Valvular heart disease

Question 1

What are the three classic symptoms of aortic stenosis?

Answer 1

Angina, heart failure and syncope

Question 2

What is the most common initial symptom for aortic stenosis?

Answer 2

decreased exercise tolerance or dyspnoea on exertion

Question 3

What causes aortic stenosis?

Answer 3

age related with congenital bicuspid valve, chronic kidney disease and previous rheumatic fever

Question 4

Where is aortic stenosis best heard?

Answer 4

aortic area (2nd intercostal space right side)

Question 5

How is an aortic stenosis murmur described?

Answer 5

ejection systolic radiating to carotid/neck

Question 6

How is aortic stenosis best assessed?

Answer 6

echocardiography

Question 7

What are the indications for surgery in Aortic stenosis?

Answer 7

symptoms, with LV systolic dysfunction, abnormal exercise test or having another surgery

Question 8

What should be considered for elderly patients with significant co-morbidities?

Answer 8

Transcatheter aortic valve implanted via the femoral artery

Question 9

What are the symptoms of Aortic regurgitation?

Answer 9

asymptomatic for many years, most common initial symptoms is exertional dyspnoea or reduced exercise tolerance

Question 10

What changes does aortic regurgitation cause to the heart?

Answer 10

causes LV dilatation and the HF

Question 11

What are the causes of aortic regurgitation?

Answer 11

Idiopathic dilatation of the aorta, congenital abnormalities of the aortic valve, calcify degeneration, rheumatic disease, infective endocarditis and marfans syndrome

Question 12

Where is the murmur of aortic regurgitation best heard?

Answer 12

left sternal edge

Question 13

What are the features of the murmur of aortic regurgitations?

Answer 13

early diastolic blowing murmur with a collapsing pulse and head bobbing

Question 14

How is aortic regurgitation assessed?

Answer 14

Echocardiogram

Question 15

What are the indications for surgery in aortic regurgitation?

Answer 15

symptomatic AR, evidence of LV systolic dysfunction, aortic root dilatation

Question 16

What are the symptoms of mitral regurgitation?

Answer 16

asymptomatic for years,

Question 17

What are the causes of mitral regurgitation?

Answer 17

Marfans syndrome, pectus excavatum, Rheumatic heart disease, IHD, infective endocarditis, collagen vascular disease,

Question 18

What is the murmur of mitral regurgitation?

Answer 18

pan systolic blowing murmur best heard in the mitral area and radiates to the axilla

Question 19

How is mitral regurgitation assessed?

Answer 19

echocardiography

Question 20

What are the indications for surgery for mitral regurgitation?

Answer 20

symptomatic or mild moderate LV dysfunction

Question 21

What is the surgical intervention for mitral regurgitation?

Answer 21

mitral valve replacement or repair

Question 22

What is the pharmacological treatment for mitral regurgitation?

Answer 22

Diuretics and if functional r ischaemic MR then ACEi can be beneficial, if LV systolic dysfunction then Beta blockers AD cut can be helpful

Question 23

What can predispose to infective endocarditis?

Answer 23

mitral valve prolapse, prosthetic materials like valves and patches, thematic heart disease, degenerative and biscupid aortic valve disease, CHD

Question 24

What is the most common organism in infective endocarditis?

Answer 24

Virigans group streptococci and then staphlococcus aureus (IV drug users and up to a year after implants) enterococcal (GU or lower GI tract disease) fungi,

Question 25

How can infective endocarditis cause mortality?

Answer 25

heart failure, CNS emboli or uncontrolled infection

Question 26

What are the symptoms of infective endocarditis?

Answer 26

fever, bacetaemia or systemic illness, new murmur

Question 27

What investigations should be done for infective endocarditis?

Answer 27

FBC, ESR, CRP, U&E, LFTs, Urien dip and MSU, CXR, ECG, diagnostic- Blood cultures and echocardiogram

Question 28

How many blood cultures should be taken in infective endocarditis?

Answer 28

at least 3 and preferably 6 from different sites over several hours

Question 29

What type of echocardiograms are there?

Answer 29

Transthoarcic echocardiogram (65% of vegetations) and transoesophageal echocardiogram (will show 95% of vegetations)

Question 30

What is the diagnostic criteria for infective endocarditis?

Answer 30

Major- postitive blood cultures, Endocardial involvement, positive echo findings, new valvular regurgitation, dehiscence of prothesis
Minor- predisposing valvular or cardiac abnormality, IV drug user, pyrexia, embolic or vasculitic phenomonem, blood cultures and echo findings suggestive

Question 31

What is the management for infective endocarditis?

Answer 31

antibiotic therapy

Question 32

How is response to therapy checked in infective endocarditis?

Answer 32

ECHO once weekly and an ECG twice a week and blood tests twice weekly

Question 33

When should referral for surgery be done in patients with infective endocarditis?

Answer 33

Cardiac failure due to valve compromise, valve dehiscence, uncontrolled infection despite appropriate antibiotics, relapse after optimal medical therapy, threatened or actual systemic embolism, coxiella burnetii and fungal infections, paravalvular infection, sinus of valsalva aneurysm, valve obstruction

Question 34

What can uncorrected valvular heart disease lead to?

Answer 34

irreversible ventricular dysfunction and or pulmonary hypertension