T1 L5: Valvular Dysfunction

• Where do we auscultate for the aortic valve?

  2nd intercostal space, right of sternum
• Where do we auscultate for the pulmonary valves?

  2nd intercostal space, left sternal border.
• Where do we auscultate for the tricuspid valve?

  left sternal border, 5th rib
• Where do we auscultate for the mitral valve?

  Apex; 5th intercostal space, along midclavicular line
• Amongst whom is degenerative valve disease most common?

  aging population
• Amongst whom is rheumatic valve disease most common?

  poverty, overcrowding, Post Streptococcal Rheumatic Fever
• Amongst whom is infective valve disease most common?

  immunocompromised, abnormal valves
• Which valve is degenerative heart disease most likely on?

  aortic (over mitral)
• Which valve is rheumatic valve disease most likely on?

  mitral (over aortic)
• Congenital valve disease can be on any valve.
• Pathology - immobility of leaflets?

  calcification
• Pathology - fusion of leaflets?

  fibrosis
• Pathology - largening of valve ring?

  dilatation
• Pathology - valve leaflets fail to open completely, causing:

  • build up of back pressure
  • loss of stroke volume?

  stenosis
• Pathology - valve leaflets fail to close properly, causing:

  • reverse flow of blood during diastole, 'incompetence'?

  regurgitation
• Symptoms due to obstruction of flow, causing decreased cardiac output.

  SAD triad:

  • Syncope (upon exertion)
  • Angina
  • Dyspnea?

  Aortic stenosis
• How does aortic stenosis cause left ventricular hypertrophy?

  Pressure overload (generation of high LV systolic pressure to overcome obstruction)
• Aortic stenosis heart sounds?

  systolic murmur, soft second heart sound if more severe
• CREAM:

  • C ongenital
  • R heumatic damage
  • E ndocarditis
  • A ortic dissection/ root dilatation
  • M arfan's?

  Causes of aortic regurgitation
• Consequences of aortic regurgitation?

  • Volume overload in LV: blood falls back into LV during diastole
  • LV dilatation: to accommodate volume
  • Late decompensation of LV function
• How does aortic regurgitation lead to pulmonary oedema?

  aortic regurg ➝ LV dilatation ➝ LV failure ➝ LA enlargement ➝ PV hypertension ➝ pulmonary oedema
• Early diastolic murmur, concomitant systolic murmur are sounds of?

  aortic regurgitation
• Often asymptomatic, chest pain, breathlessness, syncope (uncommon), fulminant pulmonary oedema are symptoms of?

  aortic regurgitation
• Pan-systolic murmur is the heart sounds of what pathology?

  mitral regurgitation
• Palpitations, peripheral oedema are symptoms of what heart pathology?

  mitral regurgitation
• Mid-systolic click & late systolic murmur are sounds of what pathology?

  mitral valve prolapse
• Mitral stenosis is almost always due to?

  rheumatic fever
• Mitral stenosis usually causes lung and right heart consequences, and left heart physiology is usually preserved.
• Mid-diastolic rumbling murmur, opening snap, loud first heart sound are sounds of?

  mitral stenosis
• Prosthetic heart sounds: if first heart sound is metallic?

  mitral valve prosthetic
• Prosthetic heart sounds: if second heart sound metallic?

  aortic valve prosthetic
• Prosthetic heart sounds: systolic murmurs common, but diastolic murmurs are usually pathological.