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Valvular Heart Disease

Valvular Heart Disease. Vincent E. Friedewald, M.D. Classification of Heart Disease. Congenital Coronary Electrical Endomyocardial Pericardial Valvular. The Cardiac Valves. Cardiac Valve Anatomy. Valvular Heart Disease. Acute and Chronic are Different Diseases. Aortic Stenosis.

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Valvular Heart Disease

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  1. Valvular Heart Disease Vincent E. Friedewald, M.D.

  2. Classification of Heart Disease Congenital Coronary Electrical Endomyocardial Pericardial Valvular

  3. The Cardiac Valves

  4. Cardiac Valve Anatomy

  5. Valvular Heart Disease Acute and Chronic are Different Diseases

  6. Aortic Stenosis

  7. Aortic StenosisTypes Valvular Subvalvular Supravalvular

  8. Aortic Valve Stenosis

  9. Aortic Valve Stenosis Bicuspid Rheumatic Degenerative

  10. Aortic Valve StenosisAge Relationship

  11. Bicuspid Aortic Stenosis

  12. Rheumatic Aortic Stenosis

  13. Degenerative Aortic Stenosis

  14. Degenerative Aortic Stenosis Risk Factors Elevated LDL-cholesterol Diabetes mellitus Systemic arterial hypertension Cigarette smoking

  15. Aortic Valve StenosisSymptoms Often Asymptomatic Angina pectoris Dyspnea Fatigue Syncope

  16. Aortic Valve Stenosis Signs ARTERIAL PULSE, GEN – RISE, SLOW ARTERIAL PULSE, GEN – AMP, ABSENT OR REDUCED ARTERIAL PULSE, GEN – DOWNSLOPE GRADUAL ARTERIAL PULSE, GEN – PULSE PRESSURE, NARROW ARTERIAL PULSE, GEN – SHUDDER ARTERY, CAROTID – THRILL HEART, LV APEX – IMPULSE, PRESYSTOLIC HEART, LSB MID – MURMUR, DIASTOLIC HEART, LSB MID – MURMUR, SYSTOLIC

  17. Aortic Valve StenosisSigns (cont) HEART, LV APEX – CLICK, SYSTOLIC HEART, LV APEX – IMPULSE, SUSTAINED HEART, RSB UPPER – MURMUR, SYSTOLIC HEART, RSB UPPER – CLICK, SYSTOLIC HEART, SOUND A2 – ABSENT OR REDUCED HEART, SOUND S1 – SOFT HEART, SOUND S2 – SINGLE HEART, SOUND S2 – SPLIT REVERSED (PARADOXICAL) NECK, SUPRATERNAL NOTCH – THRILL, SYSTOLIC

  18. Aortic Valve StenosisSymptoms FATIGUE BREATHING – DIFFICULT WITH EFFORT (DYSPNEA) CHEST, ANT – PAIN, NONPLEURITIC (ANGINA PECTORIS) CHEST, ANT – PALPITATIONS CONSCIOUSNESS – LOSS, SUDDEN (SYNCOPE) CONSCIOUSNESS – LOSS, SUDDEN EFFORT (EFFORT SYNCOPE) DIZZINESS – EFFORT

  19. Aortic Valve StenosisUntreated Prognosis

  20. Aortic Valve StenosisChest X-Ray

  21. Aortic Valve StenosisECG

  22. Aortic Valve Stenosis Echo

  23. Aortic Valve StenosisAV Pressure Gradient

  24. Aortic Valve StenosisMedicalRX No drugs alter course – only valve repair/replacement Antibiotic Prophylaxis ? Statins For symptoms (if not candidate for valve replacement) – after-load reduction, i.e., nitroglycerine, used with caution to avoid BP fall

  25. Aortic Valve StenosisSurgical Rx Valvotomy Replacement Artificial Bioprosthesis Minimally-invasive transfemoral

  26. Aortic Valve ReplacementTransfemoral

  27. Aortic Valve StenosisComplications Atrial fibrillation Aortic Dissection Heart failure Infective endocarditis Myocardial infarction Sudden death

  28. Aortic Regurgitation (Insufficiency)

  29. Aortic RegurgitationEtiologies Primary aortic valve disease Aortic root abnormalities (Dissection, Syphilis) Connective tissue disorders (Marfan’s) Infective endocarditis Inflammatory disorders (SLE) Tumors

  30. Aortic RegurgitationSymptoms BREATHING – DIFFICULT , NOCTURNAL BREATHING – DIFFICULT WITH EFFORT CHEST, ANT – PAIN, NONPLEURITIC (ANGINA) CHEST, ANT – PALPITATIONS HEAD, GEN – PAIN SWEATING – NOCTURNAL

  31. Aortic RegurgitationSigns ARTERIAL PRESSURE, GEN – DIASTOLIC, LOW ARTERIAL PRESSURE, GEN – SYSTOLIC, ELEVATED ARTERIAL PULSE, GEN – DOUBLE ARTERIAL PULSE, GEN – FALL, RAPID ARTERIAL PULSE, GEN – PULSE PRESSURE, WIDE ARTERIAL PULSE, GEN – RISE, RAPID ARTERY, CAROTID – THRILL ARTERY, FEMORAL – SOUND, DIASTOLIC BOOMING

  32. Aortic RegurgitationSigns (cont) HEAD – BOBBING HEART, LSB MID – MURMUR, DIASTOLIC HEART, LSB MID – THRILL, DIASTOLIC HEART, LV APEX – IMPULSE, INF DISPLACEMENT HEART, LV APEX – IMPULSE, LAT DISPLACEMENT HEART, LV APEX – IMPULSE, DIFFUSE HEART, LV APEX – MURMUR, DIASTOLIC HEART, RSB UPPER – MURMUR , SYSTOLIC HEART, RSB UPPER – MURMUR, DIASTOLIC

  33. Aortic Regurgitation Signs (cont) HEART, RSB UPPER – THRILL, SYSTOLIC HEART, SOUND A2 – ABSENT OR REDUCED HEART, SOUND S1 – SOFT HEART, SOUND S2 – SPLIT REVERSED HEART, SOUND S3 LV MOUTH, UVULA – PULSATIONS NAILS – PULSATIONS NECK, SUPRATERNAL NOTCH – THRILL, SYSTOLIC

  34. Aortic Regurgitation – ChronicChest X-Ray

  35. Aortic RegurgitationEcho

  36. Aortic Regurgitation Medical Rx Vasodilators to reduce systolic BP Antibiotic prophylaxis

  37. Aortic Regurgitation Surgical Rx Aortic valve replacement

  38. Mitral Regurgitation (Insufficiency)

  39. Mitral RegurgitationEtiologies Congenital deformities Degenerative, i.e., myxomatous Endomyocardial fibroelastosis Mitral annular calcification Papillary muscle dysfunction – ischemic heart disease Rheumatic

  40. Mitral RegurgitationEtiologies (cont) Ergotamine toxicity Carcinoid syndrome Radiation Rx SLE Diet-drug therapy

  41. Mitral RegurgitationPapillary Muscles

  42. Mitral RegurgitationLeaflet Prolapse (MVP Syndrome)

  43. Mitral Regurgitation Calcified Annulus

  44. Mitral Regurgitation Symptoms BREATHING – DIFF, EFFORT FATIGUE SKIN, GEN – TEMPERATURE, COOL SWEATING – EXCESSIVE

  45. Mitral RegurgitationSigns ARTERIAL PULSE, GEN - AMP, ABSENT OR REDUCED ARTERIAL PULSE, GEN - FALL, RAPID ARTERIAL PULSE, GEN - RISE, RAPID CHEST, ANT LEFT - BULGE HEART, LV APEX - IMPULSE, FORCEFUL HEART, LV APEX - IMPULSE, DIFFUSE

  46. Mitral RegurgitationSigns (cont) HEART, LV APEX - IMPULSE, SUSTAINED HEART, LV APEX - MURMUR, DIASTOLIC HEART, LV APEX - MURMUR, SYSTOLIC HEART, SOUND P2 - LOUD HEART, SOUND S3 LV SKIN, GEN - TEMPERATURE, COOL

  47. Mitral Regurgitation2-D Echo

  48. Mitral RegurgitationDoppler Echo

  49. Mitral RegurgitationComplications Atrial fibrillation Pulmonary hypertension LV dysfunction Infective endocarditis

  50. Mitral RegurgitationMedical Rx Antibiotic prophylaxis ACEIs (functional form of MR) Beta-blockers (functional form of MR)

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