valvular diseases

valvular diseases

1. Rheumatic fever

   • signs and symptoms
     • major
       • Arthritis
       • carditis
       • sydenham chorea
       • erythema marginatum
       • Subcutaneous nodules
     • minor
       • fainting (syncope)
         • occurs when the brain stops functioning properly because of a sudden decrease in blood flow
         • pre-syncope
           • feeling losing of consciousness or blacking out due to cardiac problems
       • Arthralgia
       • fever
       • pallor
       • anorexia
   • acute RF
     • an inflammatory disease that is most common in 5 to 15 years old children
     • cause :Group A streptococcus
   • chronic rheumatic heart disease
     • complications:
       • valve stenosis
       • arrhythmia
       • heart failure
       • Endocarditis
         • infective endocarditis
           • predisposing factors
             • RHD
             • congenital heart disease
             • Prosthetic Valve
             • IV drug abuse
           • pathophysiology
             • endothelial erosion>sterile micro thrombi formation>bacteremia> microorganism adhesion>vegetations
           • acute
             • staph aureus
             • affects normal valves
             • destruction of the valve
           • subacute
             • strep. viridians
             • affects abnormal valves
             • no destruction of the valve
           • C\P
             • fever
             • weakness
           • complications
             • glomerulonephritis
             • thromboembolism
         • NBTE
         • libman- sack
   • pathophysiology
     • delayed immune response to infection with group A beta hemolytic strep. which induces immunological damage in heart valves, joints &brain
   • treatment
     • antibiotics
       • penicillin
     • Anti-inflammatory drugs
       • naproxen
       • aspirin
   • investigations
     • high ESR
     • elevated C active protein
     • throat culture-GABH strep
     • ASO titer >200
     • ECHO
       • edema, MR, LA,LV dilation
     • ECG
       • prolonged P R interval, ST depression

2. heart

   • anatomy
   • cardiac cycle
     • 1st diastolic period
       • the atria and ventricles are relaxed and the atrioventricular valves are open and RA is filled.
     • 1st systolic period
       • the right ventricle is filled with blood passed on from the right atrium and it contracts
     • 2nd diastolic P.
       • the semilunar valves close and the atrioventricular valves open and the blood moves to the lung to be oxygenated.
     • 2nd systolic P
       • the atrioventricular valves close and the semilunar valves open and the left ventricle is pumped to the aorta
   • murmurs
     • heart sounds produced when blood flows across one of the valves
     • Innocent murmurs:
       • fever
       • pregnancy
       • physical activities
       • hyperthyroidism
     • abnormal
       • systolic
         • aortic stenosis, MR, MV prolapse, tricuspid insufficiency
       • diastolic
         • aortic insufficiency, mitral stenosis
   • normal sounds
     • s1:closure of Mitral, Tricuspid valves
     • S2 closure of Pulmonic, Aortic valves

3. examination of CVS

   • history taking
   • inspection
     • eyes: xanthelasma
     • chest: pigeon chest
     • skin: cyanosis, clubbing,Xanthomas, edema
     • JVP
   • palpitation
     • thrill, apex beat, size of LV
     • pulse: dorsalis pedis, posterior tibial P
   • Auscultation

4. Aortic stenosis

   • causes:
     • congenital bicuspid aortic valve
     • calcific valvular disease
   • risk factors
     • smoking
     • diabetes
     • hypertension
     • renal insufficiency
     • male
     • hyperlipidemia
   • pathophysiology
     • obstruction of LV>LV hypertrophy>aortic pressure is low>LV compliance> elevated LV contraction > MI> congestive HF.
   • signs &symptoms
     • dsyonea
     • small volume pulse
     • angina
       • stable
         • unstable
           • Variant
             • Microvascular
               • Atypical
     • mid-diastolic click murmur

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