Valvular Heart Disease Questions and Answers
what is stenosis? Answer decrease area of orifice which causes the heart to work
harder to move blood
what is regurgitation? Answer incompetent valve allows blood to backflow which
causes the heart to work harder
what is mitral stenosis? Answer obstruction of blood flow across this valve causes
increased pressure in left atrium & pulmonary vasculature & right ventricle if severe
what is the MCC of mitral stenosis? Answer rheumatic heart disease
what is rheumatic heart disease? Answer rheumatic fever produces rigidity and
deformity of valve cusps, fusion of commissures, or shortening of fusion of chordae
tendineae --> valvular stenosis and/or regurgitation
what are the symptoms of mitral stenosis? Answer dyspnea on exertion --> dyspnea
at rest
hemoptysis from abrupt elevation in PA pressure, cough, or pulmonary edema
CP
how does mitral stenosis appear on exam? Answer usually normal, subtle murmur
may have JVD, edema, ascites
lungs with crackles
RV heave
mitral facies (malar rash)
mitral facies Answer
what is heard on auscultation of mitral stenosis? Answer opening snap
low-pitched diastolic rumble best heard at apex w/ patient in left lateral decubitus
how is mitral stenosis diagnosed? Answer p mitrale in EKG
"double density" heart on CXR (LA border extends beyond cardiac silhouette)
valve leaflet thickening on ECHO
how is mitral stenosis treated? Answer secondary rheumatic fever prevention
medical management
balloon valvuloplasty
valve replacement surgery
what medications can be used to treat mitral stenosis? Answer loop diuretics
salt restriction
beta blockers
, management of a fib if present
what is mitral regurgitation? Answer backflow of blood from LV to LA
what causes primary MR? Answer mitral valve prolapse (MVP) MCC
rheumatic disease
endocarditis
what causes secondary MR? Answer ischemic heart disease
cardiomyopaties
what is physiologic MR? Answer mild, found in up to 70% of adults
what are sx of MR? Answer asx unless severe
LA enlargement -> pulm HTN & dyspnea
exertional dyspnea
a fib
what is seen on exam for MR? Answer apical impulse displaced laterally due to LV
enlargement
palpable thrill
what is heard on auscultation for MR? Answer holosystolic murmur that may radiate
to axilla
how is MR diagnosed? Answer EKG may show LA enlargement & p mitrale
cardiac catheterization recommended to evaluate for CAD
CXR may show cardiomegaly from LV enlargement
ECHO shows regurgitation
how is primary MR treated? Answer mitral valve repair/replacement
how is secondary MR treated? Answer can attempt mitral valve repair/replacement
need emergent surgical repair if acute
what is mitral valve prolapse? Answer floppy valve
can occur with or without MR
who is MVP seen in? Answer young females with pectus excavatum or scoliosis
what is heard on auscultation for MVP? Answer midsystolic ejection click
how is MVP treated? Answer follow up, many never need tx
can do MV repair if regurg severe enough
what is aortic stenosis? Answer left ventricular outflow obstruction
what is stenosis? Answer decrease area of orifice which causes the heart to work
harder to move blood
what is regurgitation? Answer incompetent valve allows blood to backflow which
causes the heart to work harder
what is mitral stenosis? Answer obstruction of blood flow across this valve causes
increased pressure in left atrium & pulmonary vasculature & right ventricle if severe
what is the MCC of mitral stenosis? Answer rheumatic heart disease
what is rheumatic heart disease? Answer rheumatic fever produces rigidity and
deformity of valve cusps, fusion of commissures, or shortening of fusion of chordae
tendineae --> valvular stenosis and/or regurgitation
what are the symptoms of mitral stenosis? Answer dyspnea on exertion --> dyspnea
at rest
hemoptysis from abrupt elevation in PA pressure, cough, or pulmonary edema
CP
how does mitral stenosis appear on exam? Answer usually normal, subtle murmur
may have JVD, edema, ascites
lungs with crackles
RV heave
mitral facies (malar rash)
mitral facies Answer
what is heard on auscultation of mitral stenosis? Answer opening snap
low-pitched diastolic rumble best heard at apex w/ patient in left lateral decubitus
how is mitral stenosis diagnosed? Answer p mitrale in EKG
"double density" heart on CXR (LA border extends beyond cardiac silhouette)
valve leaflet thickening on ECHO
how is mitral stenosis treated? Answer secondary rheumatic fever prevention
medical management
balloon valvuloplasty
valve replacement surgery
what medications can be used to treat mitral stenosis? Answer loop diuretics
salt restriction
beta blockers
, management of a fib if present
what is mitral regurgitation? Answer backflow of blood from LV to LA
what causes primary MR? Answer mitral valve prolapse (MVP) MCC
rheumatic disease
endocarditis
what causes secondary MR? Answer ischemic heart disease
cardiomyopaties
what is physiologic MR? Answer mild, found in up to 70% of adults
what are sx of MR? Answer asx unless severe
LA enlargement -> pulm HTN & dyspnea
exertional dyspnea
a fib
what is seen on exam for MR? Answer apical impulse displaced laterally due to LV
enlargement
palpable thrill
what is heard on auscultation for MR? Answer holosystolic murmur that may radiate
to axilla
how is MR diagnosed? Answer EKG may show LA enlargement & p mitrale
cardiac catheterization recommended to evaluate for CAD
CXR may show cardiomegaly from LV enlargement
ECHO shows regurgitation
how is primary MR treated? Answer mitral valve repair/replacement
how is secondary MR treated? Answer can attempt mitral valve repair/replacement
need emergent surgical repair if acute
what is mitral valve prolapse? Answer floppy valve
can occur with or without MR
who is MVP seen in? Answer young females with pectus excavatum or scoliosis
what is heard on auscultation for MVP? Answer midsystolic ejection click
how is MVP treated? Answer follow up, many never need tx
can do MV repair if regurg severe enough
what is aortic stenosis? Answer left ventricular outflow obstruction
