Valvular Heart Disease

Question 1

What is rheumatic heart disease?

Answer 1

Cause by rheumatic fever - inflammatory disease due to streptococcus A
leads to valvular damage -> heart failure, AF and valve infection
treated by penicillin and surgery

Question 2

What are the most common valve lesions?

Answer 2

Mitral valve prolapse
 Aortic stenosis / regurgitation
 Mitral regurgitation
 Mitral stenosis
 Right sided valve lesions

Question 3

What is a mitral valve prolapse?

Answer 3

systolic prolapse of 1 or both valve leaflets back into LA sometimes produces regurg, severity varies
myxomatous degeneration (CT Degen)
common in those with Marfan’s
asymptomatic, chest pain, atrial arrhythmias
late systolic murmur
no treatment usually necessary

Question 4

What are some causes of aortic stenosis?

Answer 4

• calcific disease
• congenital bicuspid valve
• rheumatic disease

Question 5

What are the signs of aortic stenosis?

Answer 5

signs - slow rising carotid pulse, S4 sound, systolic murmur

Question 6

Explain the symptoms of aortic stenosis?

Answer 6

Dyspnoea - increase in diastolic pressure in stiff non compliant LV
Angina - increased oxygen demand of hypertrophied LV
Syncope - paroxysmal ventricular arrhythmias/ exertional cerebral hypoperfusion
LV failure - contractile failure as ventricle dilates
sudden death - ventricular arrhythmias

Question 7

What are the causes of aortic regurgitation?

Answer 7

• Aortic valve leaflet disease (calcific disease, congenital bicuspid valve, rheumatic disease, infective endocarditis)
• aortic roof dilating disease (ankylosing spondylitis, marfan syndrome, aortic dissection)

Question 8

What are the signs and symptoms of aortic regurgitation?

Answer 8

Signs - rapidly rising carotid pulse, early diastolic murmur, turbulent ejection murmur from loaded LV
symptoms - dyspnoea and angina

Question 9

What causes mitral stenosis?

Answer 9

caused by rheumatic fever

Question 10

Explain the signs and symptoms of mitral stenosis?

Answer 10

signs - fast pulse due to AF, auscultation loud S1 and pre-systolic murmur, high JVP/ankle oedema as volume overload
symptoms - dynspnoea/orthopnea as increased LA pressure, palpitations as AF, RV failure as LA pressure high and pulmonary vasoconstriction, systemic emboli

Question 11

What are the causes of mitral regurgitation?

Answer 11

mitral valve leaflet disease - mitral valve prolapse, rheumatic disease, infective endocarditis
subvalvular disease - chordal rupture, papillary muscle dysfunction (ischemia), papillary muscle rupture
functional MR - LV dilatation

Question 12

What are the signs and symptoms of mitral regurgitation?

Answer 12

signs - auscultation S3, pansystolic murmur, raised JVP/ankle oedema as volume overload
symptoms - dyspnoea/orthopnoea as increased LA pressure, palpitations as AF, systemic emboli

Question 13

How is valvular heart disease medially treated?

Answer 13

• diuretics for fluid retention
• vasodilators
• digoxin/beta blockers/verapamil- anticoagulants to protect against systemic embolisation