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Valvular Heart Disease - Coggle Diagram

- - - - Faint - can be heard with difficulty
    - - Faint - can be identified immediately
    - - Moderately loud
    - - Loud and associated with a trhrill
    - - Loud byt can no be heard without stethoscope
    - - Very loud and can be heard without a stethescope
  - - - Harsh
      - Rumbling
      - Scratchy
      - Blowing
      - Squeaky
      - Musical
- - - - Valve thickening with obstruction to outflow
    - - Valve thickening /degeneration of the aorti valve in the absence of significant narrowing
  - - - Very rare
      - Congenital narrowing of the ascending aorta
    - - Dynamic obstruction - hypertrophic cardiomyopathy
      - Fixed obstruction - Subvalvular membrane or tunnel
  - - - Unicuspid valve (rare)
    - - Bicuspid valve
    - - Rheumatic valve
    - - Calcific Degeneration
  - - - Age
      - Male
      - Hypercholesterolaemia
      - RF for atherosclerosis
      - Abnormal calcium metabolism
        Pagets
        End stage renal disease
    - - Active inflammatory process similar to atherosclerosis
      - Major calcification component
  - - - .<0.8cm2
      - Mean gradient >50mmHg
  - - - Diastolic dysfunction
      - Systolic dysfunction later
    - - May occur with normal coronary arteries
      - Have a high rate of co-existing CAD
    - - Exercise - vasodilation - hypotension (increase in effective gradient)
  - - - Systolic ejection murmur - cresendo-decresendo
      - Area: Aortic area - Right upper sternal border
      - Radiation: Carotids
      - Severity of AS correlates better with the duration of the mumur than it's intensiy - longer mumur woth severe stenosis
      - Mumur may be soft with severe AS and LV dysfunction
  - - - Evidence of LV hypertrophy
      - Increased voltage +/ - strain (lateral ST depression
    - - Most important diagnostic test
      - Look at anatomy
        2 / 3 cusps
        Degree of calcification
        Extent of reduced leaflet opening
      - Measure peak gradient across the valve
      - Calculate aortic valve area
      - Severe AS
        
        MEan gradient >50mmHg
        
        Calculated aprtic valve area > 0.75cm2
    - - Put a catheter aross valve and measure the gradient on pull back
      - Import to assess for the presence of co-existing coronary artery disease