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Valvular heart disease

Valvular heart disease. Dr Husain Tayib. Dr Husain Tayib. Valvuler heart disease. 1. Anatomy. Valvuler heart disease. 2. Causes of valve disease. Valve regurgitation * Congenital *Acute rheumatic carditis *Chronic rhe. Carditis

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Valvular heart disease

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  1. Valvular heart disease Dr Husain Tayib Dr Husain Tayib

  2. Valvuler heart disease 1 Anatomy

  3. Valvuler heart disease 2 Causes of valve disease Valve regurgitation * Congenital *Acute rheumatic carditis *Chronic rhe. Carditis * I E *Syphlitic aortitis *Dilated Valve ring *Senile degeneration e.g. dilated CMP *Traumatic valve rupture *Damage to chordae and papillary muscles e.g. M I Valve stenosis * Congenital * Senile degeneration *Rheumatic carditis

  4. Mitral stenosis Dr Husain Tayib

  5. Mitral stenosis

  6. 1 Aetiology and pathophysiology Mitral stenosis *Almost rheumatic in origin. 2/3 are Females Pure or predominant MS 40% of all RVD *Heavy calcification in elderly may produce a form of mitral stenosis. *Congenital MS { rare }. _ Mitral vave orifice progressively diminish by fibrosis, calcification of leaflets and fusion 0f cusps and subvalvular apparatus. _LA dilate…LA pressure rises …pulmonary congestion occurs … later pulmonary hypertension ….RVF _Atrial fibrillation occurs in most patients with risk of thromboembolism. _> 20% remain in sinus rhythm with small fibrotic LA and severe PH

  7. 2 MItral stenosis Pathophysiology of MV : * Normal valve area: 4-6 cm2 * Mild. mitral stenosis _ MVA 1.5-2.5 cm2 _ Minimal symptoms * Mod. mitral stenosis _ MVA 1.0-1.5 cm2 usually does not produce _ Symptoms at rest * Severe mitral stenosis _ MVA < 1.0 cm2

  8. 3 Mitral stenosis Pathophsiolgy JVP

  9. Mitral stenosis 4 Clinical features Clinical features *Dyspnia {pulmonary congestion } * Fatigue { low COP } *Oedema, ascitis {RVF } *Palpitation { AF } *Haemoptysis {pulmonary congestion, PE } *Cough {pulmonary congestion } *Chest pain {PH } *Symptoms of thromboembolic complication { e.g. stroke, ischaemic limb} Symptoms Symptoms *Dyspnia {pulmonary congestion } * Fatigue { low COP } *Oedema, ascitis {RVF } *Palpitation { AF } *Haemoptysis {pulmonary congestion, PE } *Cough {pulmonary congestion } *Chest pain {PH } *Symptoms of thromboembolic complication { e.g. stroke, ischaemic limb}

  10. 5 MItral stenosis Clinical features cont. Signs : • * Atrial fibrillation • * Mitral facies , tapping apex {Palpable 1st HS} • * Auscultation : Loud first HS, Opening snap • Mid-diastolic murmer, presyst. Accentuation • * Signs of raised pulmonary capillary pressure : • _Crepitations, _Pulmonary oedema, Effusion • * Signs of pulmonary hypertension: • RV heave, Loud P2

  11. Physical examination MItral stenosis 6 Auscultation

  12. Common Murmurs and Timing (click on murmur to play) Systolic Murmurs • Aortic stenosis • Mitral insufficiency • Mitral valve prolapse • Tricuspid insufficiency Diastolic Murmurs • Aortic insufficiency • Mitral stenosis S1 S2 S1

  13. Investigations Mitral stenosis 7 * ECG : LA hypertrophy , RVH , AF * Chest X-ray : Enlarged LA Pulmonary venous congestion * ECHO : Thick immobile cusps Reduced valve area Reduced rate of LV diastolic filling * Doppler : _ PG across MV _ Pulmonary artery pressure * Cardiac catheterization : _ Pulmonary wedge pressure _ PG between LA and LV

  14. 8 Mitral stenosis ECG MS+ AF

  15. Mitral stenosis 9 Chest X-ray PA view

  16. Mitral stenosis 10 Chest X-ray lat. View +Barium swallow

  17. 11 Mitral stenosis M-mode ECHO MS Normal

  18. Mitral stenosis 12 AO MV LA . 2-d ECHO

  19. 13 MItral stenosis 2-D mode Active ECHO.

  20. 14 Mitral stenosis Pw Dopler

  21. Mitral stenosis 15 Color dopler

  22. Mitral stenosis 16 Natural history *Progressive, lifelong disease, *usually slow & stable in the early years. *Progressive acceleration in the later years *20-40 year latency from rheumatic fever to symptom onset. *Additional 10 years before disabling symptoms

  23. Management : Mitral stenosis 17 *Medical management : _Digoxin for AF +beta blocker or calcium antagonist _Diuretics for pulmonary congestion _Anticoagulant to reduce risk of systemic emboli _Antibiotic prophylaxis against IE *Mitral balloon valvoplasty : _ Significant symptoms _Isolated MS _ No or trivial MR _Mobile noncalcific valve /subvalvular apparatus on ECHO _ LA free of thrombus *Mitral valve surgery : _Closed mitral valvotomy _ Open mitral valvotomy _Mitral valve replacement * Mechanical * Bioprosthesis

  24. Mitral stenosis 18 Mechanical valves

  25. Thank you

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