Valvular Heart Disease

1. Valvular Heart Disease Hakan Karpuz, MD Dept. of Cardiology Cerrahpasa Medical School

3. Valvular Heart Disease (part I) Hakan Karpuz, MD Dept. of Cardiology Cerrahpasa Medical School

4. Aortic Valve Aortic Stenosis Aortic Regurgitation

5. Aortic Valve Aortic Stenosis Aortic Regurgitation

6. Learning Objectives Describe the pathophysiology, etiology, signs and symptoms, natural history, and treatment of aortic stenosis.

7. Aortic Stenosis Pathophysiology Related to pressure changes, Valve obstructed, LV > pressure, LV hypertrophy, LA enlarges, Decreased cardiac output

9. Aortic Stenosis • Etiology • Sub-valvular • Supra-valvular • Valvular (most common)

10. Aortic Stenosis “Valvular” • Etiology • Rheumatic Heart Disease • Congenital AV Disease •  Bicuspid Aortic Valve • Idiopathic Calcific Aortic Stenosis

12. Aortic Stenosis “Valvular” • Symptoms • Fatigue • Dyspnea on exertion • Angina • Exertional Syncope • Heart Failure • Sudden Cardiac Death

13. Aortic Stenosis “Valvular” • Vital Signs • Narrow pulse pressure • PMI • Displaced • Ascultation • S2 • Murmur

14. Aortic Stenosis “Valvular” ECG Hypertrophy CXR Cardiomegaly 50% of the time ECHO Confirm, Severity LHC Severity, Coronary Artery Disease

16. Aortic Valve Area…formula

17. don’tforget! thebestmethod is…

18. Natural History  Asymptomatic For many years Duration of symptoms (until death) Angina  - 3 years Syncope - 2 years CHF - 18 months Aortic Stenosis “Valvular”

19. Aortic Stenosis “Valvular” Natural History  Treated Aortic Stenosis 40% survived for 5 years 20% survived for 10 years Sudden Cardiac Death Decreased cerebral blood flow Arrhythmias

20. Aortic Stenosis “Valvular” Treatment Strenous Activity Limit for symptomatic Medical treatment of HF ACC/AHA guidelines for preload/afterload reduction& fluid management

21. Aortic Stenosis “Valvular” Treatment Surgical treatment indications, techniques, outcome depend on age/cause Adults: valve replacement

23. Aortic Valve Aortic Stenosis Aortic Regurgitation

24. Learning Objectives Describe the etiology, signs and symptoms, findings and treatment for aortic insufficiency.

26. Aortic Insufficiency Etiology Valvular Disease Rheumatic Heart Disease Infective Endocarditis Trauma (tear of the ascending aorta) Bicuspid valve

27. Aortic Insufficiency Etiology Aortic root disease (1/3 of patients) Marfan’s syndrome Cystic medial necrosis Syphilitic aortitis Ankylosing spondylitis Behcets syndrome Reiter’s syndrome Systemic Hypertension

28. Aortic Insufficiency Symptoms Angina, Palpitations, CHF symptoms Vital Signs Wide pulse pressure Pulses Abrupt distension/quick collapse: Corrigan’s pulse Bisferiens pulse 

29. Aortic Insufficiency Palpation PMI, Thrill Auscultation S2 variable, A2 absent Murmur Diastolic: patient sitting, leaning forward, on expiration, diaphragm at Erb’s point Austin Flint Murmur, De Musset’s

30. Aortic Insufficiency Findings   EKG LVH CXR Marked enlargement if AI is chronic ECHO Confirms/severity LHC Severity/CAD

31. remember! thebestmethod is…

32. Aortic Insufficiency Natural History 

33. Aortic Insufficiency Treatment   Follow clinically (q 6 mos) Asymptomatic with normal LV Use IE prophylaxis Treated Symptomatic with LV function decrease Medications AVR

34. Valvular Heart Disease (part II) Hakan Karpuz, MD Dept. of Cardiology Cerrahpasa Medical School

36. Mitral Valve Mitral Stenosis Mitral Regurgitation

37. Mitral Valve Mitral Stenosis Mitral Regurgitation

38. Learning Objectives Describe the etiology, pathophysiology, signs and symptoms, physical exam, and treatment of mitral stenosis.

39. Mitral Valve Stenosis Etiology Rheumatic heart disease (female) Congenital Rare: SLE Amyloid Carcinoid Rheumatoid Arthritis

40. Mitral Valve Stenosis • Pathophysiology • Minimum of 2 yrs for severe MS to develop after ARF • Pressure elevates in: • Left atrium • Pulmonary tree • Right heart • Atrial contraction • 30% of CO, Atrial fibrillation 

41. Mitral Valve Stenosis Dyspnea on exertion Hemoptysis Chest pain CHF symptoms Hoarseness Pulmonary Embolism Infective Endocarditis

42. Mitral Valve Stenosis Physical Exam Inspection JVP Sternal lift Palpation Sternal heave Apex Auscultation Accentuated S1, Opening snap, Diastolic murmur

43. Mitral Valve Stenosis EKG LAE Pulmonary HTN CXR LAE ECHO Confirm/severity LHC Severity/CAD

44. Mitral Valve Stenosis Treatment  Medical SBE prophylaxis Avoid strenuous exercise Diuretics Anticoagulants Rheumatic heart disease Atrial fibrillation Treatment AF Digoxin

45. Mitral Valve Stenosis Treatment Surgical Asymptomatic Follow Symptomatic Balloon Valvuloplasty Open commissurotomy Valve replacement Mechanical Bio-prosthetic 

48. Mitral Valve Prolapse  • Other terms: Floppy valve, Barlow’s • Etiology • Congenital • Marfan’s syndrome • RHD • Sequelae of CM or MI • Pathophysiology • Valve leaflet has redundant tissue • Extra tissue balloons into LA, click sound

49. Mitral Valve Prolapse  • Incidence • 10-20 % of population • F > M • Clinical Presentation • Asymptomatic • Symptomatic • Palpitations • Arrhythmias • Atypical Chest Pain

50. Mitral Valve Prolapse • MVP-Physical Exam/Diagnosis  • Thin, young females • Abnormalities • Skeletal • Heart • Auscultation • Mid-systolic click