Valvular Heart Disease

mitral valve 2 leaflets only

all other valves tricuspid

stenosis- narrowing of valve leaflet

regurgitation - incompetence, not keeping seal it should

rheumatic hear disease - streptococcal infection, most common cause of mitral stenosis

congenital too

mitral stenosis also seen in Lupus…

Mitral valve orifice <2 cm squared

left ventricle function normal in mitral stenosis until very late stages

flow rate depends on HR, pumping blood faster, trans valvular gradient will increase too

breathless, haemoptysis, systemic embolisation, chest pain or hoarseness in mitral stenosis

any valve that’s abnormal can get infected

clinical examination in mitral stenosis: -RV heave -JVP prominent a wave -mitral facies

can be longer p wave on ECG in mitral stenosis

prominent R waves in V1 and V2

bulging of left heart border or left atrium enlargement on xray of mitral stenosis

thickening and scarring of the leaflets

fusion of the commissures

treatment for mitral stenosis:

-diuretics -restriction of Na intake

when severe valvotomy (balloon or surgical), the balloon is very temporary measure

replacement of mitral valve

mitral regurgitation

mitral valve prolapse more likely in the UK and also degenerative

effective regurgive .. not fixed

preload, afterload, LV contractility affect whether mitral regurgitation is acute or chronic

•Acute MR (valve perforation, chordal/papillary muscle)

•Breathlessness: pulm oedema, cardiogenick shock

•Chronic MR:

•Fatigue, exhaustion (low CO), Right heart failure

•Dyspnoea or palpitations due to AFib

•Pulse – normal or reduced in heart failure

•JVP – prominent if RH failure present

•Brisk and hyperdynamic apex beat

•RV heave

holosystolic/pansystolic, loud at apex radiating to axilla

aortic valve 3-4 cm squared

degenerative, rheumatic and some born with bicuspid aortic valve through fusion of cusps or just made out of two leaflets not necessarily equal - most common

aortic stenosis most common valve disease in adult life

long asymptomatic phase

when symptomatic survival drops

4L per second speed of blood circulation, causes more degeneration as more damage and scarring and calcification will occur on endothelium

aortic regurgitation either pulmonary oedema and cardiogenic shock or left ventricular failure

early diastolic, decrescendo, soft murmur

displaced apex beat, large pulse that collapses very quickly

high systolic blood pressure

wide pulse pressure

pulse into carotids coming up and down if lying flat

after second heart sound decrescendo soft murmur

cardiomegaly/bovine heart

ECG ST/T changes (LV strain)

failure of three leaflets centrally allows regurgitation to occur

vasodilator therapy, delays surgery for 3-4 years

or aortic valve replacement or repair