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AORTIC STENOSIS ETIOLOGY Narrowing of the aortic valve caused 1. Rheumatic fever 2.

Congenital bicuspid aortic valve Haemodynamics Since the aortic valve is narrowed the left ventricle has to work harder to pump the blood through the aorta that will result in concentric left ventricular hypertrophy. Here no dilation of ventricles occurs. The bulk of ventricular musculature increases uniformly within the chamber.

Clinical features 1. Chest pain and dyspnoea appears very late. 2. Syncopal attacks are common 3. Sudden death is also common Signs 1. Pulse slow rising pulse 2. B.p- normal 3. Apical impulse- normal in position heaving in nature. 4. Systolic thrill and ejection systolic murmur in the aortic area. This thrill and murmur are sometimes conducted to the

carotid. this is known as carotid shudder. Investigations: 1. X-ray chest- normal heart size 2. ECG- features of LVH 3. Eho cardiogram- confirms the diagnosis. Complications: Left sided cardiac failure. Treatment: Medical management- treatment for the failure

Surgical management- valve replacement.

AORTIC REGURGITATION Etiology: 1. Congenital bicuspid aortic valve 2. Rheumatic fever 3. Atherosclerosis 4. Syphilis- tertiary syphilis 5. Marfans syndrome. More than usual height Hyper mobile minor joints. 6. Rheumatoid arthritis 7. Ankylosing spondylitis. Haemodynamics

Due to the improper closer of the aortic valve,some of the blood reversing back to the ventricle. So the ventricle goes for volume overload, that will result in left ventricular hypertrophy as well as enlargement. Clinical features: 1. 2. 3. Chest pain Palpitation Dyspnoea.

Signs: 1. Pulse- large volume and collapsing pulse (water hammer pulse)

2. B.P- may be 120/0, sometimes diastolic pressure may be 10, 20,or 0. 3. Apical impulse-shifted downwards and outwards and also hyperdynamic in nature. 4. Diastolic thrill and early diastolic murmur over the aortic area. Investigations: 1. X-ray chest- cardiomegaly 2. ECG- LVH features 3. Eho cardiogram and Doppler study- confirms the diagnosis. Complications: 1. Infective endocarditis

2.

Left side cardiac failure

Treatment: Medical management- treatment for the failure Surgical management- valve replacement.

TRICUSPID STENOSIS Etiology: 1. 2. Rheumatic fever Carcinoid syndrome

Haemodynamics

Because of the stenosed tricuspid valve, the right atrium has to work harder to pump blood into right ventricle. So the right atrium goes for enlargement and hypertrophy. Clinical features: 1. 2. 3. 4. Chest pain Dyspnoea Palpitation Elevated JVP

Signs: Diastolic thrill and murmur in the tricuspid area. Complications: Right side heart failure.

Investigations: 1. X-ray chest- enlarged right atrium 2. ECG- features of RAH 3. Ehocardiogram- confirms the diagnosis. Treatment: Medical management for the failure Surgical management valve replacement surgery

TRICUSPID REGURGITATION Etiology: Rheumatic fever. Haemodyanmics: Due to the improper closure of the tricuspid valve there is back flow of blood into the RA during ventricular systole. So the RA and RV goes for hypertrophy and enlargement following volume overload. Clinical features: 1. 2. 3. 4. Chest pain Dyspnoea Palpitation Elevated JVP

5. Systolic thrill and pansystolic murmur over the tricuspid area. Complications: Right sided cardiac failure Investigation: 1. X-ray chest- enlargement of RA and RV 2. ECG- features of RAH and RVH 3. Echocardiogram and colour Doppler study- confirms the diagnosis. Treatment: Medical management for the failure Surgical valve replacement.

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