VALVULAR HEART DISEASE.
BY
DR GHULAM HUSSAIN.MBBS,
Diploma in Cardiology,MD (Medicine)
Assistant Professor of Medicine Medical Unit-4
LUMHS, Jamshoro / Hyderabad
AORTIC STENOSIS.
Etiology
a. Congenital aortic stenosis
b. Senile calcific stenosis
c. Bicuspid aortic valve
d. Rheumatic aortic stenosis
PATHOPHYSIOLOGY. Aortic valve stenosis produces a pressure over load on the left ventricle due to the greater pressure that must be generated to force blood past the stenotic valve .a. Obstruction to out flow causes pressure over load
and left ventricle hypertrophyb. Hypertrophy increases thick ness of left ventricle .
Clinical Features Symptoms
1. Asymptomatic patients are little risk of death.
2. Angina
3. Syncope
4. Heart Failure
Physical Signs
1. Delayed Carotid Upstroke 2. Systolic Ejection Murmur3. Soft, Single S24. S45. Sustained, heaving apex beat
Laboratory Diagnosis
1. Electrocardiography The ECG usually shows evidence of left ventricular hypertrophy.
2. Echocardiography
3. Cardiac Catheterization
Therapy
a. Palliative Therapy- Medical Therapy
b. Curative Therapy
- Homograft Valves
- Heterograft Vales
- Mechanical Valves
- Autograft (Ross Procedure)
Aortic Regurgitation
Etiologya. Idiopathic aortic root dilatation b. Rheumatic Heart Disease c. Infective Endocarditis d. Marfan Syndrome - Proximal root dilatation - Aortic root dissection e. Aortic Dissection F. Syphilis G. Collagen Vascular disease
Pathophysiology
a. A portion of the left ventricular stroke volumeejected during systole regurgitation into the leftventricular during diastole. b. The increase in total stroke volume leads toincrease in pulse pressure and increase insystolic pressure.
Clinical Features a. Symptoms 1. Left Ventricular Failure a. Chronic Aortic Insufficiency b. Acute Aortic Insufficiency
2. Syncope
3. Angina
Clinical Features b. Physical Signs 1. Left Ventricular Impulse 2. Diastolic Murmur 3. Austin Flint Murmur 4. Total Stroke Volume
a. Corrigan’s Pulse b. Hill’s sign c. Pistol-shot femoral pulses d. Duroziez’s signe. De Musset’s sign f. Quincke’s pulse
Diagnosis 1. Electrocardiography The ECG usually shows
left ventricular hypertrophy. 2. Chest Radiography
3. Echocardiography
4. Cardiac Catheterization
Therapy
a. Aortic Valve replacement b. If surgery is not possible, therapy with digitlis,
diuretics and vasodilators may affoard symptomatic relief.
Mitral Stenosis
Etiology
Almost all cases of mitral stenosis in adult aresecondary to rheumatic heart disease. Most cases occur in women.
Pathophysiology1. Impedes left ventricular filling2. Increase left atrial pressure 3. Leads to pulmonary congestion 4. Pulmonary hypertension 5. Right Ventricular failure
Clinical Features
a. Symptoms 1. Left sided failure 2. Right Sided failure3. Hemoptysis 4. Systemic embolisim 5. Hoarseness
Clinical Features
b. Physical Signs 1. Atrial Fibrillation 2. Pulmonary rales 3. Increase intensity of the S14. Increase intensity of the P25. Opening Snap6. Diastolic rumble 7. Sternal lift 8. Other symptoms
Laboratory Diagnosis
a. Electrocardiographyb. Chest Radiography c. Echocardiography
Therapy a. Medical Therapy
- Diuretics- Digitalis - Anticoagulants
b. Balloon Valvuloplasty
c. Surgical Therapy 1. Mitral Commissurotomy 2. Mitral Valve Replacement
Mitral Regurgitation
Mitral Regurgitation
Etiologya. Rheumatic Heart Disease b. Ruptured Chordae Tendineae c. Coronary Artery Disease d. Infective Endocarditis e. Mitral Valve prolaps and click syndrome
murmur
Pathophysiology
Increase left atrial pressure and decrease forward cardiac output.
Clinical Features
a. Symptoms - Dypnea or Thopnea - Paroxysmal nocturnal dyspnea - Pulmonary hypertension and symptoms of
right sided failure - Symptoms of systemic embolization
Clinical Features b. Physical Sign- Left ventricular impulse - Murmur - An S3 usually heard in mitral regurgitation
and may occur even in the absence of overt heart failure.
Diagnosis
- Electrocardiography
- Chest Radiography
- Echocardiography
- Cardiac Catheterization
Therapy a. Medical Treatment
- Diuretics- Digitalis - Anticoagulants - Vesodilators
b. Surgical Treatment 1. Valve Replacement 2. Valve Repair
Tricuspid Regurgitation
Etiology a. Infective endocarditis
b. Right ventricular failure
c. Rehumatic heart disease
Pathophysiology
During systole, the dysfunctioning tricuspid valve allows blood to flow backward into the rightatrium, leading to systemic venous congestion and venous congestion and venous hypertension.
Clinical Features
a. Symptoms- Edema - Ascites - Hepatic Congestion - Right Upper Quadrant Pain - Jaundice
Clinical Features
b. Physical Signs- Right ventricle Lift - Murmur - Jugular Venus Pulsation - Pulsatile Liver
Diagnosis
- Chest Radiography - Echocardiography
Therapy
1. Reduced the right ventricular pressure2. Surgical Repair 3. Replacement of Tricuspid valve