Valvular Heart Disease 2
Valvular Heart Disease 2
Valvular Heart Disease 2
DISEASE
Dr.Alexandru Nechita
Valvular heart disease
MITRAL STENOSIS
AORTIC STENOSIS
MITRAL REGURGITATION
AORTIC REGURGITATION
TRICUSPID REGURGITATION
TRICUSPID STENOSIS
PULMONARY STENOSIS
PULMONARY REGURGITATION
MIXED LESIONS
MITRAL STENOSIS
Definition:
The mitral valve’s incapacity to
open completely in diastole,
due to
- comisural fusion
- cusps thickenning
- remodeling of the
subvalvular structures
MITRAL STENOSIS
Etiology
Rheumatic fever - most of the patients,
Other etiologies are very rare:
– Congenital, MS+atrial septal defect=
Lutembacher syndrome.
atrial myxoma
LA ball thrombus
cor triatriatum.
MITRAL STENOSIS-
Pathology
Posterior
Fusion of the cusp
Pressure gradient.
Elevated LA pressure.
LA pressure increases at
elevated HR.
Pulmonary vascular
resistance elevated.
Pulmonary hypertension
Systemic venous congestion. *LS Lilly, Pathophysiology of Heart Disease, Fifth Edition 2011
Mitral stenosis-
Classification
Large: more than 2 sqcm.
Medium: 1,5-2sqcm.
Severe:<1sqcm.
Mitral stenosis-
Symptoms.
Hemoptysis – usuallydyspnea.
Exertional pulmonary venous
hypertension
Fatigue.
-rupture of alveolar capillaries.
Presyncope, syncope.
-pulmonary infarction.
Cough, wheezing.
-ruptured of dilated bronchial veins.
Paroxysmal nocturnal dyspnea.
-chronic bronchitis.
Orthopnea.
Hemoptysis.
Hoarsenes(Ortner syndrome)
Mitral stenosis
Physical findings
Mitral facies.
Tachypnea.
Turgid jugulars.
Jugular pulse.
Pulmonary rales,
pleural fluid.
Diastolic thrill.
Sustained RV lift.
Mitral stenosis -
Auscultaion
Duroziez sound
RRU - FFT - TA -TA.
S1 A2,P2 OS S1
PRESYSTOLIC
MURMUR
Mitral stenosis -
auscultation
Mitral stenosis
auscultation –atrial
fibrillation
Mitral stenosis-
Complications
Atrial fibrillation/flutter.
Embolism: Systemic:cerebral,
coronary, preipheral; pulmonary.
Acute pulmonary edema.
RV heart failure.
Infective endocarditis.
Chest pain/angina.
Mitral regurgitation
LV is dilated
Syst LV dysfunction appears (may be irreversible)
LV pressure rises,.
LV dysfunction develops
LV hypertophy develops.
Angina pectoris.
Exertional presyncope
Syncope.
Heart Failure
Pulmonary edema.
AS- CLINICAL FINDINGS
Palpable G4(S4).
TAVI=
Transcatheter
Aortic
Valve
Implantation
AORTIC REGURGITATION
Definition:
Incomplete closure of
the aortic cusps in
diastole and
regurgitation of
blood from the aorta to
the left ventricle.
Aortic regurgitation can be
acute or chronic.
AORTIC REGURGITATION-
Etiology
1. Aortic root dilatation.
2. Congenital biscuspid valve.
3. Previous infective endocarditis
4. Rheumatic
5. Other congenital connective tissue disease: - Marfan,
- Osteogenesis imperfecta
- Ehlers-Danlos syndrome.
7. Syphilis
AORTIC REGURGITATION-
Pathology
Dilatation of the annulus
AR.
Valves can show
*
– Thickening
– Shortening
– Comisural lesions
– Calcification, .
LV
– dilated
– hypertrophied.
LV dysfunction develops. *LS Lilly, Pathophysiology of Heart
Disease, Fifth Edition 2011
AORTIC REGURGITATION-
Symptoms
Pounding of the head or palpitations.
Dyspnea on exerton.
Angina pectoris.
AORTIC REGURGITATION-
peripheral signs
Pulse pressure –elevated.
Corrigan pulse- celer et altur.
Atrerial hyperpulsatility:
Musset sign-bobbing of the head with each heartbeat.
Traube sign-pistol-shot heard over the femoral artery.
Duroziez sign-systolic murmur fem.a.when compressed proximally,
diastolic distally.
Quincke pulse-capillary pulsations detected pressing a glass over the
patients lips.
Arterial dance- carotid pulsations.
Waterhammer sign-pulsatons of the forearm when pressed.
Landolfi sign – intermittant pupillary hippus – miosis in systole,
midriasis in diastole.
AORTIC REGURGITATION-
physical examination
The chest may rock, cardiac impulse
may be visible.
Diastolic thrill-severe AR.
S1 usually soft.
Systolic ejection murmur.
Early or immediate, blowing
descrescendo diastolic murmur,
after S2.
IN severe AR the murmur is
holodiastolic.
Austin-Flint murmur of functional mitral
stenosis.
Tricuspid regurgitation
Definition: incapacity of the
tricuspid valve to close
completely during systole,
resulting in regurgitation of
blood from the right ventricle
to the right atrium.
Soft
early or holosystolic
murmur,
augumented with
inspiratory effort.
Tricuspid stenosis
Rare condition
Etiology: rheumatic in most of the cases.
Simptoms and general signs similar to those
met in TR.
Auscultation: low to medium pitched
diastolic rumble with inspiratory
accentuation, localized to the lower sternal
border.
Pulmonary valve
dissease.
Apart from congenital conditions is very
rare.
Congenital: PV stenosis, Pulmonary atresia,
Bicuspid valve, Infundibular(subvalvular
pulmonary stenosis), Idiopathic dilatation of
the pulmonary artery.
Acquired: rheumatic, Infective endocarditis,
carcinoid heart disease, pulmonary
hypertension, iatrogenic-Ross operation.
Pulmonary stenosis –
physical examination
Mild stenosis - systolic
ejection click+early systolic
murmur.