valvular diseases

Rheumatic fever
1. signs and symptoms
  1. major
    1. Arthritis
    2. carditis
    3. sydenham chorea
    4. erythema marginatum
    5. Subcutaneous nodules
  2. minor
    1. fainting (syncope)
      1. occurs when the brain stops functioning properly because of a sudden decrease in blood flow
      2. pre-syncope
        feeling losing of consciousness or blacking out due to cardiac problems
    2. Arthralgia
    3. fever
    4. pallor
    5. anorexia
2. acute RF
  1. an inflammatory disease that is most common in 5 to 15 years old children
  2. cause :Group A streptococcus
3. chronic rheumatic heart disease
  1. complications:
    1. valve stenosis
    2. arrhythmia
    3. heart failure
    4. Endocarditis
      1. 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
      2. NBTE
      3. libman- sack
4. pathophysiology
  1. delayed immune response to infection with group A beta hemolytic strep. which induces immunological damage in heart valves, joints &brain
5. treatment
  1. antibiotics
    1. penicillin
  2. Anti-inflammatory drugs
    1. naproxen
    2. aspirin
6. investigations
  1. high ESR
  2. elevated C active protein
  3. throat culture-GABH strep
  4. ASO titer >200
  5. ECHO
    1. edema, MR, LA,LV dilation
  6. ECG
    1. prolonged P R interval, ST depression
heart
1. anatomy
2. cardiac cycle
  1. 1st diastolic period
    1. the atria and ventricles are relaxed and the atrioventricular valves are open and RA is filled.
  2. 1st systolic period
    1. the right ventricle is filled with blood passed on from the right atrium and it contracts
  3. 2nd diastolic P.
    1. the semilunar valves close and the atrioventricular valves open and the blood moves to the lung to be oxygenated.
  4. 2nd systolic P
    1. the atrioventricular valves close and the semilunar valves open and the left ventricle is pumped to the aorta
3. murmurs
  1. heart sounds produced when blood flows across one of the valves
  2. Innocent murmurs:
    1. fever
    2. pregnancy
    3. physical activities
    4. hyperthyroidism
  3. abnormal
    1. systolic
      1. aortic stenosis, MR, MV prolapse, tricuspid insufficiency
    2. diastolic
      1. aortic insufficiency, mitral stenosis
4. normal sounds
  1. s1:closure of Mitral, Tricuspid valves
  2. S2 closure of Pulmonic, Aortic valves
examination of CVS
1. history taking
2. inspection
  1. eyes: xanthelasma
  2. chest: pigeon chest
  3. skin: cyanosis, clubbing,Xanthomas, edema
  4. JVP
3. palpitation
  1. thrill, apex beat, size of LV
  2. pulse: dorsalis pedis, posterior tibial P
4. Auscultation
Aortic stenosis
1. causes:
  1. congenital bicuspid aortic valve
  2. calcific valvular disease
2. risk factors
  1. smoking
  2. diabetes
  3. hypertension
  4. renal insufficiency
  5. male
  6. hyperlipidemia
3. pathophysiology
  1. obstruction of LV>LV hypertrophy>aortic pressure is low>LV compliance> elevated LV contraction > MI> congestive HF.
4. signs &symptoms
  1. dsyonea
  2. small volume pulse
  3. angina
    1. stable
      1. unstable
        Variant
        Microvascular
        Atypical
  4. mid-diastolic click murmur

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valvular diseases

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