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Valvular Disorders
By
Megan Rice
Annie Halverson
Sara Sabelhaus
Michelle Chung
Rheumatic Fever…
• Rheumatic fever
– an inflammatory disease of the heart
involving all layers
• Rheumatic heart disease
– Chronic condition resulting from rheumatic
fever characterized by scarring and
deformity of heart valves
Rheumatic Fever…
• Acute Rheumatic Fever
– Manifests as an abnormal immunologic
response to group A Streptococcal
Pharyngitis cell membrane antigens
– ARF affects heart, joints, CNS, and skin
– Rheumatic endocarditis forms in the
valves: valve deformities!
Valve Review…
• Heart contains 2 AV valves:
– Mitral and Tricuspid
• 2 Semilunar valves
– Aortic and Pulmonic
• Valvular heart disease is defined
according to valves affected and type
of functional alteration
Valvular Disorders
Valvular Heart Disease
• Defects in structure or function of valves
intereferes with proper cardiac circulation:
– Stenosis: heart valve leaflets are constricted,
opening is narrow, stiff, unable to open and close
properly, impending forward flow of blood
– Regurgitation (insufficiency): improper or
incomplete closure of heart valves resulting in
backflow of blood
– Prolapse: leaflets of valve buckles back
Stenosis
Regurgitation
Prolapse
Mitral Valve Stenosis
• Scarring of valve leaflets and chordae
tendinae cause contractures and adhesions
between the commissures (junctional areas)
• A thickening and shortening of the valve
structure occurs
• These structural deformities create an
obstruction of blood flow and pressure
difference between the left atruim and left
ventricle during diastole.
Mitral Valve Stenosis
Mitral Valve Stenosis
Clinical Manifestations:
ºPrimary symptom is exertional dyspnea
due to reduced lung compliance.
ºFatigue
ºPalpitations from atrial fibrillation
Mitral Valve Stenosis
Mitral Stenosis Sound
ºHeart sounds: loud first heard sound and
a low-pitched, rumbling diastolic
murmer at the apex of the heart.
Mitral Valve Regurgitation
• Any defect in the following valve
structures: mitral leaflets, mitral
annulus, chordae tendinae, papillary
muscles, left atrium and left ventricle.
• Allows blood to flow backward from the
left ventricle to the left atrium due to
incomplete valve closure during systole.
Mitral Valve Regurgitation
Mitral Valve Regurgitation
Clinical Manifestations:
ºAcute MR: thready, peripheral pulses and cool,
clammy extremities.
ºChronic MR: May remain asymptomatic for
many years. Initial symptoms of left
ventricular failure may include weakness,
fatigue, palpitations, and dyspnea that
gradually progress to orthopnea, paroxysmal
nocturnal dyspnea, and peripheral edema.
Mitral Valve Regurgitation
Mitral Regurgitation Sound
ºHeart sounds: An audible third heard
sound (S3). The murmur is a loud holoor pansystolic murmur at the apex
radiating to the left axilla.
Mitral Valve Prolapse
• An abnormality of the valve leaflets and the
papillary muscles or chordae that allows the
leaflets to buckle back into the left atrium
during systole.
• Usually benign but serious complications
such as Mitral regurgitation, infective
endocarditis, Sudden cardiac death, and
cerebral ischemia can occur.
Mitral Valve Prolapse
Mitral Valve Prolapse
Clinical Manifestations:
ºMost patients are asymptomatic for life.
ºPossible chest pain accompanied by dyspnea,
palpitations, and syncope
ºDysrhythmias, most commonly premature
ventricular contractions, paroxysmal
supraventricular tachycardia, and ventricular
tachycardia, may case palpitations, lightheadedness, and dizziness.
Mitral Valve Prolapse
Mitral Prolapse Sound
ºHeart sounds: murmur from regurgitation
that gets more intense through systole.
This could be a late or holosystolic
murmur. Another major sign is one or
more clicks usually heard during midlate systole.
Aortic Valve Stenosis
• Causes obstruction of flow from the left
ventricle to the aorta during systole.
• The effect is ventricular hypertrophy and
increased myocardial oxygen consumption
due to increased myocardial mass.
• As the disease progresses, reduced CO
leads to pulmonary hypertension and HF.
• If aortic stenosis occurs from rheumatic heart
disease, mitral valve disease accompanies it.
Aortic Valve Stenosis
Aortic Valve Stenosis
ºDevelop once the valve orifice becomes
approximately 1/3 its normal size.
ºClassic triad of angina, syncope, and
exertional dyspnea (which reflect left
ventricular failure).
Aortic Valve Stenosis
Aortic Stenosis
ºHeart sounds: normal or soft S1,
diminished or absent S2, a systolic,
crescendo-decrescendo murmur that
ends before S2, and a prominent fourth
heart sound (S4)
Aortic Valve Regurgitation
• May be the result of primary disease of the
aortic valve leaflets or the aortic root.
• Causes a retrograde blood flow from the
ascending aorta into the left ventricle during
diastole, resulting in volume overload.
• At first, the left ventricle compensates by AR
dilation and hypertrophy. Eventually, the
contractility declines which results in
pulmonary hypertension and right ventricular
failure.
Aortic Valve Regurgitation
Aortic Valve Regurgitation
Clinical Manifestations:
ºSudden symptoms of cardiovascular collapse.
ºSevere dyspnea, chest pain, and hypotension
indicating left ventricular failure and shock
(medical emergency!).
ºIn Chronic, AR, there may be a “water-hammer
pulse”, which is a strong, quick beat that
collapses immediately.
Aortic Valve Regurgitation
Aortic Regurgitation Sound
ºHeart Sounds: May include a soft or
absent S1, presence of S3 or S4, and a
soft, decrescendo, high-pitched diastolic
murmur. A systolic ejection click and a
low-frequency diastolic murmur (AustinFlint Murmur) may be heard.
Tricuspid & Pulmonic Valve
Disease
• Uncommon
• Stenosis occurs more frequently than regurgitation.
• Result in an increase in blood volume in the right
atrium (tricuspid) and right ventricle (pulmonic).
• Tricuspid stenosis: results in right atrial enlargement
and elevated systemic venous pressures.
• Pulmonic stenosis: results in right ventricular
hypertension and hypertrophy.
Tricuspid & Pulmonic Valve
Disease
Tricuspid Stenosis
Tricuspid & Pulmonic Valve
Disease
Tricuspid & Pulmonic Valve
Disease
Tricuspid & Pulmonic Valve
Disease