Valvular Stenosis and Regurgitation

Question 1

What is valvular stenosis?

Answer 1

Narrowing of the valve due to thickening and calcification = restricting movement

Question 2

What is valvular regurgitation?

Answer 2

Backflow of blood through valve (due to not closing properly) = leak

Question 3

Symptoms of aortic regurgitation?

Answer 3

• exertional dyspnoea
• reduction in exercise tolerance

Question 4

Causes of aortic regurgitation?

Answer 4

• bicuspid aortic valve
• calcification
• infective endocarditis
• Marfan syndrome

Question 5

What can aortic regurgitation cause? How can this be treated?

Answer 5

The increase in LV load, can cause LV dilatation and ultimately HF (systolic dysfunction).
- afterload reduction with ACE inhibitors can slow rate of LV dilatation

Question 6

Symptoms of aortic stenosis?

Answer 6

• angina
  -HF
• syncope
• decrease in exercise tolerance
• dysnpnoea on exertion

Question 7

What can aortic stenosis be caused by? And what can it lead to + treatments?

Answer 7

-congenital bicuspid aortic valve , chronic kidney disease
- can lead to LV systolic dysfunction
- in older patients, TAVI (trans-catheter aortic valve implantation) should be considered

Question 8

Can regurgitation occur on its own?

Answer 8

No, it is secondary to valvular disease and both permit backflow of blood

Question 9

What happens during normal systole an diastole?

Answer 9

In systole
- Mitral and tricuspid valves are closed, due to the high pressure in ventricles.
- Aortic and pulmonary valves open to allow blood to flow into pulmonary vein and aorta.

In diastole
- Mitral and tricuspid valves are open to allow ventricular filling
- aortic and pulmonary valves are closed

Question 10

Causes of mitral regurgitation?

Answer 10

• rheumatic HD
• IHD
• infective endocarditis
• collagen vascular disease

Question 11

What can mitral regurgitation lead to + treatment options

Answer 11

• patients with MR may be asymptomatic for many years, most will only have mild disease and will unlikely need surgical intervention
• it can cause LV dysfunction and hypertrophy
• surgical options include MV replacement or repair and medical therapy involves diuretics

Question 12

What can mitral regurgitation show on an ECG?

Answer 12

• arrhythmias
• atrial enlargement
• AF
• LVH/RVH
• LBBB or RBBB