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Aortic Stenosis
Calcific valvular disease
(elderly)-50%
30-40% Congenital aortic
valve stenosis (males ),
10% RHD,
Pulmonary Stenosis
Congenital (rubella etc)
Associate
d
condition
-L.V.H
-Angina
-Angiodysplasia
-RVH
-TOF!!!
Symptoms
- exercise induced
syncope
- RHF
- mild (asymptomatic)
Cause
Face
Pulse
JVP
Palpation
Auscultat
- slow rising
pulse(anacrotic)
-heaving,apex x displaced
-double impulse (d/t S4/
atrial contraction kick )
Systolic thrill @ aortic
region
-cresendo-decrescendo/
Mitral Regurgitation
RHD (50%), mitral valve prolapse,
I.E. (sub-acute), IHD, Hypertensive HD,
SLE, Marfans syndrome, degeneration of
valves, rupture of chordae tendinae, drugs
(cabergolin)
MITRAL
M-MVP
I-IHD
T-Thyrotoxicosis
R-RHD
A-Autoimmune (SLE,RA)- IE
L-Large heart (dilated cardiomyopathy)
-LAH & LVH
- a wave present
- a/w thrill (often) @
L. 2nd i/c space
- R. ventricular heave
- harsh, midsystolic
- Soft S1
Tricuspid Regurgitation
Functional TR (when RV dilates cor
pulmonale-COPD, M.I., Pul. HPT)
Organic TR ( RHD, I.E., carcinoid
syndrome, Ebstein anomaly)
Other
signs
CXR
ECG
Echo
Treatment
Leg edema
IVDU- needle track @cubital fossa
- prominent pul. artery
d/t post stenotic
dilatation
- RA & RV hypertrophy
RV &RA enlarge
prophiaxis-amoxicilin for
IE
Surgery
Diastolic
- valvotomy (young)
- Symptomatic ( aortic
valve replacement)<0.8cm2
-percutaneous valve
replacement (balloon
expandable valve for
surgically unfit pt)
Galavardin
phenomenon=high fre
ESM radiate to apex
Aortic Regurgitation
Cause
Pulmonary Regurgitation
Mitral Stenosis
Tricuspid Stenosis
Acquired lesion
RHD
Associate
d
condition
- LVH
- Pul. HPT
- CO
-hepatomegaly (pulsatile) &
splenomegaly, ascites, oedema
Symptoms
- LHF (late)
- pounding heart
- Angina
- none
Face
Pulse
- bounding/ collapsing
Signs
-Quincke (capillary pulsation at nail
bed)
- De Musset ( head nodding with
each heart beat)-systolic pulsation of
uvula
-Duroziez (diatolic murmur @
femoral art. with distal pressure
applied severe)
- pistol shot femoralis (booming @
femoral art. On each heart beat)
- abdominal pain
-swelling
-Peripheral oedema, dyspnoea
JVP
-Increased ()
Palpation
Auscultat
e
Other
signs
CXR
ECG
Echo
- decrescendo diastolic
murmur
-Tapping apex,not
displaced
- palpable S1
- Parasternal heave
- loud S1
- opening snap, rumbling
mid- diastolic murmur
(best heard with bell @ L.
lateral post.
Eccentuate~expiration
++TR/PR
Bruising (anticoagulant)
Narrow pulse pres
-Prominent a wave
-Increased ()
(severe)
Treatment
Surgery
-Trans-septal balloon
valvotomy
-Closed valvotomy
-Open valvotomy
- Mitral valve replacement
- uncommon
-W>M
- rarely isolated lesion