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VALVULAR HEART DISEASE

Mitral Stenosis Mitral Aortic Stenosis Aortic Tricuspid Pulmonary


Regurgitation Regurgitation Regurgitation Stenosis
Aetiology Rheumatic- Congenital- Fusion pulmonic
leading cause bicuspid aortic valves
Congenital valve
Degenerative -MC Congenital
CT disease- Degenerative- Carcinoid
SLE, RA calcific- elderly
RF-almost
associated mitral
valve involvement
Radiation
Criteria N MVA: 4-6 N 2-4 cm2
cm2 Stenosis < 1.5
Mitral Stenosis: cm2
< 2.0 cm2 Severe < 1.0 cm2
Severe: <1.0
cm2
Hemodyna Elevated
mic atrioventricular
hallmark pressure
gradient
Clinical Symptom Systolic Thrill Sudden Cardiac Water-hammer Signs of RHF splitting S2
manifestati occur after 2 -apex Death- MC death pulse/ Corrigans RV pulsation
ons decades of -thrill-appreciated pulse left para sternal
mitral attack of murmur stage 4 -rapidly rising border
rheumatic -collapse rapidly as
carditis Displaced apex arterial pulse drops
Dyspnea beat
Cough Presence S3 Quinckes pulse-
Progression of Acute severe visible capillary
Lesion MR-arterial pulsation in the
Easy fatigability pressure- nail beds
Orthopnea reduced
PND Traubes
Haemoptysis Duroziezs
RSHF
AF
Stroke due to
thrombus
formation
Murmur Low pitched SYSTOLIC MID SYSTOLIC Decrescendo Blowing Harsh
Rumbling murmur usually Crescendo- DIASTOLIC SYSTOLIC Crescendo-
DIASTOLIC grade 3/ grade 4 decrescendo murmur Murmur decrescendo
MURMUR -Holo systolic murmur ejection
3rd ICS LS border murmur
APEX Most prominent Loudest-BASE 4th ICS
(left lateral apex radiating MC- 2nd RICS Austin flint Left parasternal
decubitus) axilla murmur 2nd and 4th ICS
-low pitched
Pre systolic rumbling Patient lean
just before S1 -Beat to beat forward
murmur
Carvallos Sign
-functional
tricuspid valve
regurgitation
-increases in
intensity during
inspiration
-diminishes
during
expiration

Graham Steel
____________________________________________________ ____ __________________________Medicine 2
Murmur
-high pitch
diastolic
decrescendo
blowing murmur
-base-left
parasternal
border
-due to dilation
of pulmonary
valve ring
ECG Lead II- m LAH-notched P Left Axis -LVH (V1, V6) -LVH
pattern wave LII ( P Deviation -Left Atrial -Right Atrial
V1-exagerated mitrale) Enlargement Enlargement
negative -exageration -Left Axis Tall R wave- V1,
negative P wave Deviation V2
V1 Persistent S wave
V5, V6
LVH-deep S P wave-increased
wave in V1, tall R in amplitude more
waves in V5, V6 than 2.5 mm
Right Axis
Deviation
Enlargement Enlargement LA,
Left Atrium LV
CXR -Upliftment Left Displacement of Displaced apex to
Bronchus apex toward the inferior and
-Double-double leftand down lateral portion of
sign ( atrial the left side
enlargement)
-Left atrial
Appendage
enlargement
Echo Doming
motion of the
mitral valves
Treatment Rate control ACE/ ARBS Avoid physical Aortic Valve Ballooning-dilate
Beta blocker Beta Blocker activity Replacement valve
Diuretics Diuretics Beta blocker -TAVI cant be Done
Anticoagulant ACE done percutaneous
Mitral TAVI
Valvotomy Valve (transcatherter
Mitral Valve Replacement aortic valve
Replacement implant)