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Mitral stenosis & incompetence, Pathogenesis of left heart failure :
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Pathogenesis of left heart failure :
Mital valve stenosis and incompetence > increased pressure and volume at left atrium > overload > increased cardiac work > increased wall stress > cardiac myocytes stretch > sarcomere added to existed one > atrial dilation > less blood flow to fill left ventricle > left ventricle have to work harder to pump blood to systemic circulation > overall low cardiac output > unable to meet body's need > left heart failure
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Abnormality in ECG
-negative and large P wave for leads V1 and V2 due to left atrial abnormality and hypertrophy
-normal sinus axis but suggestion of early right ventricular hypertrophy
pulmonary oedema -
Left heart failure → Blood accumulates in left ventricles → blood starts backing up to the pulmonary veins → due to the heart doesn't pump properly →pulmonary venous congestion → increase pressure in the veins→ increase pressure in the capillaries → fluid starts leaking out to interstitial spaces around lungs→ pulmonary oedema.
Principles of management:
- pharmacological:
- Angiotensin converting enzyme
- Angiotensin receptor blocker
- Aldosterone antagonists
- Diuretics
- Calcium channel blocker
- Anticoagulants
- Non-pharmacological:
- Mitral valve surgery: balloon valvotomy, commissurotomy
- Mitral valve replacement
- Lifestyle changes: diet control, exercise, wear lose clothing
Chest X-Ray:
- cardiomegaly
- cardiothoracic ratio: ~0.58
- lung congestion
Symptoms
- dyspnea
- orthopnea
- paroxysmal nocturnal dyspnea
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SIGN AND SYMPTOMS OF LEFT HEART FAILURE - nocturia, fatigue. hemoptysis, exercise intolerance, Cheyne-stokes respiration,oliguria, tachychardia, pleural effusion
SIGN AND SYMPTOMS OF RIGHT HEART FAILURE - peripheral edema, lower extremeties, ascites, proteinuria, tachypne, tachychardia, pleural effusion
ANATOMY OF HEART VALVE
SURFACE MARKING 
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SEMILUNAR VALVES - AORTIC VALVVES, PULMONARY VALVE
ATRIOVENTRICULAR VALVE - TRICUSPID , MITRAL VALVE
Complications of
rheumatic valvular heart diseaseAcute
- small beady fibrinous vegetations along the line of valve closure d/t precipitation of fibrin
Chronic
- thickened and retracted valve
- commissural fusion
- chordae tendinae shorten, thickened and fused
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