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Valvular Heart Disease

This document summarizes various types of valvular heart disease including causes, symptoms, signs, and management. Mitral stenosis is most commonly caused by rheumatic fever and presents with palpitations, shortness of breath, and thromboembolic events. Examination may reveal an irregular pulse, murmurs, and elevated jugular venous pressure. Echocardiogram is used to confirm the diagnosis. Treatment involves managing heart failure, anticoagulation, and valve procedures. Valvular diseases can lead to complications like heart failure and atrial fibrillation due to impacts on cardiac chambers and pressures. Physical exam findings vary depending on whether stenosis or regurgitation impacts pressure or volume load on the heart.

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Shafiq Zahari
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147 views6 pages

Valvular Heart Disease

This document summarizes various types of valvular heart disease including causes, symptoms, signs, and management. Mitral stenosis is most commonly caused by rheumatic fever and presents with palpitations, shortness of breath, and thromboembolic events. Examination may reveal an irregular pulse, murmurs, and elevated jugular venous pressure. Echocardiogram is used to confirm the diagnosis. Treatment involves managing heart failure, anticoagulation, and valve procedures. Valvular diseases can lead to complications like heart failure and atrial fibrillation due to impacts on cardiac chambers and pressures. Physical exam findings vary depending on whether stenosis or regurgitation impacts pressure or volume load on the heart.

Uploaded by

Shafiq Zahari
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Valvular Heart Disease

 Mitral, Tricuspid, Aortic, Pulmonary


 AS, AR, MS, MR

Mitral Stenosis
Causes
 Chronic Rheumatic Heart Disease (99% cause)
 Age >70 – Degenerative valvular heart disease
 History of – joint pain, sore throat (5-15 years old),

Symptoms
 Palpitation (arrhythmia)
 Shortness of breath (Dyspnoea on exertion, PND, Orthopnoea)
 Poor effort tolerance (due to HF, Pulmonary HTN)
 Stroke, TIA, Ischemic Limb, Gangrene – Thromboembolism
 Pink frothy sputum

Signs
 Young age – CRHD
 Old Age – Fibrosis
 Features of stroke
 Amputation of leg
 Low volume pulse
 Atrial Fibrillation (irregularly irregular)
 BP – normal unless with comorbid HTN
 JVP – not raised, Elevated in CCF
 Loss of ??? wave
 Malar flush
 Bilateral pitting oedema
 Tachypnoea
 Epigastric pulsation – RVH
 Left Lower Parasternal heaves – RVH
 Apex Beat (not displaced) – tapping character (palpable S1)
 Thrills on mitral (Grade 4)
 Palpable P2 – Pulmonary HTN
 Loud P2 – Pulmonary HTN
 Heart Sound – Loud S1
 Added Sound – Mid Diastolic murmur (there is a murmur I heard more marked in the
mitral area which is mid diastolic murmur of Grade 3/4 and heard more with left
lateral on expiration), Opening Snap (Absent of snap indicates calcified)
 Bibasal Crepitation - Pulmonary oedema (HF)
Differential Diagnosis
 Triscupid Stenosis
 Atrial Myxoma

Investigation
 ECG – Normal, AF (narrow complex tachycardia, irregularly irregular, loss P waves), P
Mitrale/Broad Bifid P, Tall R in V1, V2 - RVH
 CXR – Pulmonary Oedema (ground glass appearance), Straightening of Left, Double
Shadow in LA dilatation, widening of angle of carina, Calcified valve.
 Echocardiogram with Doppler (confirmatory) – LA dilatation, LA thrombus,
Pulmonary HTN, Heart Failure
 Cardiac Catheterization – measure pressure in chamber

Management
 Avoid vigorous exercise
 Avoid fluid and salt rich food
 Prophylaxis against rheumatic fever
 No need IE Prophylaxis to be given
 Heart failure treatment – Diuretic, ACE Inhibitor
 Anti Coagulant based on CHADSVAS Score
 Valvotomy/Valvuloplasty –
 Valve Replacement –

Complication
 Heart Failure
 Atrial Fibrillation
 Thromboembolic Episodes

Mitral Regurgitation

Causes
 Acute – MI, IE, Chest Trauma, Chest Surgery, Cardiac Intervention
 Chronic – CRHD, Autoimmune(RA, SLE, Ankylosing Spondyliosis), Marfan Syndrome

Symptoms
 Same as Mitral Stenosis
 Both LV and LA on pressure, LA>LV

Signs
 Pulse – normal, Irregularly Irregular (AF)
 JVP – Same as MS
 BP – same as MS
 Inspection – visible apex beat
 Palpation – displace apex beat, forceful ill sustained, thrill (more common in systolic
murmur)
 Auscultation – normal or soft heart sound, loud S2 in Pulmonary HTN, Pansystolic
murmur more marked in mitral area, radiating to axilla, associated with thrill and
accentuated with expiration

Investigation
 ECG - LVH
 Echocardiogram – vegetation

Management
 Valve replacement

Aortic Stenosis

Causes
 Bicuspid aortic valve
 Chronic rheumatic heart disease
 Calcification or Firbrosis

Symptoms
 Angina Jolie


 Syncope
 Sudden cardiac death
 Palpitation
 Poor effort tolerance
 Fatigue

Signs
 Pulse – low volume pulse, AF(irregularly irregular)
 BP – Narrow pulse pressure (more narrow, more severe)
 JVP – normal, raised if CCF
 Inspection –
 Palpation – Displace outward, pressure heaving, thrills in aortic
 Auscultation – normal S1, soft S2 (HF), ESM at aortic area accentuated inspiration,
radiate to neck, bibasal fine crepitation (LVF)

Investigation
 ECG – LVH (findings)
 Echo with Doppler – cardiac chamber, vegetation,
 CXR – Pulmonary Oedema, Kerly B Line, Bat wing Appearance, cardiomegaly, upper
lobe diversion
 Cardiac Cathetherization – angiogram to rule out IHD, ejection fraction

Management
 Prophylaxis to IE
 Manage HF, Arrythmia
 1 episode of syncope – immediate surgery aortic valve replacement
 Anticoagulants

Aortic Regurgitation

Causes
 CRHD
 IC
 Autoimmune
 Marfan
 Carcinoid Syndrome
 Chest Trauma/Surgery

Symptoms
 Palpitation
 Poor effort tolerance
 Angina
 Syncope
 SCD
 HF

Signs
 Pulse – high volume collapsing pulse, AF (Irregularly irregular)
 BP – wide pulse pressure
 JVP –
 Inspection – hyperdynamic precordium, visible pulsation (apical)
 Palpation – displaced outward and downwards, thrusting, thrill in aortic
area(unusual)
 Auscultation – normal S1, soft in HF, normal S2, EDM accentuate on forward leaning
on inspiration at LLPS, bilateral fine crept, galloping rhythm (LVF)

Investigation
 ECG
 Echocardiogram with Doppler
 CXR
 Cardiac Cathetherization

Management
 IE Prophylaxis
 Valve Replacement
Summary

Causes
 Stenosis – CRHD, Degenerative Fibrosis (Calcification)
 Regurgitation – CRHD, IE, Autoimmune, Marfan, Cardiac Trauma / Surgery
 MR – Myocardial Infarction

Symptoms
 Palpitation
 Poor effort tolerance

Complication
 CCF – MR, MS ---Thromboembolism
 LVF – AS, MR, AR

Findings
 Pulse – AF in all cases
o MS – low volume
o MR – normal
o AS –
o AR – high volume pulse,
 BP –
o MS –
o MR –
o AS –
o AR –
 JVP
o Raised in CCF
o Loss of A waves – AF
 Condition on LV
o MS – no load
o MR – volume
o AS – Pressure
o AR – Volume
 Apex Beat
o Volume overload – outward, downward, thrusting (forceful ill-sustained)
o Pressure overload – outward, heaving (forceful well sustained)
o MS
o MR
o AS
o AR
 Heart Sound
o MS – normal s1, loud s2 in PHTN
o MR – normal s1 , loud s2 in phtn
o AS – normal s1 , soft s2 in hf
o AR – normal s1,s2
 Murmur
o MS – MDM
o MR – PSM
o AS – ESM
o AR – EDM
 Differential
o MS – TS, AR
o MR – TR, VSD
o AS – PS
o AR - PR

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