Professional Documents
Culture Documents
M Saugi Abduh
Heart contains
Mitral
Tricuspid
Aortic
Pulmonic
Valvular Disease
Normal Structure
Mitral Valve
Mitral Stenosis
Etiology & Pathology
Congenital
Carcinoid
Lupus
Amyloid
Infective Endocarditis
Mucopolysaccharide Disease
Stenotic Pathology
Commissural
Cuspal
Chordal
Mixed
30%
15%
10%
Remaining
Fig. 37-9
Fish mouth
Pathophysiology
History
Exertional Dyspnea
Cough/Wheezing
Orthopnea/PND/CHF
Hemoptysis-Rupture of Pulmonary VeinBronchial Vein Shunts
History
10
Physical Exam
Auscultation
11
Diastolic Rumble
Assoc Murmur of MR
Loud S1-thickened leaflets
Increased P2-pulmonary hypertension
Physical Exam
12
Diagnosis
ECG
13
Diagnosis
Chest X-ray
14
Natural History
15
Natural History
16
18
Moderate-Severe MS
Mild MS- if Pulmonary Artery Pressures or
Wedge Pressure Elevate with Exercise
Valve Replacement
Indications
Mortality
19
Combined MS/MR
<1.5 cm-NYHA III or IV
<1 cm
Class II if Pulmonary Artery Pressure >70mmHg
3-8%
Mitral Regurgitation
Etiology
20
Pathophysiology
21
Pathophysiology
LV Compensation
22
Pathophysiology
LV Decompensation
23
Pathophysiology
24
History
25
Shortness of Breath
Exertional Dyspnea
Congestive Heart Failure
Right Heart Failure
Significant symptoms in chronic MR usually do
not develop until LV decompensation occurs.
History
26
80% 5yr
60% 10yr
30-45% 5yr if MR severe
Diagnosis
Physical Exam
ECG
LA abnormality
LVH
RVH
Chest X-ray
27
Holosystolic Murmur
Increase Carotid Impulse
Diagnosis
Echo
28
Management of Acute MR
Medical
29
Management of Acute MR
Surgical Intervention
30
Management of Chronic MR
Medical
31
Digoxin
Diuretics*
After load Reduction
Anticoagulation in A-fib
Endocarditis Prophylaxis
Management of Chronic MR
Surgical
Indications
Asymptomatic Class I
32
Aortic Valve
Normal Structure
33
34
Valvular
Supravalvular
Subvalvular
Hyperthrophic Cardiomyopathy
Unicuspid
Bicuspid
Adult Presentation
Chronic turbulent flow
Leads to fibrosis, rigidity, calcification
Tricuspid
35
Rheumatic
Degenerative or Senile
36
Rare
Usually mitral valve also involved
Most common cause of adult AS
Most common cause of valve replacement
Inflammatory or Infectious component??
>age 65 30% Aortic Sclerosis
37
Hemodynamics
Critical (Surgical) AS
Moderate AS
38
1-1.5cm
Mild AS
1.5-2cm
Aortic Sclerosis
History
39
Hypertrophied myocardium
Increased ventricular systolic pressure
All of which increase myocardial oxygen
consumption
Oxygen supply-demand imbalance leads to
subendocardial ischemia
Diagnosis
Physical Examination
Systolic Murmur
Pulses Parvus
42
Diagnosis
ECG
Chest X-ray
Concentric LVH
Calcification of Aortic Valve
Echo
43
Classic LVH
Diagnosis
44
Cardiac Catherization
Medical Management
45
Endocarditis Prophylaxis
Limit Physical Activity
Watch Beta Blockers and Diuretics
*Treatment of Critical AS in viable
candidates is surgery
Indications
46
Aortic Regurgitation
Etiology and Pathology
Valvular
47
48
History
Acute AR
Chronic AR
49
50
Physical Examination
Diastolic Murmur
51
Physical Examination
Bisferiens-pulse
Duroziezs Sign
52
2 peaks
Traubes Sign
Physical Examination
Quinckes Sign
Mullers Sign
Hills Sign
53
Capillary pulsations
Physical Examination
Korotkoff Sounds
54
Diagnosis
ECG
Chest X-ray
55
Echo
LVH
Cardiac Catheterization
Medical Treatment
Symptomatic Moderate-Severe AR
56
Surgical Treatment
Indications
57
Surgical Treatment
Mortality
58
3-8% perioperative
5-10% late mortality with significant preop LV
dysfunction
Uncommon
Diagnostic Tests
Medications
ACE inhibitors
Digoxin
Diuretics
Vasodilators
Beta blockers
Anticoagulants
*Prophylactic antibiotics