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VALVULAR HEART DISEASE. BY DR GHULAM HUSSAIN. MBBS, Diploma in Cardiology, MD (Medicine) Assistant Professor of Medicine Medical Unit-4 LUMHS, Jamshoro / Hyderabad . AORTIC STENOSIS. Etiology. Congenital aortic stenosis b. Senile calcific stenosis c. Bicuspid aortic valve

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valvular heart disease

VALVULAR HEART DISEASE.

BY

DR GHULAM HUSSAIN.

MBBS,

Diploma in Cardiology,

MD (Medicine)

Assistant Professor of Medicine

Medical Unit-4

LUMHS, Jamshoro / Hyderabad

etiology

Etiology

Congenital aortic stenosis

b. Senile calcific stenosis

c. Bicuspid aortic valve

d. Rheumatic aortic stenosis

pathophysiology

PATHOPHYSIOLOGY.

Aortic valve stenosis produces a pressure over load on the left ventricle due to the greater pressure that must be generated to force blood past the stenotic valve .

a. Obstruction to out flow causes pressure over load and left ventricle hypertrophy

b. Hypertrophy increases thick ness of left ventricle .

clinical features

Clinical Features

Symptoms

Asymptomatic patients are little risk of death.

Angina

Syncope

Heart Failure

physical signs

Physical Signs

Delayed Carotid Upstroke

Systolic Ejection Murmur

Soft, Single S2

S4

Sustained, heaving apex beat

laboratory diagnosis

Laboratory Diagnosis

Electrocardiography  The ECG usually shows evidence of left ventricular hypertrophy.

2. Echocardiography

Cardiac Catheterization

therapy

Therapy

Palliative Therapy

Medical Therapy

b. Curative Therapy

Homograft Valves

Heterograft Vales

Mechanical Valves

Autograft (Ross Procedure)

etiology1

Etiology

Idiopathic aortic root dilatation

Rheumatic Heart Disease

Infective Endocarditis

Marfan Syndrome

Proximal root dilatation

Aortic root dissection

e. Aortic Dissection

Syphilis

Collagen Vascular disease

slide11

Pathophysiology

a. A portion of the left ventricular stroke volume

ejected during systole regurgitation into the left

ventricular during diastole.

b. The increase in total stroke volume leads to

increase in pulse pressure and increase in

systolic pressure.

clinical features1

Clinical Features

a. Symptoms

Left Ventricular Failure

Chronic Aortic Insufficiency

Acute Aortic Insufficiency

2. Syncope

3. Angina

clinical features2

Clinical Features

b. Physical Signs

Left Ventricular Impulse

Diastolic Murmur

Austin Flint Murmur

Total Stroke Volume

a. Corrigan’s Pulse

b. Hill’s sign

c. Pistol-shot femoral pulses

d. Duroziez’s sign

e. De Musset’s sign

f. Quincke’s pulse

diagnosis

Diagnosis

Electrocardiography  The ECG usually shows left ventricular hypertrophy.

2. Chest Radiography

3. Echocardiography

4. Cardiac Catheterization

therapy1

Therapy

Aortic Valve replacement

b. If surgery is not possible, therapy with digitlis, diuretics and vasodilators may affoard symptomatic relief.

etiology2

Etiology

Almost all cases of mitral stenosis in adult are

secondary to rheumatic heart disease.

Most cases occur in women.

pathophysiology1

Pathophysiology

1. Impedes left ventricular filling

2. Increase left atrial pressure

3. Leads to pulmonary congestion

4. Pulmonary hypertension

5. Right Ventricular failure

clinical features3

Clinical Features

Symptoms

Left sided failure

Right Sided failure

Hemoptysis

Systemic embolisim

Hoarseness

clinical features4

Clinical Features

b. Physical Signs

Atrial Fibrillation

Pulmonary rales

Increase intensity of the S1

Increase intensity of the P2

Opening Snap

Diastolic rumble

Sternal lift

Other symptoms

laboratory diagnosis1

Laboratory Diagnosis

Electrocardiography

Chest Radiography

Echocardiography

therapy2

Therapy

Medical Therapy

Diuretics

Digitalis

Anticoagulants

b. Balloon Valvuloplasty

c. Surgical Therapy

1. Mitral Commissurotomy

2. Mitral Valve Replacement

mitral regurgitation1

Mitral Regurgitation

Etiology

Rheumatic Heart Disease

Ruptured ChordaeTendineae

Coronary Artery Disease

Infective Endocarditis

Mitral Valve prolaps and click syndrome murmur

pathophysiology2

Pathophysiology

Increase left atrial pressure and decrease

forward cardiac output.

clinical features5

Clinical Features

a. Symptoms

Dypnea or Thopnea

Paroxysmal nocturnal dyspnea

Pulmonary hypertension and symptoms of right sided failure

Symptoms of systemic embolization

clinical features6

Clinical Features

b. Physical Sign

Left ventricular impulse

Murmur

An S3 usually heard in mitral regurgitation and may occur even in the absence of overt heart failure.

diagnosis1

Diagnosis

- Electrocardiography

- Chest Radiography

- Echocardiography

- Cardiac Catheterization

therapy3

Therapy

Medical Treatment

Diuretics

Digitalis

Anticoagulants

Vesodilators

b. Surgical Treatment

1. Valve Replacement

2. Valve Repair

etiology3

Etiology

Infective endocarditis

b. Right ventricular failure

c. Rehumatic heart disease

pathophysiology3

Pathophysiology

During systole, the dysfunctioning tricuspid valve

allows blood to flow backward into the right

atrium, leading to systemic venous congestion

and venous congestion and venous

hypertension.

clinical features7

Clinical Features

Symptoms

Edema

Ascites

Hepatic Congestion

Right Upper Quadrant Pain

Jaundice

clinical features8

Clinical Features

b. Physical Signs

Right ventricle Lift

Murmur

Jugular Venus Pulsation

Pulsatile Liver

diagnosis2

Diagnosis

Chest Radiography

Echocardiography

therapy4

Therapy

Reduced the right ventricular pressure

Surgical Repair

Replacement of Tricuspid valve