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Valvular Heart Disease (Aortic Stenosis (Signs (Soft or absent second…
Valvular Heart Disease
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Mitral Valve Stenosis
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Aetiology
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Main cause is rheumatic heart disease, secondary to rheumatic fever due to infection with strep. pyogenes
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Pathophysiology
In order to maintain cardiac output, the LA pressure increases and LA hypertrophy and dilation occurs
Consequently, pulmonary venous, pulmonary arterial and right heart pressures increase
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Hemoptysis (coughing up blood) occurs - due to rupture of bronchial vessels due to elevated pulmonary pressyre
Signs
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Right sided heart failure = weakness, fatigue, lower limb and abdominal swelling
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Investigations
Chest x-ray: LA enlargement, calcification and pulmonary congestion
Echo: gold standard for diagnosis, assesses mitral valve mobility, gradient and area
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Treatment
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Balloon valvuloplasty: catheter is inserted into RA and a balloon is inflated which puts pressure on the valve and increases its orifice size
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Aortic Stenosis
Definition
= Narrowing of aortic valve, resulting in obstruction to the LV stroke volume
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Types
Subvalvular - below valve, e.g. congenital fibrous ridge below aortic valve
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Supravalvular - above valve, e.g. congenital fibrous diaphragm above aortic valve
Aetiology
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Degenerative calcification - calcification of aortic valve, most common cause
Pathophysiology
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When the compensatory mechanisms are exhausted, the LV function declines
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Investigations
ECG: LV hypertrophy, LBBB or complete AV block
Chest X-Ray: LV hypertrophy, calcified aortic valve
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Treatment
Vasodilators are contraindicated in severe aortic stenosis as they may trigger hypotension and thus syncope
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Aortic valve replacement - for symptomatic patients with severe AS, any patient with decreasing ejection fraction + any patient undergoing CABG
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Aortic Regurgitation
Definition
= Leakage of blood into LV from aorta during diastole due to ineffective coaptation (closing) of the aortic cusps
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Pathophysiology
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To maintain cardiac output, the total blood volume pumped into the aorta must increase - this causes LV dilation and hypertrophy
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Treatment
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Valve replacement for those with worsening symptoms, enlarged ascending aorta, enlarging LV or deteriorating lV function
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