Valvular Disorders

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Valvular Disorders

• By
• Megan Rice
• Annie Halverson
• Sara Sabelhaus
• Michelle Chung

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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

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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!

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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

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Valvular Disorders
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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

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Stenosis
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Regurgitation
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Prolapse
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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.

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Mitral Valve Stenosis
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Mitral Valve Stenosis

• Clinical Manifestations
• ºPrimary symptom is exertional dyspnea due to
  reduced lung compliance.
• ºFatigue
• ºPalpitations from atrial fibrillation

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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.

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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.

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Mitral Valve Regurgitation
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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.

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Mitral Valve Regurgitation

• Mitral Regurgitation Sound
• ºHeart sounds An audible third heard sound (S3).
  The murmur is a loud holo-or pansystolic murmur
  at the apex radiating to the left axilla.

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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.

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Mitral Valve Prolapse
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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,
  light-headedness, and dizziness.

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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
  mid-late systole.

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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.

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Aortic Valve Stenosis
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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).

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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)

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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.

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Aortic Valve Regurgitation
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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.

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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 (Austin-Flint Murmur) may be heard.

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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.

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Tricuspid Pulmonic Valve Disease
Tricuspid Stenosis
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Tricuspid Pulmonic Valve Disease
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Tricuspid Pulmonic Valve Disease
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Tricuspid Pulmonic Valve Disease