Valvular Heart Disease

Valvular Heart Disease

Valvular Heart Disease

-Aortic Stenosis

-Can be congenital or acquired

-Most common congenital abnormality

-Causes LVH

-Symptoms-angina, syncope, CHF

-Systolic Murmur Crescendo-Decrescendo over right sternal border

-Diagnosis and determination of severity is by ECHO and physical examination

-Treatment is surgical replacement of the valve

-Aortic Regurgitation

-may be secondary to or primary disease of aortic leaflets or root.  

-Can come from rheumatic heart disease

-Symptoms-DOE, PND, and fatigue

-Decrescendo diastolic murmur head at left sternal border

-Medical therapy includes ACE inhibitors and Nifedipine (vasodilators) to help unload ventricle

-Valve Replacement for low ejection fraction (usually less than 14%)

-Mitral Stenosis

-thickening of the mitral leaflets impeding flow into left ventricle

-Rheumatic fever most common cause

other etiologies-congenital, connective tissue disease and carcinoid

-can cause right heart failure

-Dyspnea and orthopnea are common presenting symptoms

-Low pitched diastolic murmur heard best at apex with patient in left lateral decubitus position

-Medical treatment involve rate control because patients are prone to tachycardia

-Diuretics are helpful for decreasing pulmonary vascular resistance and helping after load

-Balloon Valvuoplasty or surgery for severe cases

-Mitral Regurgitation (MR)

-most common cause is rheumatic fever and mitral valve prolapse

-Fatigue and dyspnea on exertion common symptoms

-Right Heart Failure may occur

-Holosystolic murmur best heard at apex

-Medical therapy-ACE inhibitors, vasodilators and hydralazine

-Surgery is often difficult to time for severe cases and can cause more damage to left ventricle

-Many cases valve can be repaired

-Mitral Valve Prolapse

-Most common valvular abnormality.  

-Systolic murmur

-it is when there is superior displacement of one or both leaflets across the plane of the mitral annulus towards left atrium

-Sometimes get palpitations, chest pain, anxiety and dizziness

-Tricuspid Stenosis

-Caused mainly by rheumatic fever

-Can cause right heart failure

-High pitched diastolic murmur

-Tricuspid Regurgitation (TR)

-most often due to dilation of the Right Ventricle secondary to right heart failure

-Pulmonary HTN can cause

-High Pitched Pansystolic murmur

-Pulmonic Stenosis

-Usually congenital. Rheumatic fever can cause on occasion

-Systolic murmur

-Pulmonic Regurgitation

-Usually from dilation of the annulus secondary to pulmonary hypertension

-Diastolic murmur

-Severe cases will present with right heart failure

-Treatment is usually at underlying cause of pulmonary hypertension