1. Valvular Disorders By Megan Rice Annie Halverson Sara Sabelhaus Michelle Chung

2. 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

3. 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!

4. 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

5. Valvular Disorders

6. 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

7. Stenosis

8. Regurgitation

9. Prolapse

10. 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.

11. Mitral Valve Stenosis

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

13. 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.

14. 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.

15. Mitral Valve Regurgitation

16. 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.

17. 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.

18. 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.

19. Mitral Valve Prolapse

20. 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.

21. 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.

22. 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.

23. Aortic Valve Stenosis

24. 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).

25. 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)

26. 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.

27. Aortic Valve Regurgitation

28. 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.

29. 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.

30. 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.

31. Tricuspid & Pulmonic Valve Disease Tricuspid Stenosis

32. Tricuspid & Pulmonic Valve Disease