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Valvular diseases - Coggle Diagram

- - - - LV and LA enlargement w or w/o ischemia
    - - Cardiomegaly
      - Pulmonary edema
    - - Low intensity and high pitched decrescendo type murmur, over left sternal border or right second IC space, early diastile
      - murmur louder when due to annular pathology
      - S3 with dilated LV
      - pt sits and leans forward in expiration
    - - De Musset's sign- visible pulsation of uvula
      - Traube sign- loud noise heard when auscultating femoral arteries
      - Corrigan's sign- visible carotid pulsation, 'dancing neck arteries'
      - Quincke sign/pulse- visible capillary pulsation in the nail bed (angiodema)
      - Waterhammer pulse- forceful + rapidly increasing and collapsing
      - Duroziez sign- murmur over femoral artery when compressed
  - - - Acute
        
        Aortic dissection
        
        Trauma
      - Complications
        
        Diastolic cusp prolapse in dissection
      - Chronic
        
        Connective tissue disorders - ex. Marfan's
        
        Bicuspid aortic valve
    - - chronic
        
        Degenerative
        
        Congenital
        
        Rheumatic - fibrosis, fusion, retraction of cusps
        
        Connective tissue disorders
      - acute
        
        infectious endocarditis - destruction of valve leaflets
  - - - Vasodilators
      - ACEi
      - Loop diuretics
      - BB
    - - when symptoms have dvlp or evidence of significant LV dysfunction appears
      - Aortic valve replacement (AVR)/ root replacement
- - - - P mitrale
      - AF (common)
      - RV hypertrophy
    - - Straightening of left heart border
      - Prominent upper lobe veins
      - Pulmonary artery enlargement
      - Interstitial edema
      - Enlarged LA
    - - Murmur lourdest at medial to apex in expiration
      - Graham steel murmur (due to pulmonary HTN)
        early blowing diastolic murmur, heard along left border of sternum due to functional regurgitation through pulmonic valve
      - Mid-diastolic crescendo murmur (low-pitch, rumbling) with opening snap
  - - - Sinus rhythm, BB, Ca-channel blockers
      - Anticoagulants
    - - Mild: salt intake restrictions and oral diuretics
      - AF: BB, Ca-channel blockers or digoxin
        Anticoagulants
      - Severe: indication for surgery (ACC/AHA guidelines)
        Percutaneous mitral balloon valvotomy (PMBV)
        Closed valvotomy - separation of fused cusps
        Open valvotomy w/ cardiopulmonary bypass (pref)
        Mitral valve replacement
- - - - Calcific AS (degenerative calcification) most common
        elderly and risk factors for atherosclerosis
      - Rheumatic AS - usually together with mitral valve disease
    - - Bicuspid aortic valve - 2% of pop
      - Unicuspid aortic valve
  - - - Possible S3 and S4
      - Aortic ejection click
      - Mid-systolic crescendo-decrescendo murmur- aortic area in full expiration, extends to carotids
      - Soft or absent S2
      - Delayed carotid upstroke
    - - BBB
      - possible AF
      - LV hypertrophy with strain
    - - Pulsus parvus et tardus - small volume, slow rising pulse
      - narrow pulse pressure
    - - Post-stenotic dilation in ascending aorta
      - Cardiomegaly
      - Calcification involving aortic root
      - Pulm. congestion
    - - Color doppler- concomitant AR and/or MR
      - Continuous Wave Doppler- measure transvalvular pressure gradients
      - Confirms dg- calcified valve with restricting opening, or showing congenital abnormalities and aortic pathology
      - Cardiac catheterization
      - TEE- calculation of valve area
- - - - Ischemic heart disease
      - LV dilation of any cause
      - Rheumatic heart disease
      - Hypertrophic cardiomyopathy
      - Mitral valve prolapse
      - Carcinoid syndrome
      - Fen-phen valvulopathy (anti-obesity drug induced)
      - Congenital
    - - AMI (inferior wall) from papillary muscle dysfunction or acute rupture
      - Trauma
      - Infective endocarditis
  - - - LA enlargement, LV hypertrophy and RA enlargement in pulmonary HTN
        AF (common)
    - - Cardiomegaly, calcified mitral valve, pulm, venous congestion
    - - S3 gallop
      - Mid-diastolic click in mitral valve prolapse
      - Pansystolic plateau murmur, at apex in lateral decubitus
    - - confirms dg (+ catheterization)
        hyperdynamic LV, possible vegetations in IE
        color doppler to detect and quantify the MR, assess LV size and function (EF, End-systolic diameter, End-diastolic diameter)
        CW Doppler: assess velocity of regurgitant jet and estimate PA pressure
  - - - ACE inhibitors - decrease preload and afterload
      - Diuretics
      - Supportive when waiting for surgery (chronic type EF<60%)
      - Digoxin/ BB helps in AF
      - Anticoagulants
    - - Mitral valve repair is pref
      - Mitral valve replacement
      - Ind for acute type, and symptomatic pt and asymptomatic with severe MR (LV enlargement or LV systolic dysfunction)
- - - - Rumbling mid-diastolic murmur is heard best at lower left sternal border in inspiration
      - May increase in intensity with inspiration : Carvallo's sign
    - - Hepatomegaly
      - Elevated JVP
    - - Thickened restricted leaflets
      - CW doppler - diagnostic of increased transvalvular gradient