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Valvular Heart Disease

Valvular Heart Disease. Aortic Stenosis Aortic Regurgitation Mitral Stenosis Mitral Regurgitation Tricuspid Regurgitation (Tricuspid Stenosis, Pulmonary Stenosis, Pulmonary Regurgitation). Aortic Stenosis. Valvular Aortic Stenosis Supra-valvular Aortic Stenosis

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Valvular Heart Disease

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  1. Valvular Heart Disease • Aortic Stenosis • Aortic Regurgitation • Mitral Stenosis • Mitral Regurgitation • Tricuspid Regurgitation (Tricuspid Stenosis, Pulmonary Stenosis, Pulmonary Regurgitation)

  2. Aortic Stenosis • Valvular Aortic Stenosis • Supra-valvular Aortic Stenosis • Sub-valvular Aortic Stenosis Hypertrophic cardiomyopathy Sub-valvular membrane Left ventricular tunnel

  3. Valvular Aortic Stenosis • Congenital • Rheumatic • Degenerative/Calcific

  4. Symptoms • Angina • Dyspnoea • Syncope on exertion

  5. Signs • Slow rising/anachrotic pulse • Sustained apex • 2nd sound quiet • Ejection click • Ejection type systolic murmur usually best heard 2nd RICS, into carotids. Often well heard throughout praecordium

  6. Complications • Left heart failure • Sudden death

  7. Investigations • ECG • Chest x-ray • Echocardiogram • Cardiac catherisation

  8. Treatment • Surgical Aortic Valve Replacement • TAVI

  9. Causes of Aortic Regurgitation • Rheumatic fever • Bicuspid aortic valve • Infective endocarditis • Syphillis • Arthritides Reiter’s, Ank Spond, Rheumatoid

  10. Aortic Regurgitation Symptoms asymptomatic, dyspnoea Signs Pulse “collapsing”, “Water Hammer” Quinque’s, Corrigans, De Musset’s, pistol shot femorals, Duroziez’s signs

  11. Apex – displaced and hyperdynamic • Early diastolic murmur usually best heard lower left sternal edge

  12. Investigations ECGCXREchocardiogram Cardiac Catherisation

  13. Complications Left heart failure Endocarditis • Treatment Aortic Valve Replacement

  14. Mitral Stenosis • Symptoms • -Breathlessness • Complications Atrial fibrillation Systemic emboli Pulmonary hypertension Chest infections Infective endocarditis Right heart failure

  15. Signs of mitral stenosis • Atrial fibrillation • Maybe para sternal heave • “tapping” apex • Loud 1st sound • Maybe loud 2nd sound • Opening snap • Rumbling mid diastolic murmur at apex radiating to axilla

  16. Investigations ECGCXREchocardiogram Cardiac catheterisation

  17. Treatment • Rhythm control – Digitalis, beta blockers, calcium antagonists • Diuretics • Anti-coagulants • Balloon Valvotomy or Valve repair/replacement

  18. Mitral Regurgitation • Rheumatic fever • Prolapsing valve • Infective endocarditis • Papillary muscle dysfunction • Ruptured chordae • Left heart dilation • Connective tissue disorders

  19. Apex displaced • Quiet first sound • Pan systolic murmur at apex • If severe, 3rd heart sound

  20. Investigations ECGCxREcho Cardiac catheter

  21. Treatment • Diuretics • Vasodilators • (Anti-coagulation) • Mitral valve repair/replacement

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