Valvular heart disease

INDRA SM MANULLANG

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Valve disease
• Aetiology
• Clinical findings
• Investigations
• Management

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 Heart Valve lesions
• Mitral stenosis • Mitral regurgitation
• Aortic stenosis • Aortic regurgitation
• Pulmonary stenosis • Pulmonary regurgitation
• Tricuspid stenosis • Tricuspid regurgitation
• Prosthetic stenosis • Prosthetic regurgitation

• Mitral valve prolapse

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Mitral regurgitation - Aetiology
• Valve
– Rheumatic fever
– Endocarditis
• Mitral valve annulus
– Dilation
– Calcification
• Chordae tendinae
– Rupture
– Lengthening
• Papillary muscle
– ischaemia
– dilation
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 Mitral regurgitation –
pathophysiology
•  LV emptying
•  LA pressure (if acute, pulmonary odema)
•  LV filling
•  LVedd
• LV stretch  failure

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 Mitral regurgitation – Clinical
• Symptoms appear late
– SOB
– Fatigue
– Right heart failure
• Signs
– Full volume pulse
– Pan systolic murmur
radiating to apex
– Right heart failure
– Pulmonary hypertension

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 Mitral Regurgitation
• Investigations
– ECG p mitrale
– Xray large heart, calcified
mv annulus, pulmonary
odema
– Echocardiogram large LA,
abnormal valve, MR
– LV angio MR, large LA

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Mitral Regurgitation

• Heart Failure
• Decrease afterload
• Replacement
• Anticoagulation
• Antibiotic prophylaxis

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Mitral Stenosis - Aetiology

• Rheumatic fever
• Congenital

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Mitral Stenosis - pathophysiology

•  LA pressure
•  Pulmonary pressure
• R Heart failure
•  LV function

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Mitral Stenosis – Symptoms/Signs
• SOB
• Haemoptysis
• Embolisation
• Mitral Facies
• AF, thready pulse
•  JVP
• RV heave
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Mitral Stenosis – Symptoms/Signs

• Opening snap
• Rumbling diastolic murmur
• Presystolic murmur

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Mitral stenosis - Investigations
• ECG – AF
• Xray – Pulmonary congestion, large LA
and R heart
• Echo – tight valve, high inflow large LA

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MS ECG

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MS x-ray

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MS echo

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 MS Treatment
• Antibiotic prophylaxis
• Anticoagulation (AF)
• Digoxin (AF)
• Mitral Valvuloplasty
• Surgical Replacement

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Mitral Valvuloplasty

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Aortic Stenosis - aetiology

• Congenital – bicuspid valve

• Acquired
– Rheumatic
– Senile/degenerative

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Aortic Stenosis – pathophysiology

• LVH
•  Cardiac output on exercise
• LV dilatation and failure

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Aortic stenosis – symptoms/
signs
• Asymptomatic
• Angina
• Heart Failure
• Syncope
• Sudden Death

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Aortic stenosis – symptoms/
signs
• Slow rising pulse
• LV heave
• Ejection systolic
murmur radiating to
carotids

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 Aortic Stenosis - investigations
• ECG – LVH
• Echo – LVH, calcified valve, high
doppler velocity
• Angio – Ao valve gradient

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AS ECG

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Congenital AS

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Echo AS

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Doppler/Pressure Aortic
stenosis

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Aortic stenosis - treatment

• Antibiotic prophylaxis
• Surgical replacement
before heart failure

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Aortic valve replacement

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Aortic Regurgitaiton- aetiology
• Aortic valve
– Rheumatic fever
– Infective endocarditis
– Bicuspid vlave
• Aortic dilation
– Age related
– Marfans
– Dissection

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Aortic regurg - pathophysiology

• Increased Lved volume

• Increased stroke volume
• LV dilatation
• LV failure

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AR – symptoms/signs

• Often asymptomatic
• Chest pounding
• Prominent pulse
• Heart failure

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AR – symptoms/signs
• deMusset’s sign
• Collapsing pulse
• Displaced apex beat
• Early diastolic murmur

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Auscultation AR

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 AR investigations
• ECG – LVH
• X-ray – abnormal aorta, large heart
• Echo – AR, LV dilation, dissection
• Angiogram – AR, LV dilation

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AR - xray

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AR - Echo

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 AR - treatment

• Antibiotics
• Vasodilators
• Replacement – when
LV begins to dilate or
fail

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When to replace the aortic
valve?

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When to replace the mitral
valve

• When symptoms significant

• Before LV failure
• Before significant pulmonary
hypertension

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 Right heart valves

• Low pressure
• Tricuspid regurg (drug addicts)
• Pulmonary stenosis (congenital)

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