Valvulopathy

Question 1

AS

Answer 1

Aortic stenosis - most common cause:
younger patients < 65 years: bicuspid aortic valve
older patients > 65 years: calcification degeneration

Question 2

Signs of AS

Answer 2

ESM
late-peaking systolic murmur heard best at the right upper sternal border with radiation to the carotids, associated slow-rising carotid pulse

Decreased followed valsalva manevour

Question 3

Mitral regurgitation

Answer 3

Common in elderly patient : degenerative mitral valve regurgitation

Sound of mitral regurgitation - a pansystolic murmur heard best at the apex

Question 4

Mitral stenosis

Answer 4

Common in rheumatic fever - uncommon in developed countries

mitral stenosis (low-pitched decrescendo-crescendo rumbling diastolic murmur)

Question 5

Valsalva maneuvour and murmur

Answer 5

AS- decreased ESM
HCM- increased murmur

Why decreased in AS:- The individual exhales against a closed airway, increasing intrathoracic pressure. This elevated pressure compresses the vena cava, reducing venous return to the heart and thereby decreasing preload—the volume of blood filling the heart before contraction. With less blood entering the left ventricle, the stroke volume diminishes. In aortic stenosis, where the aortic valve is narrowed, a reduced stroke volume leads to decreased turbulence across the stenotic valve, resulting in a softer systolic ejection murmur. 

Clinical Significance:

• why increased in Hypertrophic Cardiomyopathy (HCM): In contrast, the murmur associated with HCM typically increases during the Valsalva maneuver. The reduced preload leads to a smaller left ventricular cavity size, exacerbating the outflow tract obstruction characteristic of HCM, thereby intensifying the murmur. 

Question 6

Signs if severe AS

Answer 6

Features of severe aortic stenosis
narrow pulse pressure
slow rising pulse
delayed ESM
soft/absent S2
S4
thrill
duration of murmur
left ventricular hypertrophy

Why narrow pulse pressure

In aortic stenosis (AS), the narrowing of the aortic valve impedes blood flow from the left ventricle to the aorta, leading to a reduction in stroke volume—the amount of blood ejected with each heartbeat. This diminished stroke volume results in a lower systolic blood pressure. Meanwhile, diastolic pressure often remains unchanged. The combination of decreased systolic pressure and stable diastolic pressure leads to a narrowed pulse pressure, which is the difference between systolic and diastolic pressures.

Question 7

Williams syndrome

Answer 7

supravalvular aortic stenosis