Degenerative Valvular disease

Aortic Valve
1. Aortic stenosis
  1. Causes
    1. Degenerative calcification of tricuspid valve
    2. Rheumatic heart disease
    3. Congenital calcification of bicuspid valve
    4. Radiation
    5. CTD
  2. Features
    1. most common valvular lesion in the elderly
    2. Severity define according to
      1. Size of valve area
      2. Velocity ratio
      3. Pressure gradient across the valve
  3. Risk Factors
    1. Atherosclerosis
    2. Genetic factors
    3. Hypercholesterolaemia
    4. End-stage renal diseas
    5. Congenital Valve abnormality
  4. Symptoms
    1. asymptomatic for prolonged period
    2. Presenting Symptoms
      1. Dysponoea on exertion or decreased exercise tolerance
      2. Exertional dizziness and pre syncope
      3. Excertional angina
      4. Mnemonic SAD = Syncope, Angina, Dyspnoea
    3. End-stage symptoms
      1. Heart failure
      2. syncope
      3. angina
  5. Sign
    1. Slow rising pulse
      1. parvus
      2. Tardus
    2. Apex beat sustained and later in disease displaced
    3. Palpable systolic thrill
    4. S2 soft, Split S2,S4
    5. Early disease
      1. Ejection click
    6. Murmur
      1. Ejection systolic
      2. Best heard at base of heart
        Right second intercostal space
      3. Peaking
        Early
        Mild to moderate AS
        Late
        Severe
      4. Loudest on expiration and with leaning forward
      5. Radiating to carotid and apex but not axilla
  6. Complications
    1. Arrhythmias
    2. Sudden Cardiac death
    3. Endocarditis
    4. Heart-failure-systolic and diastolic
    5. Associated with calcific coronary disease
    6. Aortic aneurysm
2. Aortic regurgitation
  1. Cause
    1. Chronic
      1. Aortic root dilatation
      2. Congenital bicuspid valve
      3. Rheumatic heart disease
    2. Acute
      1. Endocarditis
      2. Aortic dissection
      3. Ruptured Cusp
      4. Traumatic injury
      5. Failed repair
  2. Symptoms
    1. Palpitations
    2. Atypical chest pain
    3. Symptoms of left-sided heart failure
      1. Dyspnoea
      2. Orthopnoea
      3. Paroxysmal nocturnal dysmoea
  3. Signs
    1. Wide pulse pressure
    2. "waterhammer" pulse or Corrigan pulse
    3. Inferior and lateral displacement of apex beats
    4. Soft S, variable S2, S3
    5. Murmur
      1. Diastolic
      2. Louder when sitting forward and accentuate with expiration
      3. Decreases with valsalva manoeurve
Mitral valve
1. Mitral Regurgitation
  1. Definition
    1. can arise from abnormalities of any part of the mitral valve apparatus including the valve leaflets, annulus, chordae tendineae, and papillary muscles
  2. Cause
    1. Mitral valve prolapse-degenerative
    2. Infective endocarditis
    3. LV dysfunction with annular dilatation
    4. Rheumatic
    5. Hypertrophic cardiomyopathy
  3. Symptoms
    1. Atrial fibrillation
      1. Palpitation
      2. Embolic phenomena
    2. Pulmonary hypertension
    3. Left heart failure
      1. Paroxysmal dysnoea
      2. Orthopnoea
      3. Dysnoea
    4. Asymptomatic
  4. Signs
    1. Soft S1, Splitting of S2, S3 gallop
    2. Murmur
      1. Pansystolic
      2. Heard best over apex
      3. Radiates to axilla
    3. Mitral valve prolapse
      1. Mid systolic click
      2. late systolic murmur
2. Mitral stenosis
  1. Cause
    1. Pheumatic heart disease
    2. Congenital MS
  2. Symptoms
    1. Asymptomatic
    2. dyspnoea
    3. Haemoptysis
    4. symptoms related to atrial fibrillation or embolic event
    5. Symptoms of pulmonary hypertension and right-sided heart failure
  3. Signs
    1. Low volume pulse
    2. Mitral facies-malar lfush
      Annotations:
      - Might related to SLE
    3. Rised JVP
    4. S1 initially loud then later soft
    5. Loud P2
    6. Opening snap
    7. Diastolic murmur

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Degenerative Valvular disease

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	Created by Ice Berg about 6 years ago