Valvular Heart Disease

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Valvular Heart Disease

• Aortic Stenosis
• Aortic Regurgitation
• Mitral Stenosis
• Mitral Regurgitation
• Tricuspid Regurgitation
• (Tricuspid Stenosis, Pulmonary Stenosis,
  Pulmonary Regurgitation)

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Aortic Stenosis

• Valvular Aortic Stenosis
• Supra-valvular Aortic Stenosis
• Sub-valvular Aortic Stenosis
• Hypertrophic cardiomyopathy
• Sub-valvular membrane
• Left ventricular tunnel

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Valvular Aortic Stenosis

• Congenital
• Rheumatic
• Degenerative/Calcific

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Symptoms

• Angina
• Dyspnoea
• Syncope on exertion

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Signs

• Slow rising/anachrotic pulse
• Sustained apex
• 2nd sound quiet
• Ejection click
• Ejection type systolic murmur
• usually best heard 2nd RICS, into carotids.
• Often well heard throughout praecordium

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Complications

• Left heart failure
• Sudden death

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Investigations

• ECG
• Chest x-ray
• Echocardiogram
• Cardiac catherisation

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Treatment

• Surgical Aortic Valve Replacement
• TAVI

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Causes of Aortic Regurgitation

• Rheumatic fever
• Bicuspid aortic valve
• Infective endocarditis
• Syphillis
• Arthritides
• Reiters, Ank Spond, Rheumatoid

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Aortic Regurgitation

• Symptoms
• asymptomatic, dyspnoea
• Signs
• Pulse collapsing, Water Hammer
• Quinques, Corrigans, De Mussets, pistol shot
  femorals, Duroziezs signs

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• Apex displaced and hyperdynamic
• Early diastolic murmur
• usually best heard lower lest sternal edge

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Investigations

• ECGCXREchocardiogram
• Cardiac Catherisation

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• Complications
• Left heart failure
• Endocarditis
• Treatment
• Aortic Valve Replacement

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Mitral Stenosis

• Symptoms
• -Breathlessness
• Complications
• Atrial fibrillation
• Systemic emboli
• Pulmonary hypertension
• Chest infections
• Infective endocarditis
• Right heart failure

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Signs of mitral stenosis

• Atrial fibrillation
• Maybe para sternal heave
• tapping apex
• Loud 1st sound
• Maybe loud 2nd sound
• Opening snap
• Rumbling mid diastolic murmur at apex radiating
  to axilla

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Investigations

• ECGCXREchocardiogram
• Cardiac catheterisation

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Treatment

• Rhythm control Digitalis, beta blockers,
  calcium antagonists
• Diuretics
• Anti-coagulants
• Balloon Valvotomy or Valve replacement

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Mitral Regurgitation

• Rheumatic fever
• Prolapsing valve
• Infective endocarditis
• Papillary muscle dysfunction
• Ruptured chordae
• Left heart dilation
• Connective tissue disorders

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• Apex displaced
• Quiet first sound
• Pan systolic murmur at apex
• If severe, 3rd heart sound

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Investigations

• ECGCxREcho
• Cardiac catheter

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Treatment

• Diuretics
• Vasodilators
• (Anti-coagulation)
• Mitral valve repair/replacement

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