Valvular heart disease

1
Valvular heart disease

• Richard Schilling
• St Marys Hospital
• London

2
Valve disease

• Aetiology
• Clinical findings
• Investigations
• Management

3
Heart Valve lesions

• Mitral stenosis
• Aortic stenosis
• Pulmonary stenosis
• Tricuspid stenosis
• Prosthetic stenosis

• Mitral regurgitation
• Aortic regurgitation
• Pulmonary regurgitation
• Tricuspid regurgitation
• Prosthetic regurgitation
• Mitral valve prolapse

4
Mitral regurgitation - Aetiology

• Valve
• Rheumatic fever
• Endocarditis
• Mitral valve annulus
• Dilation
• Calcification
• Chordae tendinae
• Rupture
• Lengthening
• Papillary muscle
• ischaemia
• dilation

5
Mitral regurgitation pathophysiology

• ? LV emptying
• ? LA pressure (if acute, pulmonary odema)
• ? LV filling
• ? LVedd
• LV stretch ? failure

???
6
Mitral regurgitation Clinical

• Symptoms appear late
• SOB
• Fatigue
• Right heart failure
• Signs
• Full volume pulse
• Pan systolic murmur radiating to apex
• Right heart failure
• Pulmonary hypertension

7
Mitral Regurgitation

• Investigations
• ECG p mitrale
• Xray large heart, calcified mv annulus, pulmonary
  odema
• Echocardiogram large LA, abnormal valve, MR
• LV angio MR, large LA

8
(No Transcript)
9
(No Transcript)
10
Mitral Regurgitation

• Heart Failure
• Decrease afterload
• Replacement
• Anticoagulation
• Antibiotic prophylaxis

11
Mitral Stenosis - Aetiology

• Rheumatic fever
• Congenital

12
Mitral Stenosis - pathophysiology

• ? LA pressure
• ? Pulmonary pressure
• R Heart failure
• ? LV function

13
Mitral Stenosis Symptoms/Signs

• SOB
• Haemoptysis
• Embolisation
• Mitral Facies
• AF, thready pulse
• ? JVP
• RV heave

14
Mitral Stenosis Symptoms/Signs

• Opening snap
• Rumbling diastolic murmur
• Presystolic murmur

15
(No Transcript)
16
Mitral stenosis - Investigations

• ECG AF
• Xray Pulmonary congestion, large LA and R heart
• Echo tight valve, high inflow large LA

17
MS ECG
18
MS x-ray
19
MS echo
20
MS Treatment

• Antibiotic prophylaxis
• Anticoagulation (AF)
• Digoxin (AF)
• Mitral Valvuloplasty
• Surgical Replacement

21
Mitral Valvuloplasty
22
Aortic Stenosis - aetiology

• Congenital bicuspid valve
• Acquired
• Rheumatic
• Senile/degenerative

23
Aortic Stenosis pathophysiology

• LVH
• ? Cardiac output on exercise
• LV dilatation and failure

24
Aortic stenosis symptoms/ signs

• Asymptomatic
• Angina
• Heart Failure
• Syncope
• Sudden Death

25
Aortic stenosis symptoms/ signs

• Slow rising pulse
• LV heave
• Ejection systolic murmur radiating to carotids

26
Aortic Stenosis - investigations

• ECG LVH
• Echo LVH, calcified valve, high doppler
  velocity
• Angio Ao valve gradient

27
AS ECG
28
Congenital AS
29
Echo AS
30
Doppler/Pressure Aortic stenosis
31
Aortic stenosis - treatment

• Antibiotic prophylaxis
• Surgical replacement before heart failure

32
Aortic valve replacement
33
Aortic Regurgitaiton- aetiology

• Aortic valve
• Rheumatic fever
• Infective endocarditis
• Bicuspid vlave
• Aortic dilation
• Age related
• Marfans
• Dissection

34
Aortic regurg - pathophysiology

• Increased Lved volume
• Increased stroke volume
• LV dilatation
• LV failure

35
AR symptoms/signs

• Often asymptomatic
• Chest pounding
• Prominent pulse
• Heart failure

36
AR symptoms/signs

• deMussets sign
• Collapsing pulse
• Displaced apex beat
• Early diastolic murmur

37
Auscultation AR
38
AR investigations

• ECG LVH
• X-ray abnormal aorta, large heart
• Echo AR, LV dilation, dissection
• Angiogram AR, LV dilation

39
AR - xray
40
AR - Echo
41
AR - treatment

• Antibiotics
• Vasodilators
• Replacement when LV begins to dilate or fail

42
When to replace the aortic valve?
43
When to replace the mitral valve

• When symptoms significant
• Before LV failure
• Before significant pulmonary hypertension

44
Right heart valves

• Low pressure
• Tricuspid regurg (drug addicts)
• Pulmonary stenosis (congenital)