VALVULAR HEART DISEASE. BY DR GHULAM HUSSAIN. MBBS, Diploma in Cardiology, MD (Medicine) Assistant Professor of Medicine Medical Unit-4 LUMHS, Jamshoro / Hyderabad

AORTIC STENOSIS.

Etiology a.Congenital aortic stenosis b. Senile calcific stenosis c. Bicuspid aortic valve d. Rheumatic aortic stenosis

PATHOPHYSIOLOGY. Aortic valve stenosis produces a pressure over load on the left ventricle due to the greater pressure that must be generated to force blood past the stenotic valve. a. Obstruction to out flow causes pressure over load and left ventricle hypertrophy b. Hypertrophy increases thick ness of left ventricle.

Clinical Features Symptoms 1.Asymptomatic patients are little risk of death. 2.Angina 3.Syncope 4.Heart Failure

Physical Signs 1.Delayed Carotid Upstroke 2.Systolic Ejection Murmur 3.Soft, Single S2 4. S4 5.Sustained, heaving apex beat

Laboratory Diagnosis 1.Electrocardiography  The ECG usually shows evidence of left ventricular hypertrophy. 2. Echocardiography 3.Cardiac Catheterization

Therapy a.Palliative Therapy -Medical Therapy b. Curative Therapy - Homograft Valves -Heterograft Vales -Mechanical Valves -Autograft (Ross Procedure)

Aortic Regurgitation

Etiology a.Idiopathic aortic root dilatation b.Rheumatic Heart Disease c.Infective Endocarditis d.Marfan Syndrome -Proximal root dilatation -Aortic root dissection e. Aortic Dissection F.Syphilis G.Collagen Vascular disease

Pathophysiology a. A portion of the left ventricular stroke volume ejected during systole regurgitation into the left ventricular during diastole. b. The increase in total stroke volume leads to increase in pulse pressure and increase in systolic pressure.

Clinical Features a. Symptoms 1.Left Ventricular Failure a.Chronic Aortic Insufficiency b.Acute Aortic Insufficiency 2. Syncope 3. Angina

Clinical Features b. Physical Signs 1.Left Ventricular Impulse 2.Diastolic Murmur 3.Austin Flint Murmur 4.Total Stroke Volume a. Corrigan’s Pulse b. Hill’s sign c. Pistol-shot femoral pulses d. Duroziez’s sign e. De Musset’s sign f. Quincke’s pulse

Diagnosis 1.Electrocardiography  The ECG usually shows left ventricular hypertrophy. 2.Chest Radiography 3.Echocardiography 4.Cardiac Catheterization

Therapy a.Aortic Valve replacement b.If surgery is not possible, therapy with digitlis, diuretics and vasodilators may affoard symptomatic relief.

Mitral Stenosis

Etiology Almost all cases of mitral stenosis in adult are secondary to rheumatic heart disease. Most cases occur in women.

Pathophysiology 1. Impedes left ventricular filling 2. Increase left atrial pressure 3. Leads to pulmonary congestion 4. Pulmonary hypertension 5. Right Ventricular failure

Clinical Features a.Symptoms 1.Left sided failure 2.Right Sided failure 3.Hemoptysis 4.Systemic embolisim 5.Hoarseness

Clinical Features b. Physical Signs 1.Atrial Fibrillation 2.Pulmonary rales 3.Increase intensity of the S1 4. Increase intensity of the P2 5.Opening Snap 6.Diastolic rumble 7.Sternal lift 8.Other symptoms

Laboratory Diagnosis a.Electrocardiography b.Chest Radiography c.Echocardiography

Therapy a.Medical Therapy -Diuretics -Digitalis -Anticoagulants b. Balloon Valvuloplasty c. Surgical Therapy 1. Mitral Commissurotomy 2. Mitral Valve Replacement

Mitral Regurgitation

Etiology a.Rheumatic Heart Disease b.Ruptured Chordae Tendineae c.Coronary Artery Disease d.Infective Endocarditis e.Mitral Valve prolaps and click syndrome murmur

Pathophysiology Increase left atrial pressure and decrease forward cardiac output.

Clinical Features a. Symptoms -Dypnea or Thopnea -Paroxysmal nocturnal dyspnea -Pulmonary hypertension and symptoms of right sided failure - Symptoms of systemic embolization

Clinical Features b. Physical Sign -Left ventricular impulse -Murmur -An S3 usually heard in mitral regurgitation and may occur even in the absence of overt heart failure.

Diagnosis - Electrocardiography - Chest Radiography - Echocardiography - Cardiac Catheterization

Therapy a.Medical Treatment -Diuretics -Digitalis -Anticoagulants -Vesodilators b. Surgical Treatment 1. Valve Replacement 2. Valve Repair

Tricuspid Regurgitation

Etiology a.Infective endocarditis b. Right ventricular failure c.Rehumatic heart disease

Pathophysiology During systole, the dysfunctioning tricuspid valve allows blood to flow backward into the right atrium, leading to systemic venous congestion and venous congestion and venous hypertension.

Clinical Features a.Symptoms -Edema -Ascites -Hepatic Congestion -Right Upper Quadrant Pain -Jaundice

Clinical Features b.Physical Signs -Right ventricle Lift -Murmur -Jugular Venus Pulsation -Pulsatile Liver

Diagnosis -Chest Radiography -Echocardiography

Therapy 1.Reduced the right ventricular pressure 2.Surgical Repair 3.Replacement of Tricuspid valve