ejection systolic

Question 11

What are the types of diastolic murmur?

Answer 11

Early diastolic

Mid diastolic

Question 12

Which murmur radiates to the carotid?

Answer 12

Aortic stenosis

Question 13

Which murmur radiates to the axilla?

Answer 13

Mitral regurgitation

Question 14

Which murmurs are influenced by respiration?

Answer 14

Right sided murmurs are louder with inspiration

Question 15

What are the gradings of murmur severity?

Answer 15

I.	Very quiet
II.	Quiet- easy to hear
III.	Loud
IV.	Loud with a thrill
V.	Very loud with a thrill

Question 16

Describe an innocent murmur?

Answer 16

Soft (less than 3/6)
Position dependant
Often early systolic

Question 17

What are the causes of mitral regurgitation?

Answer 17

Leaflets
>prolapse
>rheumatic
>myxomatous
>endocarditis

Chordae rupture (dengenerative) 
>prolapse, flail leaflet

Papillary muscle rupture
>ischaemia

Annular dilatation
>functional

Question 18

What are the symptoms of mitral regurgitation?

Answer 18

Breathlessness
Peripheral oedema
Fatigue

Question 19

What are the signs of mitral regurgitation?

Answer 19

Displaced apex

Pansystolic murmur radiating to the axilla

Question 20

What are the treatments for mitral regurgitation?

Answer 20

Medication
>diuretics and heart failure (ACE)

Surgical
>repair- prolapse
>replacement- degenerative

Percutaenous
>clips in infancy

Question 21

What are the causes of aortic stenosis?

Answer 21

Degenerative
Congenital e.g. bicuspid valve
Rheumatic

Question 22

What are the symptoms of aortic stenosis?

Answer 22

Breathlessness
Chest pain
Dizziness/syncope

Question 23

What are the signs of aortic stenosis?

Answer 23

Low volume pulse
Forceful displaced apex
ejection systolic murmur radiating to carotids

Question 24

What are the treatment options of aortic stenosis?

Answer 24

Conventional valve replacement

Trans-catheter aortic valve replacement (TAVI)

Balloon aortic valvotomy

Question 25

What are the types of valves used in aortic stenosis valve replacement?

Answer 25

Mechanical - longevity - warfarin - younger patients Bio-prosthetic - no warfarin - 10 years - older patients

Question 26

What are the benefits of AVR over TAVI?

Answer 26

Long term outcomes, no contra-indications. TAVI has other co-morbities associated with it

Question 27

What are the causes of aortic regurgitation?

Answer 27

Leaflets >endocarditis >connective tissue disease >rheumatic Annulus >marfans >aortic dissection

Question 28

What are the symptoms of aortic regurgitation?

Answer 28

Breathlessness

Question 29

What are the signs of aortic regurgitation?

Answer 29

Collapsing pulse Wide pulse pressure displaced apex early diastolic murmur left sternal edge

Question 30

What is the treatment for aortic regurgitation?

Answer 30

Medication >ACE inhibitors Surgery >symptoms and LV dilatation >Valve replacement

Question 31

What are the causes of mitral stenosis?

Answer 31

Rheumatic Rarely congenital

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

Malar flush Tapping apex beat Mid diastolic rumbling localised to apex

Question 34

What are the treatments of mitral stenosis?

Answer 34

Medication -diuretics and treat AF Surgery -valve replacement Balloon valvuloplasty

Question 35

What other heart sounds can be present?

Answer 35

continuous murmurs tricuspid regurgitation pericardial rub 2nd sound splitting third sound fourth sound systolic clicks

Question 36

Describe valve stenosis?

Answer 36

Valves which do not open properly

Question 37

Describe valve regurgitation?

Answer 37

Valves which do not close properly

Question 38

Describe mixed valve disease?

Answer 38

Valves that neither open or close properly