Rheumatic heart disease Mitral stenosis. Valvular heart disease Rheumatic Age related congenital

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  • Rheumatic heart diseaseMitral stenosis

  • Valvular heart diseaseRheumatic Age related congenital

  • Mitral valve StenosisRegurgitation Prolapse

  • Mitral stenosis 2/3 females Usually rheumaticRarely congenital 40% of all RHD

  • Structural defects Diffusely thickened fibrous tissue /calcified deposits Mitral commisures fuse Corde tendinae fuse /shortenNarrowing of the apex of funnel shaped valves

  • Calcification of slender valves immobilises the leaflet and narrows the orifice thrombus formation arterial thrombus from calcified Valves

  • Pathophysiology Normal mv dia -4-6 cm2
  • Increased Lap --------increased pulm pressure ------increased capillary pressure -----decreased pulm compliance -------exertional dyspnoea.

    Increased heart rate decreased transvalvular gradient ----increased LAPLv diastolic pressure in normal in msCo is normal at rest ---at exercise decreased co.

  • $Clinical /hemodynamic Features influenced byPassive backward transmission of LAPPulmonary arteriolar constrictionIntertitial edemaOrganic obliterative changes in the pul vascular bed Phtn----Tr------rt sided failures---bornheimeffect

  • symptomsCarditis---ms-----2 decades,Dyspnoea on exertion ----4 th decadeprogressive worsening to death---2-5 yrsDoe ,orthopnoea ,pnd,arrthmia-premature atraial complex,paroxysysmal tachycardia,flutter,fibrilationHaemoptysis increased pulm venous pressure

  • Recurrant pulm embolismPulm infectionEndocarditisChest pain -10%Thrombus formation in the left atrium-afappendages of LAPedunculated thrombus ball valve thrombi-syncope-angina changing ascultatory signs

  • On examination Malar flush-pinched blue faciesJVP-a wave prominence af a wave absentPalpation-tapping apical impulse ,s1 loud,palpable ,s2 p2 loudDiastolic thrillAuscultation-s1 accentuated /snapping delayed mv doesnt close till LVP>LAPQs prolongation ,p2 loud

  • A2-p2-os -0.05-0.12P2-os severity of msIntensity of s1/os pliability of leAFLETMDM after os Duration correlates with ms severityS1-closure of mitral /tricuspid valve

  • Intensity of s1Pos of mv at onset of vent systole Rate of increase in LAPDegree of structural damage of the valve Amt of tissue bet heart and sthetoscope

  • S1 loud diastole is shortened by tachycardia S1 split -10-30 msecS1 m1t1-----prolonged in rbbb t1m1 severe ms ,left atrial myoma lbbb

  • Mitrl regurgitation

  • etiologyChronic rhd severe mr- 1/3Seen in males mostlyRheumatic process-rigidity,deformity,retraction of the valve cusps-commisural fusion Congenital-endocardial cushion defectsFibrosis of papillary muscles in MIIscheamia paplillary dysfn

  • Lv dilated in DCMHOCM-ant displace ment of the ant leafletMitral prolapse MRAcute MR-inf endocarditis

  • pathophysiologyClinical pic depends on p-v relation ship of LA AND PUL -VENOUS BED Increased LAP-Increased pulm edema Effective forward pressure of lv decreasesInc-LA volume due to atrial compliance Low cardiac out put Atrial fibrillation

  • SYMPTOMSFATIGUEDoeOrthopneaPndHaemoptysisSys embolismRh f-jvp inc,tr,phtn,hep congestion

  • Physical examinationSys thrill-left apexHyperdynmic apical impulseLaterally displacedPalpable p2Parasternal heave

  • auscultationS1-absent/softor buried in systolic murmurDecreased co-aorta closes early-a2 early-wide spliting of s2Os indicates ms Gallop rhythm Pansystolic murmur

  • labEcg sinus rhythm ,prominent p waves ,af lvhEchoCxr-kerley b lines

  • managementMedicalDec exertion Dec NA intake Diuretics Digitalis/vasodilators-inc coAce inhibitors /hydralazineSurgical-valve replacement