Valvular heart disease – pathophysiology, presentation and investigation

Question 1

What are the four common heart valve lesions?

Answer 1

1️⃣ Aortic Stenosis (AS)
2️⃣ Aortic Regurgitation (AR)
3️⃣ Mitral Stenosis (MS)
4️⃣ Mitral Regurgitation (MR)

Question 2

What is the pathophysiology of aortic stenosis (AS)?

Answer 2

Narrowing of the aortic valve → ↑ afterload → LV hypertrophy
↓ stroke volume & cardiac output
Compensatory LV hypertrophy → diastolic dysfunction

Question 3

What are the classic symptoms of aortic stenosis (AS)?

Answer 3

📌 “SAD” mnemonic:

Syncope
Angina
Dyspnoea (heart failure)

Question 4

What is the natural history of untreated aortic stenosis?

Answer 4

🩺 Long asymptomatic phase → Symptoms appear (SAD) → Rapid decline → Death if untreated

Question 5

What are the murmur characteristics of aortic stenosis (AS)?

Answer 5

🎵 Ejection systolic murmur
📍 Best heard: Right upper sternal border
📈 Crescendo-decrescendo
🩻 Radiates to carotids

Question 6

What are the causes of aortic regurgitation (AR)?

Answer 6

🦠 Infective endocarditis
💀 Rheumatic heart disease
📌 Bicuspid aortic valve
🩸 Aortic root dilation (e.g., Marfan’s, aortic dissection)

Question 7

What are the clinical signs of aortic regurgitation (AR)?

Answer 7

📌 Wide pulse pressure
🎵 Early diastolic murmur (blowing, decrescendo)
📍 Best heard: Left sternal border
🩺 “Water hammer pulse” (Corrigan’s pulse)

Question 8

What are the common causes of mitral stenosis (MS)?

Answer 8

1️⃣ Rheumatic heart disease (most common)
2️⃣ Congenital
3️⃣ Severe mitral annular calcification

Question 9

What is the classic murmur of mitral stenosis (MS)?

Answer 9

🎵 Mid-diastolic rumbling murmur
📍 Best heard: Apex
🔹 Loud opening snap

Question 10

What are the symptoms of mitral stenosis (MS)?

Answer 10

💨 Dyspnoea (pulmonary congestion)
🔄 Atrial fibrillation (LA dilation)
🩸 Haemoptysis

Question 11

What are the common causes of mitral regurgitation (MR)?

Answer 11

📌 Mitral valve prolapse
🦠 Infective endocarditis
💀 Rheumatic heart disease
💔 Papillary muscle infarction (post-MI)

Question 12

What is the classic murmur of mitral regurgitation (MR)?

Answer 12

🎵 Pansystolic murmur
📍 Best heard: Apex
🩻 Radiates to axilla

Question 13

What investigations are used for heart valve disease?

Answer 13

📌 Echocardiography (TTE/TEE) → Gold standard
📌 ECG → Detects AF or LVH
📌 Chest X-ray → Cardiomegaly, pulmonary congestion
📌 Cardiac MRI → Structural assessment
📌 Cardiac catheterization → Severity & coronary artery disease

Question 14

What are the treatment options for heart valve disease?

Answer 14

🔹 Medical: Diuretics, Beta-blockers (for symptoms)
🔹 Surgical: Valve repair or replacement
🔹 Percutaneous: Transcatheter Aortic Valve Implantation (TAVI)

Question 15

Mnemonic for Heart Valve Murmurs

Answer 15

📌 “MR. ASS & MS. ARD”

Mitral Regurgitation = Apical Systolic Sound
Aortic Stenosis = Systolic murmur
Mitral Stenosis = Apical Rumbling Diastolic murmur
Aortic Regurgitation = Diastolic murmur