Valvular heart

disease
Tengku Winda Ardini, Sp.JP
 CARDIAC ANATOMY
AORTA
KATUP AORTA
ATRIUM KANAN ATRIUM KIRI

KATUP TRICUSPID KATUP MITRAL

ARTERI PULMONAL

VENTRIKEL KANAN VENTRIKEL KIRI

KATUP PULMONAL
CARDIAC VALVES
CARDIAC CYCLE
LA  LV (Mitral Valve)

LV  Aorta (Aortic Valve)

RA  RV (Tricuspid Valve)

RV  Arteri Pulmonal (Pulmonic Valve)

HEART SOUNDS (STETHOSCOPE)

S1 = Atrioventricular Valves closure

S2 = Semilunar valves closure

STENOSIS
• Tidak terbuka secara penuh atau sempurna

REGURGITASI/INSUFISIENSI
• Tidak tertutup secara penuh atau sempurna

CARDIAC MURMUR
MITRAL STENOSIS

Symptoms: Fatique, shortness of breath,

palpitation, swollen feet, chestpain, coughing of
blood

Signs: cardiomegaly, cardiac murmur (mid

diastolic murmur)

Etiology: Rheumatic heart disease

 MITRAL STENOSIS
Mid Diastolic Murmur

Cardiomegaly, Pulmonal
prominent, LA >, Apex upward

ECG: Sinus rhythm/ atrial fibrillation + Right

axis deviation + right ventricular hypertrophy
 MITRAL STENOSIS (TREATMENT)

Medical therapy (Heart Failure) : Diuretics

(furosemide, spironolactone), Rate control
(beta blocker, digoxin), anticoagulant (if
needed)

Ballon Mitral Valvuloplasty (BMV)

Surgery : Mitral Valve Replacement

MITRAL REGURGITASI

Symptoms: Fatique, shortness of breath,

palpitation, swollen feet, chestpain

Signs: cardiomegaly, cardiac murmur (pan

systolic murmur)

Etiology: Rheumatic heart disease, mitral valve

prolapse, infective endocarditis, cardiomyopathy,
ischemic heart disease
 MITRAL REGURGITASI
Pan Systolic Murmur

Cardiomegaly, LA >, LV >

ECG: Sinus rhythm/ atrial fibrillation + Left atrial

enlargement / Left ventricular hypertrophy
MITRAL REGURGITATION (TREATMENT)

Medical therapy (Heart Failure) :

Diuretics (furosemide, spironolactone),
Rate control (beta blocker), Ace
inhibitor/Angiotensin receptor blocker,
anticoagulant (if needed)

Surgery : Mitral Valve Repair /

Replacement
AORTIC STENOSIS

Symptoms: Fatique, shortness of breath,

palpitation, fainting, chestpain, syncope.

Signs: cardiomegaly, cardiac murmur

(ejection systolic murmur)

Etiology: Rheumatic heart disease,

calcification, congenital (bicuspid valve)
 AORTIC STENOSIS
Ejection Systolic Murmur

ECG: Left atrial enlargement + Left ventricular

hypertrophy + left ventricular strain
 AORTIC STENOSIS (TREATMENT)

Medical therapy (Heart Failure) : Diuretics

(furosemide, spironolactone), beta blocker,
statin, Renin angiotensin aldosterone blocker

Transcatheter Aortic Valve Implabtation

(TAVI)

Surgery : Aortic Valve Replacement

AORTIC REGURGITATION

Symptoms: Fatique, shortness of breath,

palpitation, swollen feet, chestpain.

Signs: cardiomegaly, cardiac murmur

(early diastolic murmur), 14 signs

Etiology: Rheumatic heart disease,

calcification, congenital, aortic root
disease, connective tissue disease
 14 SIGS AORTIC REGURGITATION
• CORRIGAN’S PULSE: A RAPID AND FORCEFUL DISTENSION OF THE ARTERIAL PULSE WITH A
QUICK COLLAPSE

• DE MUSSET’S SIGN: BOBBING OF THE HEAD WITH EACH HEARTBEAT (LIKE A BIRD WALKING)

• MULLER’S SIGN: VISIBLE PULSATIONS OF THE UVULA

• QUINCKE’S SIGN: CAPILLARY PULSATIONS SEEN ON LIGHT COMPRESSION OF THE NAIL BED

• TRAUBE’S SIGN: SYSTOLIC AND DIASTOLIC SOUNDS HEARD OVER THE FEMORAL ARTERY
(“PISTOL SHOTS”)

• DUROZIEZ’S SIGN: GRADUAL PRESSURE OVER THE FEMORAL ARTERY LEADS TO A SYSTOLIC
AND DIASTOLIC BRUIT

• HILL’S SIGN: POPLITEAL SYSTOLIC BLOOD PRESSURE EXCEEDING BRACHIAL SYSTOLIC BLOOD
PRESSURE BY ≥ 60 MMHG (MOST SENSITIVE SIGN FOR AORTIC REGURGITATION)

• SHELLY’S SIGN: PULSATION OF THE CERVIX

• ROSENBACH’S SIGN: HEPATIC PULSATIONS

• BECKER’S SIGN: VISIBLE PULSATION OF THE RETINAL ARTERIOLES

• GERHARDT’S SIGN (AKA SAILER’S SIGN): PULSATION OF THE SPLEEN IN THE PRESENCE OF
SPLENOMEGALY

• MAYNE’S SIGN: A DECREASE IN DIASTOLIC BLOOD PRESSURE OF 15 MMHG WHEN THE ARM IS
HELD ABOVE THE HEAD (VERY NON-SPECIFIC)

• LANDOLFI’S SIGN: SYSTOLIC CONTRACTION AND DIASTOLIC DILATION OF THE PUPIL

AORTIC REGURGITATION

Early Diastolic Murmur

PULMONARY STENOSIS

Symptoms: Fatique, shortness of

breath, sianosis.

Signs: cardiomegaly, cardiac

murmur (ejection systolic murmur)

Etiology : congenital
PULMONARY REGURGITATION

Etiology :
pulmonary
hypertension
TRICUSPID REGURGITATION

Symptoms: Fatique, shortness of

breath.

Signs: cardiomegaly, cardiac

murmur (systolic murmur)

Etiology : pulmonary hypertention,

rheumatic heart disease
TRICUSPID STENOSIS
ETIOLOGY
ETIOLOGY
 RHEUMATIC HEART DISEASE
• Streptococcus Beta Haemolytic group A
infection  throat (pharynx)  pharyngitis
 Rheumatic Fever
• Several episodes
• Autoimmun inflammatory reaction
• Children and young adult
• Low - middle income countries, marginal
communities in high income countries.
 ECHOCARDIOGRAPHY

VENTRIKEL KANAN VENTRIKEL KIRI

KATUP TRICUSPID
KATUP MITRAL

VENTRIKEL KANAN
ATRIUM KIRI
TERIMA KASIH
 FIGURE 2. THERAPEUTIC ROLES OF RENIN-
ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITION
IN AORTIC STENOSIS.
FIGURE 1. THERAPEUTIC ROLES OF STATINS AND
OTHER LIPID-LOWERING THERAPY IN AORTIC
STENOSIS.