Valvular Disorders

Mitral Stenosis Causes Rheumatic heart disease, congenital rheumatoid arthritis, SLE

The University of Manchester | W.L. Gan | 2012

Mitral Regurgitation Rheumatic heart disease, IE, SLE, RA Marfan's syndrome, mitral valve prolapse cardiomyopathies, osteogenesis imperfecta, papillary muscle dysfunction, mitral annular calcification

Presentation Signs

Dyspnea, palpitations, fatigue Malar flush Mid diastolic murmur, accentuated by lying on the left, best heard using bell Opening snap, tapping apex beat, small volume pulse

Dyspnea, palpitations, fatigue Pansystolic murmur radiating to axilla, systolic thrill, displaced apex beat

Complications Severity

Pulmonary hypertension, AF Early opening snap Signs of pulmonary hypertension Aortic Stenosis

Pulmonary hypertension, AF Soft first heart sound, third, fourth heart sound, signs of pulmonary hypertension Aortic Regurgitation Rheumatic heart disease, IE, RA, SLE, aortic dissection, hypertension, Marfan syndrome, aortitis, bicuspid valve Dyspnea, palpitations, CCF Early diastolic murmur, best heard when patient leaning forward and breath held in expiration, Collapsing pulse Wide pulse pressure Hyperdynamic apex beat Austin Flint murmur - mid diastolic rumbling murmur heard best at apex Corrigan's sign ( prominent carotid puls ) De Musset's sign ( head nodding ) Mueller's sign ( uvula pulsation ) Quincke's sign ( nailbed capillary puls ) Severity markers : long duration murmur, third heart sound, wide pulse pressure, signs of pulmonary hypertension

Causes

Degenerative calcification, congenital ( bicuspid ), rheumatic heart disease

Presentation Signs

Angina, dyspnea, dizziness, syncope Ejection systolic radiating to carotids Severity markers : Anacrotic / slow rising pulse Narrow pulse pressure Heaving apex beat Fourth heart sound Late systolic peaking of a long murmur Soft second heart sound Signs of pulmonary hypertension

** Timing, Intensity, Area where loudest, Radiation, Accentuating manoeurvres, Added sound ** Inspiration accentuates right sided murmurs, expiration accentuates left sided murmurs. Mitral valve prolapse late systolic murmur w mid systolic click, accentuated by Valsalva Tricuspid regurgitation - pansystolic murmur at left lower parasternal edge - loudest during inspiration, no radiation to axilla - prominent v wave, pulsatile hepatomegaly Pulmonary regurgitation - Graham Steell's murmur ( early diastolic murmur at left sternal edge in second intercostal space in full inspiration. Often in cor pulmonale ( pulmonary hypertension )