VALVULAR HEART DISEASE. BY DR GHULAM HUSSAIN. MBBS, Diploma in Cardiology, MD (Medicine) Assistant...
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Transcript of VALVULAR HEART DISEASE. BY DR GHULAM HUSSAIN. MBBS, Diploma in Cardiology, MD (Medicine) Assistant...
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VALVULAR HEART DISEASE.
BY
DR GHULAM HUSSAIN.MBBS,
Diploma in Cardiology,MD (Medicine)
Assistant Professor of Medicine Medical Unit-4
LUMHS, Jamshoro / Hyderabad
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AORTIC STENOSIS.
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Etiology
a. Congenital aortic stenosis
b. Senile calcific stenosis
c. Bicuspid aortic valve
d. Rheumatic aortic stenosis
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PATHOPHYSIOLOGY. Aortic valve stenosis produces a pressure over load on the left ventricle due to the greater pressure that must be generated to force blood past the stenotic valve .a. Obstruction to out flow causes pressure over load
and left ventricle hypertrophyb. Hypertrophy increases thick ness of left ventricle .
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Clinical Features Symptoms
1. Asymptomatic patients are little risk of death.
2. Angina
3. Syncope
4. Heart Failure
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Physical Signs
1. Delayed Carotid Upstroke 2. Systolic Ejection Murmur3. Soft, Single S24. S45. Sustained, heaving apex beat
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Laboratory Diagnosis
1. Electrocardiography The ECG usually shows evidence of left ventricular hypertrophy.
2. Echocardiography
3. Cardiac Catheterization
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Therapy
a. Palliative Therapy- Medical Therapy
b. Curative Therapy
- Homograft Valves
- Heterograft Vales
- Mechanical Valves
- Autograft (Ross Procedure)
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Aortic Regurgitation
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Etiologya. Idiopathic aortic root dilatation b. Rheumatic Heart Disease c. Infective Endocarditis d. Marfan Syndrome - Proximal root dilatation - Aortic root dissection e. Aortic Dissection F. Syphilis G. Collagen Vascular disease
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Pathophysiology
a. A portion of the left ventricular stroke volumeejected during systole regurgitation into the leftventricular during diastole. b. The increase in total stroke volume leads toincrease in pulse pressure and increase insystolic pressure.
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Clinical Features a. Symptoms 1. Left Ventricular Failure a. Chronic Aortic Insufficiency b. Acute Aortic Insufficiency
2. Syncope
3. Angina
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Clinical Features b. Physical Signs 1. Left Ventricular Impulse 2. Diastolic Murmur 3. Austin Flint Murmur 4. Total Stroke Volume
a. Corrigan’s Pulse b. Hill’s sign c. Pistol-shot femoral pulses d. Duroziez’s signe. De Musset’s sign f. Quincke’s pulse
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Diagnosis 1. Electrocardiography The ECG usually shows
left ventricular hypertrophy. 2. Chest Radiography
3. Echocardiography
4. Cardiac Catheterization
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Therapy
a. Aortic Valve replacement b. If surgery is not possible, therapy with digitlis,
diuretics and vasodilators may affoard symptomatic relief.
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Mitral Stenosis
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Etiology
Almost all cases of mitral stenosis in adult aresecondary to rheumatic heart disease. Most cases occur in women.
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Pathophysiology1. Impedes left ventricular filling2. Increase left atrial pressure 3. Leads to pulmonary congestion 4. Pulmonary hypertension 5. Right Ventricular failure
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Clinical Features
a. Symptoms 1. Left sided failure 2. Right Sided failure3. Hemoptysis 4. Systemic embolisim 5. Hoarseness
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Clinical Features
b. Physical Signs 1. Atrial Fibrillation 2. Pulmonary rales 3. Increase intensity of the S14. Increase intensity of the P25. Opening Snap6. Diastolic rumble 7. Sternal lift 8. Other symptoms
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Laboratory Diagnosis
a. Electrocardiographyb. Chest Radiography c. Echocardiography
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Therapy a. Medical Therapy
- Diuretics- Digitalis - Anticoagulants
b. Balloon Valvuloplasty
c. Surgical Therapy 1. Mitral Commissurotomy 2. Mitral Valve Replacement
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Mitral Regurgitation
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Mitral Regurgitation
Etiologya. Rheumatic Heart Disease b. Ruptured Chordae Tendineae c. Coronary Artery Disease d. Infective Endocarditis e. Mitral Valve prolaps and click syndrome
murmur
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Pathophysiology
Increase left atrial pressure and decrease forward cardiac output.
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Clinical Features
a. Symptoms - Dypnea or Thopnea - Paroxysmal nocturnal dyspnea - Pulmonary hypertension and symptoms of
right sided failure - Symptoms of systemic embolization
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Clinical Features b. Physical Sign- Left ventricular impulse - Murmur - An S3 usually heard in mitral regurgitation
and may occur even in the absence of overt heart failure.
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Diagnosis
- Electrocardiography
- Chest Radiography
- Echocardiography
- Cardiac Catheterization
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Therapy a. Medical Treatment
- Diuretics- Digitalis - Anticoagulants - Vesodilators
b. Surgical Treatment 1. Valve Replacement 2. Valve Repair
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Tricuspid Regurgitation
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Etiology a. Infective endocarditis
b. Right ventricular failure
c. Rehumatic heart disease
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Pathophysiology
During systole, the dysfunctioning tricuspid valve allows blood to flow backward into the rightatrium, leading to systemic venous congestion and venous congestion and venous hypertension.
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Clinical Features
a. Symptoms- Edema - Ascites - Hepatic Congestion - Right Upper Quadrant Pain - Jaundice
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Clinical Features
b. Physical Signs- Right ventricle Lift - Murmur - Jugular Venus Pulsation - Pulsatile Liver
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Diagnosis
- Chest Radiography - Echocardiography
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Therapy
1. Reduced the right ventricular pressure2. Surgical Repair 3. Replacement of Tricuspid valve