Valvular Heart Disease- Systolic murmurs

Question 1

Aortic Stenosis

epidemiology?

Answer 1

most common valve disease

Question 2

Aortic Stenosis

pathophysiology?

Answer 2

LV outflow obstruction–>LV hypertrophy & reduced stroke volume

hypertrophy –> increased oxygen demand

Question 3

Aortic Stenosis

causes?

Answer 3

• congenital bicuspid aortic valve
• idiopathic age related calcification
• rheumatic heart disease

Question 4

Aortic Stenosis

symptoms?

Answer 4

• SOB
• Angina
• syncope (esp on exertion)

Question 5

Aortic Stenosis

signs?

Answer 5

• pulse
  
  • narrow pulse pressure
  • slow rising pulse
• heart
  
  • aortic thrill
• murmur
  
  • ejection systolic, high pitched murmur
  • crescendo-decrescendo
  • heard over aortic valve area & radiates to carotids

Question 6

Aortic Stenosis

Ix?

Answer 6

• Echo–> GOLD STANDARD; confirms diagnosis
  
  • severe AS: pressure gradient >40mmHg/ aortic orifice <1cm²
• ECG–> LVH
• CXR
  
  • post stenotic dilatation of ascending aorta
  • may see calcification of valve on lateral view
  • LV enlargement
• Cardiac catheterisation
  
  • can assess valve gradient & LV function
  • assess coronaries in pts planned for surgery

Question 7

Aortic Stenosis

Mx?

Answer 7

• Conservative
  
  • manage CV risk factors
• Medical
  
  • treatment aimed at symptoms/managing risk factors
• Surgical
  
  • valve replacement - treatment of choice
    
    • mechanical valve- last longer but require anti-coagulation
    • bio-prosthetic - fail sooner (10-15years)

Question 8

complications of aortic stenosis?

Answer 8

• sudden death
• arrhythmia
• HF
• IE

Question 9

Mitral Regurgitation

pathophysiology?

Answer 9

incompetent mitral valve allows blood to leak back through during systolic contraction of LV:

reduced CO

increase in volume of LA & LV –> eccentric hypertrophy of both chambers

Question 10

Mitral Regurgitation

causes?

Answer 10

• mitral valve prolapse
• idiopathic weakening of valve with age
• rheumatic heart disease
• IHD
• IE
• connective tissue disorders
  
  • marfan’s
  • ehlers danlos syndrome
• Post MI- papillary muscle rupture/dysfunction
• LV dilatation

Question 11

Mitral Regurgitation

symptoms?

Answer 11

• SOB
• orthopnoea
• fatigue
• HF

Question 12

Mitral Regurgitation

signs?

Answer 12

• Heart
  
  • displaced apex beat (due to eccentric hypertrophy)
  • apical thrill
  • left parasternal heave (RVH)
    
    • pul congestion –> HTN+ pul oedema
• Murmur
  
  • harsh pansystolic murmur
    
    • high pitched whistling murmur
  • radiates to axilla

Question 13

Mitral Regurgitation

Ix?

Answer 13

• Echo- confirm diagnosis
• ECG
  
  • LA enlargement / LVH
• CXR
  
  • LA&LV hypertrophy
• Cardiac catheterisation
  
  • confirm diagnosis / assess CAD

Question 14

what would be seen in LA enlargement on ECG?

Answer 14

bifid P waves- P mitrale

Question 15

Mitral Regurgitation

Mx

Answer 15

• conservative
  
  • aimed at risk factors
• Medical
  
  • aimed at symptoms
• surgical
  
  • mitral valve repair preferred to replacement

Question 16

Mitral Regurgitation

Complications?

Answer 16

• HF
• AF
• IE
• PHT