Cardiac Physiology 101 Regurg/ Insuff leaking (backflow) of
blood across a closed valve Stenosis Obstruction of (forward) flow
across an opened valve
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Severity of Valvular Diseases According to Echocardiography
Severity of stenotic valve diseases The evaluation should combine
the estimation of valve area and flow-dependent indices AS is
severe if valve area is < 1.0 cm or < 0.6 cm/m Severe AS is
unlikely if mean gradient is < 50 mmHg with normal cardiac
output MS is significant if valve area is < 1.5 cm, preferably
using planimetry
Aortic Regurg Austin Flint Murmur Due to the vibration of the
anterior leaflet of the mitral valve as it is buffetted
simultaneously by the blood jets from the left atrium and the
aorta.
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Aortic Regurgitation Diagnosis Ecg LAE, LVH Echo 2D/color
doppler test of choice Cardiac Cath helpful, confirmatory, needed
if the pt is older look at the coronaries
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Aortic Regurgitation Treatment of Asymptomatic Aortic Regurg
Medical Therapy treats the symptoms not the cause Serial Check ups
with Echos (EF, Severity AR)Serial Check ups with Echos (EF,
Severity AR) SBE ProphylaxisSBE Prophylaxis Vasodialators
(Nifedipine, ACE-I)Vasodialators (Nifedipine, ACE-I)
DiureticsDiuretics Treatment of Symptomatic Aortic Regurg Aortic
Valve Replacement Bioprosthetic vs Mechanical AVR
Diagnosis Ecg LAE, LVH Echo 2D/color doppler test of choice
Cardiac Cath helpful, confirmatory, needed if the pt is older look
at the coronaries
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Aortic Stenosis Treatment of Symptomatic Aortic Stenosis or
Decreased LV Function Medical Therapy treats the symptoms not the
cause Aortic Valve Replacement Bioprosthetic vs Mechanical AVR
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Spectrum of VHD Right Sided VHD Tricuspid Valve Tricuspid
ValveEndocarditis IV drug abusers or inpt with IVs IV drug abusers
or inpt with IVs Carcinoid HD - classically TS TR common, benign,
may be secondary to Pulm HTN Pulm HTN Pulmonic Valve Pediatrics
Pulm Stenosis Rheumatic HD PI (Graham Steel Murmur) Right sided
valvular lesions change in intensity with inspiration
Mitral Regurgitation Etiologies Alterations of the Leaflets,
Commissures, Annulus Rheumatic MVP Endocarditis Alterations of LV
or LA size and Function Papillary Muscle (Ischemic, MI,
Myocarditis, DCM) HOCM LV Enlargement Cardiomyopathies - LA
Enlargement from MR MR begets MR
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Mitral Regurg pathophysiology
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Mitral Regurgitation Symptoms Fatigue and weakness Dyspnea and
orthopnea Right sided HF MVP Syndrome (if present)
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Mitral Regurgitation Physical Exam Holosystolic Apical Blowing
Murmur Laterally displaced apical impulse Split S2 (but is obscured
by the murmur) S3 Gallop (increased volume during diastole)
Radiation depends on the etiology
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Mitral Regurgitation Diagnosis Ecg LAE, LVH Echo 2D/color
doppler test of choice Cardiac Cath helpful, confirmatory, needed
if the pt is older look at the coronaries
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Mitral Regurgitation - SBE Prophylaxis
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Mitral Regurgitation
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Mitral Valve Prolapse
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Mitral Regurgitation MVP Pathophysiology
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Mitral Regurgitation -MVP
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Diagnosis and Treatment Echo 2D/Color B-Blockers
(hyperadrenergic symptoms, Palpitations) Aspirin (TIAs without
etiology) SBE Prophylaxis (only if associated with MR) Severe
Symptomatic MR same as chronic MR
Mitral Stenosis Etiologies Rheumatic almost all cases in adults
Mitral Annular Ca+ - massive (rare) Congenital rare 60% of pts dont
have a history of ARC 50% of pts who have ARC dont develop VHD
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Mitral Stenosis
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Physical Exam Loud S1 Opening Snap Diastolic Apical Rumble
(murmur) May be associated with: MR or AS Right Sided Murmurs oPI
Graham Steel Murmur oTR
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Mitral Stenosis Diagnosis Ecg A Fib, LAE, RAE, RVH Echo
2D/color doppler test of choice Cardiac Cath helpful, confirmatory,
needed if the pt is older look at the coronaries
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Mitral Stenosis Treatment of Symptomatic Mitral Stenosis
Medical Therapy treats the symptoms not the cause Diuretics for
congestion Digoxin, Beta and Ca Channel Blockers for Afib rate
control Anticoagulation for AFib and LA clots SBE Prophylaxix
prevent endocarditis
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Mitral Stenosis Treatment of Symptomatic Mitral Stenosis
Surgical Therapy treats the cause Percutaneous Ballon
Valvulaoplasty Non-calcified, pliable valve
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Mitral Stenosis Treatment of Symptomatic Mitral Stenosis
Surgical Therapy treats the cause Open Commisurotomy valve repair
Mitral Valve Replacement