Valvular Heart Disease

What is aortic stenosis?

Narrowing of the aortic valve causing obstruction to left ventricular outflow.

What causes aortic stenosis?

• Calcification (most common)

• Congenital bicuspid valve

• Rheumatic disease

What are symptoms of aortic stenosis?

• Exertional dyspnea

• Angina

• Syncope

What is the classic triad of aortic stenosis?

• Chest pain

• Syncope

• Dyspnea

What physical exam finding occurs in aortic stenosis?

Harsh systolic crescendo-decrescendo murmur at right upper sternal border radiating to carotids.

What pulse finding occurs in aortic stenosis?

Pulsus parvus et tardus (weak and delayed).

What imaging evaluates aortic stenosis?

Echocardiogram.

What is the treatment for severe aortic stenosis?

Valve replacement.

What is aortic regurgitation?

Backflow of blood from the aorta into the left ventricle during diastole.

What causes aortic regurgitation?

• Aortic root dilation

• Bicuspid valve

• Endocarditis

• Rheumatic disease

What are symptoms of aortic regurgitation?

• Dyspnea

• Fatigue

• Palpitations

What physical exam finding occurs in aortic regurgitation?

High-pitched blowing diastolic murmur at left sternal border.

What pulse finding occurs in aortic regurgitation?

Wide pulse pressure

What imaging evaluates aortic regurgitation?

Echocardiogram.

What is the treatment for severe aortic regurgitation?

Valve replacement.

What is mitral stenosis?

Narrowing of the mitral valve causing obstruction to left ventricular filling.

What causes mitral stenosis?

Rheumatic heart disease (most common).

What are symptoms of mitral stenosis?

• Dyspnea

• Orthopnea

• Hemoptysis

• Fatigue

What physical exam finding occurs in mitral stenosis?

Opening snap followed by low-pitched diastolic rumble at apex.

What imaging evaluates mitral stenosis?

Echocardiogram.

What complications occur from mitral stenosis?

• Atrial fibrillation

• Pulmonary hypertension

What is the treatment for severe mitral stenosis?

Balloon valvotomy or valve replacement.

What is mitral regurgitation?

Backflow of blood from the left ventricle into the left atrium during systole.

What causes mitral regurgitation?

• Mitral valve prolapse

• Rheumatic disease

• Endocarditis

• Papillary muscle dysfunction

What are symptoms of mitral regurgitation?

• Dyspnea

• Fatigue

• Palpitations

What physical exam finding occurs in mitral regurgitation?

Holosystolic blowing murmur at apex radiating to axilla.

What imaging evaluates mitral regurgitation?

Echocardiogram.

What complications occur from mitral regurgitation?

• Atrial fibrillation

• Heart failure

What is the treatment for severe mitral regurgitation?

Valve repair or replacement.

What is mitral valve prolapse?

Bulging of one or both mitral leaflets into the left atrium during systole.

What causes mitral valve prolapse?

• Myxomatous degeneration

• Connective tissue disorders

What are symptoms of mitral valve prolapse?

• Palpitations

• Chest pain

• Anxiety

• Often asymptomatic

What physical exam finding occurs in mitral valve prolapse?

Mid-systolic click with late systolic murmur.

What imaging evaluates mitral valve prolapse?

Echocardiogram.

What complications occur from mitral valve prolapse?

• Mitral regurgitation

• Arrhythmias

What is the treatment for symptomatic mitral valve prolapse?

Beta-blockers.

What imaging modality is preferred for all valvular diseases?

Echocardiography

What is the most common cause of left-sided valvular disease?

Degenerative calcification.

What valvular disease causes wide pulse pressure?

Aortic regurgitation.

What valvular disease causes pulsus parvus et tardus?

Aortic stenosis.

What valvular disease causes opening snap?

Mitral stenosis.

What valvular disease causes mid-systolic click?

Mitral valve prolapse.

What valvular disease causes holosystolic murmur radiating to axilla?

Mitral regurgitation.

What valvular disease causes systolic murmur radiating to carotids?

Aortic stenosis.