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VALVULAR HEART DISEASE.

VALVULAR HEART DISEASE. BY DR GHULAM HUSSAIN. MBBS, Diploma in Cardiology, MD (Medicine) Assistant Professor of Medicine Medical Unit-4 LUMHS, Jamshoro / Hyderabad . AORTIC STENOSIS. Etiology. Congenital aortic stenosis b. Senile calcific stenosis c. Bicuspid aortic valve

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VALVULAR HEART DISEASE.

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  1. VALVULAR HEART DISEASE. BY DR GHULAM HUSSAIN. MBBS, Diploma in Cardiology, MD (Medicine) Assistant Professor of Medicine Medical Unit-4 LUMHS, Jamshoro / Hyderabad

  2. AORTIC STENOSIS.

  3. Etiology Congenital aortic stenosis b. Senile calcific stenosis c. Bicuspid aortic valve d. Rheumatic aortic stenosis

  4. PATHOPHYSIOLOGY. Aortic valve stenosis produces a pressure over load on the left ventricle due to the greater pressure that must be generated to force blood past the stenotic valve . a. Obstruction to out flow causes pressure over load and left ventricle hypertrophy b. Hypertrophy increases thick ness of left ventricle .

  5. Clinical Features Symptoms Asymptomatic patients are little risk of death. Angina Syncope Heart Failure

  6. Physical Signs Delayed Carotid Upstroke Systolic Ejection Murmur Soft, Single S2 S4 Sustained, heaving apex beat

  7. Laboratory Diagnosis Electrocardiography  The ECG usually shows evidence of left ventricular hypertrophy. 2. Echocardiography Cardiac Catheterization

  8. Therapy Palliative Therapy Medical Therapy b. Curative Therapy Homograft Valves Heterograft Vales Mechanical Valves Autograft (Ross Procedure)

  9. Aortic Regurgitation

  10. Etiology Idiopathic aortic root dilatation Rheumatic Heart Disease Infective Endocarditis Marfan Syndrome Proximal root dilatation Aortic root dissection e. Aortic Dissection Syphilis Collagen Vascular disease

  11. Pathophysiology a. A portion of the left ventricular stroke volume ejected during systole regurgitation into the left ventricular during diastole. b. The increase in total stroke volume leads to increase in pulse pressure and increase in systolic pressure.

  12. Clinical Features a. Symptoms Left Ventricular Failure Chronic Aortic Insufficiency Acute Aortic Insufficiency 2. Syncope 3. Angina

  13. Clinical Features b. Physical Signs Left Ventricular Impulse Diastolic Murmur Austin Flint Murmur Total Stroke Volume a. Corrigan’s Pulse b. Hill’s sign c. Pistol-shot femoral pulses d. Duroziez’s sign e. De Musset’s sign f. Quincke’s pulse

  14. Diagnosis Electrocardiography  The ECG usually shows left ventricular hypertrophy. 2. Chest Radiography 3. Echocardiography 4. Cardiac Catheterization

  15. Therapy Aortic Valve replacement b. If surgery is not possible, therapy with digitlis, diuretics and vasodilators may affoard symptomatic relief.

  16. Mitral Stenosis

  17. Etiology Almost all cases of mitral stenosis in adult are secondary to rheumatic heart disease. Most cases occur in women.

  18. Pathophysiology 1. Impedes left ventricular filling 2. Increase left atrial pressure 3. Leads to pulmonary congestion 4. Pulmonary hypertension 5. Right Ventricular failure

  19. Clinical Features Symptoms Left sided failure Right Sided failure Hemoptysis Systemic embolisim Hoarseness

  20. Clinical Features b. Physical Signs Atrial Fibrillation Pulmonary rales Increase intensity of the S1 Increase intensity of the P2 Opening Snap Diastolic rumble Sternal lift Other symptoms

  21. Laboratory Diagnosis Electrocardiography Chest Radiography Echocardiography

  22. Therapy Medical Therapy Diuretics Digitalis Anticoagulants b. Balloon Valvuloplasty c. Surgical Therapy 1. Mitral Commissurotomy 2. Mitral Valve Replacement

  23. Mitral Regurgitation

  24. Mitral Regurgitation Etiology Rheumatic Heart Disease Ruptured ChordaeTendineae Coronary Artery Disease Infective Endocarditis Mitral Valve prolaps and click syndrome murmur

  25. Pathophysiology Increase left atrial pressure and decrease forward cardiac output.

  26. Clinical Features a. Symptoms Dypnea or Thopnea Paroxysmal nocturnal dyspnea Pulmonary hypertension and symptoms of right sided failure Symptoms of systemic embolization

  27. Clinical Features b. Physical Sign Left ventricular impulse Murmur An S3 usually heard in mitral regurgitation and may occur even in the absence of overt heart failure.

  28. Diagnosis - Electrocardiography - Chest Radiography - Echocardiography - Cardiac Catheterization

  29. Therapy Medical Treatment Diuretics Digitalis Anticoagulants Vesodilators b. Surgical Treatment 1. Valve Replacement 2. Valve Repair

  30. Tricuspid Regurgitation

  31. Etiology Infective endocarditis b. Right ventricular failure c. Rehumatic heart disease

  32. Pathophysiology During systole, the dysfunctioning tricuspid valve allows blood to flow backward into the right atrium, leading to systemic venous congestion and venous congestion and venous hypertension.

  33. Clinical Features Symptoms Edema Ascites Hepatic Congestion Right Upper Quadrant Pain Jaundice

  34. Clinical Features b. Physical Signs Right ventricle Lift Murmur Jugular Venus Pulsation Pulsatile Liver

  35. Diagnosis Chest Radiography Echocardiography

  36. Therapy Reduced the right ventricular pressure Surgical Repair Replacement of Tricuspid valve

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