Valvular heart disease

Question 1

Apex beat in aortic stenosis

Answer 1

NOT displaced because this is a pressure not volume overload
However it is “heaving” / strong

Question 2

Causes for pathological 3rd heart sounds

Answer 2

Heart failure 
MI 
Cardiomyopathy 
Hypertension (pressure overload) 
Mitral / Aortic regurgitations (volume overload)

Question 3

5 signs of infective endocarditis

Answer 3

hands - clubbing and splinter haemorrhages
heart - CHANGING MURMUR
Abdo - Splenomegaly & microscopic haematuria

Question 4

pulse in aortic stenosis

Answer 4

slow rising pulse

narrow pulse pressure

Question 5

how can an aortic stenosis murmur be described

Answer 5

ejection systolic

Question 6

causes of aortic stenosis

Answer 6

calcification of the valve due to ageing
bifid valve
rheumatic heart disease

Question 7

presentation of aortic stenosis

Answer 7

SOB
Syncope
Angina

Question 8

Heart sound associated with aortic stenosis

Answer 8

4th heart sound - atrial contraction against an non compliant / hypertrophied ventricle

Question 9

ECG features associated with aortic stenosis

Answer 9

LVH / LV strain

Question 10

Medical treatment in aortic stenosis

Answer 10

treat HTN

Question 11

Surgical options in aortic stenosis

Answer 11

Open valve replacement

TAVI

Question 12

Aortic scelrosis is?

Answer 12

thickening of the valve leaflets NOT causing haemodynamic changes

Question 13

Describing features of a murmur

T
I
P1
P2
Q
R
S

Answer 13

Timing - diastolic or systolic?
Intensity - grade 2 if quiet and grade 3 if loud
Position on chest where it is loudest
Position of the patient when it is loudest
Quality
Radiation
Systemic features - signs of valve complications?

Question 14

what happens to the apex beat in aortic regurg

Answer 14

displaced but NOT strong

Question 15

Causes of mitral regurg

Answer 15

Leaflets - Valve prolapse, endocarditis
Muscles - Pupillary muscle rupture post MI, marfans
Annular dilation - cardiomyopathy, IHD w/ failure

Rheumatic HD
SLE
Marfans

Question 16

Apex beat in Mitral regurg

Answer 16

Displaced

Question 17

Timing of mitral regurg murmur

Answer 17

Pansystolic

Question 18

Where does the murmur radiate in MR

Answer 18

Axilla

Question 19

ECG features associated with MR

Answer 19

AF

Question 20

Differentials for MR

Answer 20

AS
VSD
TR

Question 21

DDx for AS

Answer 21

Aortic sclerosis
MR
Hypertrophic cardiomyopathy

Question 22

Where does AS radiate to?

Answer 22

carotids

Question 23

Treatment of MR - medical

Answer 23

Diuretics and ACE-i

Treat AF