Valve Diseases

Valve Disease

	Mitral Stenosis	Mitral Regurgitation	Aortic stenosis	Aortic regurgitation
Causes	Rheumatic, congenital parachute valve- all chordate insert into 1 papillary muscle., mucopolysacharide	Functional (LV dilatation) annular calcification, Rheumatic, IE, HOCM	senile calcification, bicuspid valve, William’s syndrome	congenital, rheumatic fever, IE, RA, aortic root disease
Symptoms	dyspnoea, PND, haemoptysis (ruptured bronchial vein), ascites	dyspnoea, fatigue	Exertional chest pain/dyspnoea/ syncope	Exertional dyspnoea, angina, palpitation
General	tachypnoea, mitral stenosis	tachypnoea	-	Marfan, ankylosing spondilytis
Pulse, BP	normal/↓	normal/ sharp upstroke	Pulse: Plateu/ anacrotic/ late peaking/ small volume	Pulse :collapsing, water hammer/ bisfirens Corrigan sign
Palpation	tapping apex beat (palpable S1	displaced apex beat, pansystolic thrill, parasternal impulse	apex beat hyperdynaamic, slightly displaced	apex beat displaced & hyperkinetic
Auscultation	Loud S1, mid-diastolic murmur over mitral area using bell, louder with isometric handgrib and left lateral position	Soft/ no S1 pansystolic murmur maximal at the apex and radiating to the axilla, louder with isometric handgrib and left lateral position	narrowly  split/ reversed S2 Ejection systolic murmur, radiates to carotid arteries, louder when pt squats rapidly from standing position	Soft S1 Early diastolic murmur, maximal at the left sternal border with diaphragm and pt leans forward in full expiration
Severe	valve area<1cm. longer murmur, early opening snap, soft S1	larger left ventricle, loud S3	valve area <1cm, valve gradient > 50mmHg,delayed carotid upstroke,late peaking murmur	collapsing pulse, wide pulse pressure, soft A2, Austin Flint murmur, systolic 80mmHg & than diatolic BP
Complication	Pulm. HTN, emboli, pressure effect
Test	ECG(AF, P-mitrale if in sinus rhytm, RVH) CXR(large left atrial, pulm edema, valve calcification), Echo. Indication for cardiac catheter: prev. valvotomy, other valve disease, angina, severe pulm HTN	ECG(AF, P-mitrale if in sinus rhytm, RVH) CXR(large LA & LV), Echo, Doppler echo, cardiac catheterisation	ECG(P-mitrale, LVH, LAD, LBBB), CXR(LVH, calcified aortic valve), Echo: (dx, measure valve gradient) Cardiac catheter: LV function	ECG:(LVH), CXR; (cardiomegaly), Echo, cardiac catheter
Management	control AF, warfarin, diuretics. if fail:balloon valvuloplasty, open valvulotomy/valve replacement, penicillin for recurrent rheumatic fever if <;30 Indication for surgey LVEF <60%, LVESD < 45mm		symptomatic: Prompt valve replacement, except for unfit: percutaneous valvuloplasty. Asymptomatic: regular monitor Poor prognosis: 2-3y if angina,	Valve replacement