C14 Valvular Heart Disease

Front 1

Incidence of valvular heart disease increases with

Back 1

advancing age

Front 2

Patients feel breathless because

Back 2

increased left atrial pressure causes pulmonary congestion and lungs become stiff/non-compliant

Front 3

Symptoms of increased LA pressure/LV strain:

Back 3

breathless + angina on exertion, symptoms of HF, palpitations

Front 4

What clinical signs would you expect?

Back 4

cardiac murmurs(!)/thrills, HF signs (JVP, basal insp crackles, peripheral oedema), heave, apex displacement

Front 5

An ejection vs pansystolic murmur points towards...

Back 5

Ejection = pulmonary or aortic; Pan = tricuspid or mitral

Front 6

Where can murmurs radiate to?

Back 6

carotid or axilla

Front 7

Intensity can be graded. What grade is moderately loud?

Back 7

Grade 3

Front 8

A flow murmur is

Back 8

benign, soft systolic over pulmonary valve, no radiation, no other signs of cardiac disease

Front 9

A bell is useful to listen to low pitch sounds, such as

Back 9

mitral stenosis

Front 10

What would a high speed doppler be suggestive of?

Back 10

stenosis (high speed going through narrowing)

Front 11

Aortic valve disease is common in people with

Back 11

bicuspid valve

Front 12

AORTIC STENOSIS

Back 12

(calcific deposits on aortic valve)

Front 13

The most common cause of A. stenosis is

Back 13

degenerative calcific stenosis of normal valve presenting in 7th decade (risk factor = atherosclerosis)

Front 14

The second most common cause of A. stenosis is

Back 14

degenerative calcific stenosis of bicuspid valve presenting in 5th/6th decade (+ aortic root/asc. aorta dilatation)

Front 15

Another less common cause of A. stenosis is

Back 15

rheumatic stenosis (+ mitral valve stenosis)

Front 16

Symptoms of A. stenosis (3)

Back 16

dyspnoea, syncope, angina

Front 17

A. stenosis murmur findings:

Back 17

ejection systolic, crescendo-decrescendo, aortic valve area, radiation to carotids

Front 18

Progression of A. stenosis: normal Vmax <1m/s... severe Vmax = ?

Back 18

normal <1m/s; mild <3m/s; moderate <4m/s; severe >4m/s

Front 19

When should you treat A. stenosis?

Back 19

at the onset of symptoms (angina, syncope, failure)

Front 20

Aortic sclerosis is when some valves have calcific change and generate a typical

Back 20

stenotic murmur but no gradient

Front 21

Time taken for aortic sclerosis to progress to severe A. stenosis is

Back 21

~8years

Front 22

What is the prognosis of A. stenosis without valve replacement?

Back 22

extremely poor vs very good

Front 23

AORTIC REGURGITATION

Back 23

(leaky aortic valve)

Front 24

Aortic regurgitation has 2 underlying causes:

Back 24

leaflet pathology and root dilatation

Front 25

Aortic leaf pathology can be due to

Back 25

bicuspid aortic valve; endocarditis; rheumatic valve disease; vasculitis; dopamine agonists

Front 26

Aortic root dilatation can be due to

Back 26

idiopathic; HTN; aortic dissection; Marfan's; syphilis

Front 27

A. regurg murmur findings:

Back 27

early diastolic, quiet grade 2 murmur

Front 28

A. regurg clinical findings:

Back 28

LV dilatation -> apex displacement; wide pulse pressure and collapsing; visible nail bed pulsation (Quincke's); pistol shot sound when femoral a. is compressed (Duroziez's)

Front 29

What is Quincke's sign?

Back 29

visible nail bed pulsation

Front 30

What is Duroziez's sign?

Back 30

pistol shot when fem. a. compressed

Front 31

What is de Musset's sign?

Back 31

head nodding in time with heart beat

Front 32

Who with a. regurg. should be considered for valve replacement?

Back 32

symptomatic or asymptomatic with LV dilatation/systolic impairment

Front 33

MITRAL REGURGITATION

Back 33

(leaky mitral valve)

Front 34

Underlying causes include

Back 34

LV impairment dilatation (post MI, cardiomyopathy); Valve leaflet disease (endocarditis, rheumatic heart disease, papillary muscle rupture)

Front 35

M. regurg causes

Back 35

LA dilatation -> AF and elevated pulmonary pressures

Front 36

M. regurg murmur findings:

Back 36

pansystolic murmur, loud at LLSE, may radiate to axilla, structural leaflet disease (e.g. mitral prolapse) louder

Front 37

M regurg clinical findings:

Back 37

apex displacement, AF, elevated JVP, signs of HF

Front 38

MR: Type 1 dilated annulus is when

Back 38

the leaflets don't properly shut closed

Front 39

MR: Type 2 rupture/prolapse is when

Back 39

the chordae tendinae breaks and flap goes back into atrium

Front 40

MR: Type 3a/b (rheumatic/ischaemic) is when

Back 40

flaps are inflammed/papilla weak

Front 41

Treatment of severe m. regurg: surgery indicated if

Back 41

symptoms of HF; LV dilatation/impairment of LV Fx; valve suitable for repair

Front 42

MITRAL STENOSIS

Back 42

(calcific changes on mitral valve -> stiff)

Front 43

M. stenosis is most common valvular manifestation of

Back 43

rheumatic heart disease

Front 44

What is the Duckett-Jones criteria for Acute Rheumatic Fever?

Back 44

MAJOR: carditis, arthritis, chorea, erythema marginatum, SC nodules; MINOR: arthralgia, fever, ESR, CRP, prolonged PR [2 major or 1 major + 2 minor]

Front 45

What organism causes rheumatic fever?

Back 45

strep Group A

Front 46

What gradient in m. stenosis is unusual?

Back 46

high gradient between LA and LV

Front 47

M. stenosis causes elevated pulmonary pressures and

Back 47

LA dilatation -> AF

Front 48

M. stenosis murmur findings:

Back 48

quiet mid diastolic, low pitch rumbling

Front 49

M. stenosis clinical finidngs:

Back 49

pulmonary HTN signs (loud P2, elevated JVP, mitral facies, RV heave), AF

Front 50

Treatment for M. stenosis includes

Back 50

balloon valvuloplasty or mitral valve replacement

Front 51

NEW TREATMENTS OF VALVE DISEASE:

Back 51

self-expanding multi-level support frame, mitral annuloplasty, Alfieri mitraclip