Download VALVULAR HEART DISEASE

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 hypertrophy
b. 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.
2.
3.
4.
5.
Delayed Carotid Upstroke
Systolic Ejection Murmur
Soft, Single S2
S4
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
Etiology
a.
b.
c.
d.
e.
F.
G.
Idiopathic aortic root dilatation
Rheumatic Heart Disease
Infective Endocarditis
Marfan Syndrome
Proximal root dilatation
Aortic root dissection
Aortic Dissection
Syphilis
Collagen Vascular disease
Pathophysiology
a. A portion of the left ventricular stroke volume
ejected during systole regurgitation into the left
ventricular during diastole.
b. The increase in total stroke volume leads to
increase in pulse pressure and increase in
systolic 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 sign
e. 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 are
secondary to rheumatic heart disease.
Most cases occur in women.
Pathophysiology
1. Impedes left ventricular filling
2. 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 failure
3. Hemoptysis
4. Systemic embolisim
5. Hoarseness
Clinical Features
b. Physical Signs
1. Atrial Fibrillation
2. Pulmonary rales
3. Increase intensity of the S1
4. Increase intensity of the P2
5. Opening Snap
6. Diastolic rumble
7. Sternal lift
8. Other symptoms
Laboratory Diagnosis
a. Electrocardiography
b. 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
Etiology
a. 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 right
atrium, 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 pressure
2. Surgical Repair
3. Replacement of Tricuspid valve