Valvular Disease Flashcards
Causes
The leading cause of valvular heart disease in the united states is mechanical degeneration.
In the devloping world rheumatic fever is the most common eitiology
Types
Aortic Stenosis
Aortic Regurgitation
Mitral Stenosis
Mitral Regurgitation
Aortic Regurgitation
May appear acutely or as a chronic condition
Aortic Regurgitation
Chronic Cases
Birth Defects
Rheumatic Fever
Connective Tissue Disorders
Aortic Regurgitation
Symptoms
Dyspnea on exertion
Paroxysmal Nocturnal Dyspnea
Lightheadedness on standing or changing positions too quickly
Aortic Regurgitation
Physical Exam
Chest ausculation characterized by three distinct murmurs
Blowing diastolic murmur at LSB
Midsystolic murmur at the apex
Mid-diastolic rumble
Other signs
Head-bobbing with heart beats caused by caudal venous outflow obstruction
Water hammer pulse
Femoral bruits on compression of femoral pulse
Aortic Regurgitation
Evaluation
Echocardiography is diagnostic
Doppler imaging shows back-flow across the aortic valve during diastole
EKG may show signs of dilated ventricles
Aortic Regurgitation
Differential
Other valvular disease, including aortic stenosis or mitral regurgitation , CHF
Aortic Regurgitation
Treatment
Medical management until symptoms warrant intervention
Vasodilator therapy: CCBs and ACEIs
Aortic Regurgitation
Prevention, Prevention and Complications
Acute cases rapidly progress to pulmonary congestion, shock, and death if not
treated
Mitral Valve Stenosis
Etiology
Rheumatic Fever
Mitral Valve Stenosis
Symptoms
Presents with wide range of symptoms
Dyspnea on exertion
Arrhythmias
Orthopnea
Infective endocarditis
Paroxysmal nocturnal dyspnea
Mitral Valve Stenosis
Physical Exam
Chest auscultation may reveal opening snap
Other signs include
Crackles and rales indicative of pulmonary edema
Mitral Valve Stenosis
Evaluation
Doppler echocardiography is diagnostic
CXR will likely demonstrate mild to severe pulmonary edema
Mitral Valve Stenosos
Differential
Other valvular disease, CHF
Mitral Valve Stenosis
Treatment
Antiarrhythmics for symptom relief
Beta blockers, digoxin
Severe cases require surgical intervention.
Repair by commissurotomy preferred over replacement
Balloon valvotomy
Valve Replacement
Mitral Valve Stenosis
Prognosis , Prevention and Complications
If left untreated, can progress to severe CHF and ultimately death
Mitral Valve Regurgitation
Causes
Rheumatic Fever
Chordae Tamponade Rupture
Mitral Valve Regurgitation
Symptoms and Physical Exam
Presents with a range of symptoms including
Dyspnea
Orthopnea
Fatigue
Chest auscultation reveals holosystolic murmur that radiates to the axillae
Mitral Valve Regurgitation Evaluation
Doppler echocardiography is diagnostic - shows regurgitant flow
CXR may show enlarged left atrium
Angiography used to assess severity of disease
Mitral Valve Regurgitation
Differential Diagnosis
Other valvular diseases, CHF
Mitral Valve Regurgitation
Treatment
Decrease afterload: ACE inhibitors and ARBs
Antiarrythmics may be necessary if AF or others develop
Prevention, Prognosis, and Complications
At increased risk of developing atrial fibrillation due to enlargement
Cardiac Auscultation in Valvular Disease
Aortic Stenosis
Loud crescendo-decrescendo systolic ejection murmur in right 2nd intercostal space
Mitral Regurgitation
High pitched holosystolic loudest at apex radiating to axilla
Tricuspid Regurgitation
Soft holosystolic at right sternal border
Mitral Prolapse
Crisp midsystolic click and a delayed or late systolic regurgitation murmur.
Aortic Regurgitation
High pitched blowing early diastolic decrescendo murmur at left sternal border
Mitral Stenosis
Rumbling mid-diastolic murmur with accentuated S1. S2, best heard on expiration or when the patient is squating or exercising because venous return is increased
