Valvular Diseases

Question 1

Murmur

Answer 1

Turbulence/rough sound of blood, leaky valve. Normal functional murmur: a lot of blood flow, valve is normal. Abnormal murmur: dysfunctional valve, either not enough blood gets through or valves are leaky. Stenosis(hard valve, blood can’t get through), regurgitation/insufficient(leaky valve, blood back flows). Symptoms of valve problems: fatigue, shortness of breath, swelling of feet.

Question 2

Valvular heart disease causes

Answer 2

Calcification of valves, degeneration(connective tissue issues- Marfan syndrome), pathogen can lead to immune response if found on valves. Annulas rings, support valves,Annular dilation occurs in aneurysm as they get pulled away or even in heart dilation/hypertrophy they get pulled away leading to leaky valve. Ventricular attachment/ papillary muscles (hold chordae tendonae, these are attached to the valves) if a break of these occur, it can lead to valve problems.

Question 3

Identifying murmur

Answer 3

S1 (Systole starts, mitral, tricuspid close, and aortic, pulmonic are open-> lub), S2 (diastole starts, Aortic, Pulmonic close, mitral, tricuspid open ->Dub)
If murmur is occurring in systole period than that means its either stenosis of Aortic and Pulmonic valves or Regurgitation of Mitral and Tricuspid valve has occurred.
If murmur is occurring in Diastole period than it can be either stenosis of Mitral and Tricuspid valves or Regurgitation of Aortic and Pulmonic valves has occurred.
Auscultating in second intercostal space on right : aortic area
Auscultating in second intercostal space on left - Pulmonic area
Auscultating in fourth intercostal space on left side - Tricuspid area
Auscultation in fifth intercostal space in midclavicular line - Mitral area

Question 4

Aortic stenosis

Answer 4

Aortic stenosis causes (bicuspid valve (congenital condition where there is two cusps instead of normal three cusps )), age related calcification (risk factors - smoking, CAD, hypertension, diabetes mellitus), rheumatic fever)
Signs and symptoms - syncope, angina, dyspnea, pulse parvus et Tardus (small / week + slow to rise), left ventricle hypertrophy (palpate PMI -> 5th intercostal space in midclavicualr line), systolic ejection murmur (with or without ejection sound) can be heard at right upper eternal border).

Question 5

Aortic regurgitation

Answer 5

Aortic regurgitation causes ( widening or aneurysm change of aortic annulus, example - tertiary syphilis, connective tissue disorders - Marfan Syndrome, Ethers Darlos , endocarditis , rheumatic fever),
Signs and symptoms - fatigue, syncope, shortness of breath, palpitations, widened pulse pressure (pulse pressure : systolic BP - Diastolic BP), left ventricle dilation (sounds S3 or displaced PMI), can be heard as an early diastolic murmur at left sternal border

Question 6

Mitral valve regurgitation

Answer 6

Causes - left ventricle dial action, dilated cardiomyopathy, rheumatic fever, endocarditis, papillary muscles / chordae tendonae rupture, calcification of valves
Signs and symptoms - acute MR : papillary muscles rupture (acute pulmonary edema), chronic MR : dilated ischemic cardiomyopathy (fatigue, SOB, pulmonary edema, left atrial enlargement, hollow systolic murmur heard at 5th intercostal space on midclavicular line / apex

Question 7

Mitral valve prolapse

Answer 7

Bulged flap into left atrium
Causes - connective tissue disorders (Marfan syndrome, Ethlers Danilo’s syndrome)
Signs and symptoms - atypical chest pain, palpitation, SOB, Dizziness / syncope, mid systolic click is heard,
Associated Risk - this can lead to infective endocarditis, certain arrhythmias, progress into mitral regurgitation

Question 8

Mitral stenosis

Answer 8

Causes - rheumatic fever (caused by streptococcus pyogenesis -> causes strep throat, if not treated then can lead to joint issues, skin and heart problems -> molecular mimicry (this bacteria puts out antigens that are similar to normal antigens present in heart muscles, when body goes to attack the antigens it end up attacking the heart muscles as well ), endocarditis (infective -> acute endocarditis : normal valve , worse bacteria - staph aureus, subacute endocarditis : damaged valve (normal flora -> strep virudans), prosthetic valve (staph epidermidis )
Signs and symptoms - fatigue, SOB, exercise intolerance, cough, left atrial enlargement, pulmonary edema, heard at diastolic rumble after a open snap

Question 9

Valvular heart disease diagnosis and treatment

Answer 9

History and physical ( chest pain, SOB, palpitations, dizziness, exercise intolerance, swelling, syncope, chronic cough, jugular vein destention, audible extra heart sounds, widened pulse pressure, change in blood pressure, irregular pulses, PMI change, edema in extremities, murmur )
Diagnostic testing - EKG, Chest X-ray, echocardiogram, cardiac catheterization
Treatment - medical : beta blockers, ACE inhibitors, diuretics, calcium channel blockers
Surgical : ballon valvular plastic, open heart surgery ( metal valve, prosthetic valve), TAVR (trans catheter aortic valve replacement )