This document discusses various types of valvular heart disease, including rheumatic and non-rheumatic causes. It focuses on the anatomy, pathology, pathophysiology, clinical features, investigations, and management of mitral stenosis, mitral regurgitation, aortic stenosis, aortic regurgitation, tricuspid stenosis, tricuspid regurgitation, and pulmonic valve disease. Key points covered include the predominant involvement of the left side valves in rheumatic heart disease, common murmurs associated with different valve lesions, and treatments involving surgery, balloon dilation, or medication management.
2. PREAMBLE
īŽ Predominantly rheumatic in this environment
īŽ Most important cause of cardiac disease in
teenagers, young adults
īŽ Epidemiology reflects Rh. Fever
īŽ Disease of under privilege
īŽ Yet management expensive, risky
īŽ Other causes:
- Congenital
-Degenerative
-Ischaemic, CCF, inflammatory
3. PATTERN OF
INVOLVEMENT
īŽ Rheumatic, predominantly left side,
mitral > aortic
īŽ Rarely tricuspid, almost never
pulmonic
īŽ May present as stenosis regurgitation
or both
īŽ May be multivalvular
13. Recognizing Mitral
Stenosis
Palpation:
īŽ Small volume pulse
īŽ Tapping apex-palpable
S1
īŽ +/- palpable opening
snap (OS)
īŽ RV lift
īŽ Palpable S2
ECG:
īŽ LAE, AFIB, RVH, RAD
Auscultation:
īŽ Loud S1- as loud as S2 in
aortic area
īŽ A2 to OS interval inversely
proportional to severity
īŽ Diastolic rumble: length
proportional to severity
īŽ In severe MS with low flow-
S1, OS & rumble may be
inaudible
20. MR Symptoms
īŽ Similar to MS
īŽ Dyspnea, Orthopnea, PND
īŽ Fatigue
īŽ Pulmonary HTN, right sided failure
īŽ Hemoptysis
īŽ Systemic embolization in A Fib
īŽ Features of CCF
45. TRICUSPID STENOSIS
SYMPTOMS
ī§ Low output:- fatigue etc
ī§ Systemic congestion:- abd swelling,
discomfort; leg swelling; fluterring in
the neck
ī§ Absence of chest symptoms( even
with MS)
46. TRICUSPID STENOSIS
SIGNS
ī§ Prominent âaâ waves on JVP
ī§ Low volume pulse
ī§ Negatives â No PHT, RVH and clear
lung fields in MS
ī§ Auscultation - LSE opening snap,
MDM- increased on inspiration
47. TRICUSPID STENOSIS
INVESTIGATIONS
ī§ CXR â Marked âcardiomegalyâ- RA
enlargement ,with clear lung fields
ī§ ECG â RAH, ? Biatrial hypertrophy
with NO RVH
ī§ ECHO â Confirm stenosis, gradient
- Coexistent MS