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Valvular Heart Diseases
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Valvular Heart Diseases Done by : Resources : Objectives : 437 slides, 436 team, Davidson. Important Notes Golden Notes Extra Book 1. Describe the etiology, pathology, and natural history of valvular heart disease. 2. Describe the clinical symptoms and signs of valvular heart disease. ...

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  • December 17, 2024
  • 30
  • 2024/2025
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Valvular Heart Diseases
Objectives :
1. Describe the etiology, pathology, and natural history of valvular heart
disease.
2. Describe the clinical symptoms and signs of valvular heart disease.
3. Explain the clinical examination findings of particular valvular
problems.
4. Determine the role of echocardiograms in valvular heart disease, both
in diagnosis and prognosis.
5. Discuss the long-term systemic consequences of valvular heart
disease.
6. Describe the management and identify the indications of surgical
intervention for particular valvular heart diseases.


Done by :
Leader: Mohammed Alswoaiegh

Members: Ghada Almuhanna Mohammad Alasqah
Sara al-sultan Abdulelah Alsaeed


Revised by :
Aseel Badukhon



Resources :
437 slides, 436 team, Davidson.




Important Notes Golden Notes Extra Book

, Mitral Stenosis Mitral Regurgitation
General Characteristics General Characteristics
1. Almost all cases are due to rheumatic heart disease. (Patient may not recall a history of Pathophysiology
rheumatic fever.) a. Acute Abrupt elevation of left atrial pressure in the setting of normal
LA size and compliance, causing backflow into pulmonary circulation
Pathophysiology
a. Immune-mediated damage to the mitral valve (due to rheumatic fever) caused by
with resultant pulmonary edema Cardiac output decreases because of
cross-reactivity between the streptococcal antigen and the valve tissue leads to scarring and decreased forward flow, so hypotension and shock can occur
narrowing of the mitral valve orifice.
b. Chronic Gradual elevation of left atrial pressure in the setting of
b. Mitral stenosis results in elevated left atrial and pulmonary venous pressure leading to
dilated LA and LV (with increased left atrial compliance) LV
pulmonary congestion.
dysfunction occurs due to dilation Pulmonary HTN can result from
c. Anything that increases flow across the mitral valve (exercise, tachycardia, and so on) chronic backflow into pulmonary vasculature
exacerbates the pulmonary venous HTN and associated symptoms.

d. Long-standing mitral stenosis can result in pulmonary HTN and ultimately can result in
right ventricular failure (RVF).

e. Long-standing mitral stenosis can also lead to AFib due to increased left atrial pressure
and size.

f. Patients are usually asymptomatic until the mitral valve area is reduced to approximately
Extra slide from Step-up
1.5 cm 2 (normal valve area is 4 to 5 cm 2 ).


Aortic Stenosis Aortic Regurgitation
General Characteristics
General Characteristics
Pathophysiology
a. Causes obstruction to LV outflow, which results in LVH. Pathophysiology
b. When the aortic valve area falls below 1 cm 2 , cardiac output fails to increase with exertion, causing angina (but may
a. Also called aortic insufficiency; this condition is due to inadequate closure of the aorti
be normal at rest).
valve leaflets. Regurgitant blood flow increases left ventricular end-diastolic volume.
c. With long-standing AS, the LV dilates, causing progressive LV dysfunction.
b. LV dilation and hypertrophy occur in response in order to maintain stroke volume and
d. With severe AS, LV dilation pulls the mitral valve annulus apart, causing MR.
prevent diastolic pressure from increasing excessively.
2. Causes
c. Over time, these compensatory mechanisms fail, leading to increased left-sided and
a. Calcification of a congenitally abnormal bicuspid aortic valve.
pulmonary pressures.
b. Calcification of tricuspid aortic valve in elderly.
d. The resting left ventricular EF is usually normal until advanced disease.
c. Rheumatic fever.


Course Course
a. Patients are often asymptomatic for years (until middle or old age) despite severe obstruction. a. For chronic aortic regurgitation, survival is 75% at 5 years.
b. Development of angina, syncope, or heart failure is a sign of poor prognosis.
After the development of angina, death usually occurs within 4 years. After the
Survival is similar to that of the normal population before the development of these three classic symptoms. Without development of heart failure, death usually occurs within 2 years.
surgical intervention, the survival is poor:

Angina (35%)—average survival, 3 years Syncope (15%)—average survival, 2 years Heart failure (50%)—average
b. For acute aortic regurgitation, mortality is particularly high without surgical repair.
survival, 1.5 years



Tricuspid Regurgitation Mitral Valve Prolapse
General Characteristics
General Characteristics
1. Tricuspid regurgitation (TR) results from a failure of the
tricuspid valve to close completely during systole, causing 1. MVP is defined as the presence of excessive or redundant mitral
leaflet tissue due to myxomatous degeneration of mitral valve leaflets
regurgitation of blood into the RA. It is estimated that up to 70%
and/or chordae tendineae. The redundant leaflet(s) prolapse toward the
of normal adults have mild, physiologic TR as seen on LA in systole, which results in the auscultated click and murmur.
high-resolution echocardiography. A much smaller percentage of
people are actually symptomatic. 2. MVP is common in patients with genetic connective tissue disorders
such as Marfan syndrome, osteogenesis imperfecta, and Ehlers–Danlos
syndrome.

3. MVP is a common cause of MR in developed countries.

4. Arrhythmias and sudden death are very rare.

, Overview
Cardiac cycle + Heart sounds 14 min start this lecture by watching this video,
by one of our colleagues: (it includes the introductory part of female slides.)
Valvular Heart Disease Explanation By OnlineMedEd
Mitral Pulmonary
Notes Valve Valve
from
Osmosis Aortic Tricuspid
Characteristics of heart valves: Valve Valve

Phase when
Valve Structure Site of auscultation Sound
valve open

Mitral Bicuspid Left 5th IS(intercostal space) at the
midclavicular line Diastole S1 (LUB)

Tricuspid Tricuspid Left 5th IS at the SB(sternal border)


Aortic Semilunar (3 cusps) Right 2nd IS at SB
Systole S2 (DUB)

Pulmic Semilunar (3 cusps) Left 2nd IS at SB




Heart sounds and significance

Sound SIGNIFICANCE

S1 MV & TV closure; the MV closes before the tricuspid valve, so S1 may be split.

S2 AV & PV closure; the AV closes before the PV; inspiration causes increased splitting of S2.

S3 During rapid ventricular filling (early diastole) normal in children; in adults, associated with dilated
ventricle (ie, dilated CHF) & increased filling pressure.

S4 Late diastole; not audible in normal adults; its presence suggest high atrial pressure or stiff ventricle (ie.
Ventricular hypertrophy). The left atrium must push against a stiff LV wall (“atrial kick”)


● Regurg/ Insuff: leaking (backflow; against its direction) of blood across a closed valve.
● Stenosis: Obstruction of (forward) flow across an opened valve.

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