Structural, Infectious, and Inflammatory Cardiac Disorders

Valvular Disorders

Heart valves regulate blood flow between the atria, ventricles, pulmonary artery, and aorta by opening and closing with pressure changes during systole and diastole.

Regurgitation (insufficiency)

Valve does not close properly → backward blood flow.

Stenosis

Valve does not open fully → reduced forward blood flow.

Mitral valve prolapse

Deformity of the mitral valve where leaflets balloon back into the LA during systole. Usually asymptomatic, rarely severe → may progress to mitral regurgitation or sudden death. Associated with connective tissue disorders; annulus dilates, chordae/papillary muscles may elongate or rupture.

Mitral Regurgitation

Condition where blood flows backward from the left ventricle into the left atrium during systole due to incomplete closure of the mitral valve. Can be chronic or acute.

Most are asymptomatic.

Possible symptoms: fatigue, dyspnea, dizziness, syncope, palpitations, chest pain, anxiety.

Clinical Manifestations of MVP

Chronic MR: Often asymptomatic.

Acute MR (e.g., post-MI): Sudden severe heart failure.

Common symptoms: Dyspnea Fatigue and weakness Palpitations Exertional shortness of breath Cough due to pulmonary congestion

Clinical Manifestations of MR

Mitral valvuloplasty (valve repair).

Valve replacement (mechanical or tissue valve).

Surgical Intervention for MR if symptomatic or progressive

Mitral Stenosis

calcified mitral valve impedes forward flow of blood into left ventricle during diastole. Most often due to rheumatic endocarditis, which thickens and fuses valve leaflets and chordae tendineae, narrowing the mitral orifice.

DOE, Fatigue, Cough, wheezing, hemoptysis, Palpitations, orthopnea, Atrial arrhythmias

Clinical Manifestation of MS

Aortic Regurgitation (AR)

A condition where the aortic valve fails to close properly, allowing blood to leak back from the aorta into the left ventricle (LV) during diastole. Also called aortic insufficiency.

"Pounding" heartbeat, forceful palpitations (especially in head/neck). Visible pulsations in carotids, nailbed capillary pulsations (Quincke's sign), head bobbing with each heartbeat (de Musset's sign). Water hammer (Corrigan's) pulse: Bounding, collapsing pulse. Hill's sign: Popliteal systolic BP > brachial BP by >20 mmHg. Duroziez's sign: Systolic and diastolic murmurs heard over femoral artery. Traube's sign: "Pistol-shot" sounds over femoral artery.

Clinical Manifestations of AR

Aortic valve replacement (AVR): Gold standard, indicated before severe LV dysfunction develops.

Valvuloplasty: May be used in select cases but less common.

Surgical Interventions for AR

Aortic Stenosis (AS)

Narrowing of the aortic valve orifice between the left ventricle (LV) and aorta, obstructing LV outflow.

Dyspnea on exertion (DOE), Angina, Syncope

Clinical Manifestations of AS

Aortic valve replacement (AVR)

Transcatheter aortic valve replacement (TAVR)

Percutaneous balloon valvuloplasty

Surgical Interventions for AS

Cardiomyopathy

A disease of the heart muscle associated with cardiac dysfunction.

Dilated (DCM)

Hypertrophic (HCM)

Restrictive (RCM)

Classifications of Cardiomyopathy

Dilated Cardiomyopathy (DCM)

Most common cardiomyopathy with ventricular dilation without hypertrophy. ↓ systolic function, ↓ ejection fraction, ↑ end-diastolic pressure. HFrEF

Hypertrophic Cardiomyopathy (HCM)

CM that can be caused by autosomal dominant genetic disorder. Leading cause of sudden death in young athletes. May cause LV outflow tract (LVOT) obstruction. HFpEF

Restrictive Cardiomyopathy (RCM)

Rarest Type of cardiomyopathy where heart muscle stiffens, impairing ventricular filling. HFpEF

Decrease SNS and RAAS activity, venous congestion, Increase BNP activity

Dilated and Restrictive CM management

Increase Venous return and afterload, decrease contractility, Myectomy

Hypertrophic CM management

Rheumatic Endocarditis

Develops after acute rheumatic fever (ARF), which follows untreated or inadequately treated group A beta-hemolytic streptococcal (GAS) pharyngitis. Most common in school-age children.

New heart murmur (due to valve damage)

Cardiomegaly

Pericarditis

Heart failure

Acute rheumatic fever may present with:

Infective Endocarditis (IE)

Microbial infection of endothelial surface of the heart. High mortality.

Petechiae (skin, mucous membranes, conjunctiva)

Osler nodes: painful nodules (fingers/toes)

Janeway lesions: painless macules (palms/soles)

Roth spots: retinal hemorrhages with pale centers

Splinter hemorrhages (nails

Peripheral/immune signs of Infective Endocarditis

Myocarditis

inflammation of the muscle of the heart

Heart dilation

Formation of mural thrombi (clots on the heart wall)

Infiltration of blood cells between fibers

Muscle fiber degeneration

Myocarditis can lead to:

Fatigue, malaise, flu-like symptoms

Dyspnea, syncope, palpitations

Chest or upper abdominal discomfort

Common symptoms of Myocarditis

Acute

Chronic

Recurrent

types of Pericarditis

Constrictive Pericarditis

fibrous scar tissue making the pericardium stick to the heart, decreases elasticity

Chest pain that is Worse with deep inspiration, lying down, or turning. Relieved by sitting up or leaning forward. Friction Rub at LLSB

Cardinal Symptom of Pericarditis

Annuloplasty

Repair of a cardiac valve's outer ring (annulus).

Autograft

Valve replacement using the patient's own valve (e.g., pulmonic valve moved to replace aortic valve).

Bioprosthesis / Heterograft

Tissue valve replacement made from animal heart valve.

Commissurotomy

Surgical splitting/separating of fused valve leaflets (used for stenosis).

Ejection fraction (EF)

% of blood ejected from ventricle per beat (normal ≈ 55-70%).

Homograft / Allograft

Valve replacement from a human donor heart valve.

Total artificial heart (TAH)

Mechanical device replacing both ventricles to aid circulation.

Valvuloplasty

Repair of a stenosed/regurgitant valve by commissurotomy, annuloplasty, leaflet repair, or combination.

Ventricular assist device (VAD)

Mechanical pump to assist a failing left or right ventricle.

muffled heart sounds, JVD, hypotension

Beck's triad for cardiac tamponade

Quincke's sign

nailbed capillary pulsations

de Musset's sign

head bobbing with each heartbeat

Water hammer (Corrigan's) pulse

Bounding, collapsing pulse

Hill's sign

Popliteal systolic BP > brachial BP by >20 mmHg

Duroziez's sign

Systolic and diastolic murmurs heard over femoral artery

Traube's sign

"Pistol-shot" sounds over femoral artery.