| Aortic Stenosis | |
| Signs | Systolic ejection murmur heard best at the 2nd right intercostal space, which may radiate to the neck and carotids. |
| Symptoms | Dyspnoea on exertion, chest pain, dizziness, and syncope. |
| Initial Investigations | Physical examination, ECG findings (Left ventricular hypertrophy, as indicated by tall R waves in the left precordial leads and deep S waves in the right precordial leads. Left axis deviation. Possible atrial fibrillation in severe or chronic cases.) |
| Diagnostic Investigations | Echocardiogram |
| Medical Management | Treatment of symptoms with medications like diuretics and beta-blockers. |
| Interventions | Balloon valvuloplasty, aortic valve replacement (AVR), and transcatheter aortic valve replacement (TAVR). |
| Aortic Regurgitation | |
| Signs | High pitched early diastolic decrescendo murmur heard best at the left sternal border when leaning forward and during exhalation |
| Symptoms | Shortness of breath, fatigue, palpitations, chest pain, and symptoms of left heart failure |
| Initial Investigations | Physical examination, ECG (Left ventricular hypertrophy, Left axis deviation, Signs of left atrial enlargement) |
| Diagnostic Investigations | Echocardiogram |
| Medical Management | Vasodilators like ACE inhibitors, ARBs, or hydralazine |
| Intervention | Aortic valve replacement in severe cases or if symptomatic |
| Mitral Stenosis | |
| Signs | Opening snap followed by a mid-diastolic rumble heard best at the apex in left lateral decubitus position |
| Symptoms | Fatigue, dyspnoea on exertion, orthopnoea, palpitations, and possible thromboembolic events |
| Initial Investigations | Physical examination, ECG (Left atrial enlargement (P mitrale), Right axis deviation, Possible atrial fibrillation in severe or chronic cases) |
| Diagnostic Investigations | Echocardiogram |
| Medical Management | Anticoagulation, diuretics, beta-blockers, or non-dihydropyridine calcium channel blockers for rate control if atrial fibrillation is present |
| Intervention | Percutaneous mitral balloon commissurotomy (PMBC), open commissurotomy, or mitral valve replacement |
| Mitral Regurgitation | |
| Signs | Pansystolic/Holosystolic murmur heard best at the apex, radiating towards the left axilla |
| Symptoms | Fatigue, shortness of breath, orthopnoea, palpitations, and possible signs of left heart failure |
| Initial Investigations | Physical examination, ECG (Left atrial enlargement, Possible left ventricular hypertrophy, Possible atrial fibrillation in chronic severe cases) |
| Diagnostic Investigations | Echocardiogram |
| Medical Management | Vasodilators (ACE inhibitors, ARBs), diuretics, and anticoagulation if atrial fibrillation is present |
| Intervention | Mitral valve repair or replacement |
| Mitral Valve Prolapse | |
| Signs | Mid-systolic click followed by a late systolic murmur heard best at the apex |
| Symptoms | Most are asymptomatic, but can have palpitations, chest discomfort, anxiety, and dyspnea |
| Initial Investigations | Physical examination, ECG |
| Diagnostic Investigations | Echocardiogram |
| Medical Management | Beta-blockers for symptoms such as palpitations |
| Intervention | Mitral valve repair or replacement in severe cases or if symptomatic |
| Pulmonary Stenosis | |
| Signs | Systolic ejection murmur heard best in the 2nd left intercostal space, with possible radiation to the left shoulder |
| Symptoms | Often asymptomatic, but in severe cases, may include dyspnea on exertion, chest pain, and fainting |
| Initial Investigations | Physical examination, ECG showing right ventricular hypertrophy, right axis deviation, and possibly right atrial enlargement in severe cases |
| Diagnostic Investigations | Echocardiogram |
| Medical Management | Diuretics for symptoms of heart failure |
| Intervention | Balloon valvuloplasty or surgical valvotomy |
| Pulmonary Regurgitation | |
| Signs | Early diastolic decrescendo murmur heard best at the left sternal border with the patient leaning forward and during exhalation |
| Symptoms | Often asymptomatic but can include fatigue, palpitations, and chest pain |
| Initial Investigations | Physical examination, ECG showing right ventricular hypertrophy, right axis deviation, and signs of right atrial enlargement |
| Diagnostic Investigations | Echocardiogram |
| Medical Management | Diuretics for symptoms of heart failure |
| Intervention | Pulmonary valve replacement in severe cases or if symptomatic |
| Tricuspid Stenosis | |
| Signs | Diastolic rumble heard best at the left lower sternal border with the patient in a left lateral position |
| Symptoms | Right-sided heart failure symptoms like edema, ascites, and hepatomegaly |
| Initial Investigations | Physical examination, ECG showing right atrial enlargement and possible atrial fibrillation in severe or chronic cases |
| Diagnostic Investigations | Echocardiogram |
| Medical Management | Diuretics for symptoms of heart failure |
| Intervention | Tricuspid valve replacement or valvuloplasty |
| Tricuspid Regurgitation | |
| Signs | Holosystolic murmur heard best at the lower left sternal border, which may increase with inspiration (Carvallo’s sign) |
| Symptoms | Right-sided heart failure symptoms like peripheral edema, ascites, hepatomegaly, and jugular venous distention |
| Initial Investigations | Physical examination, ECG showing right atrial enlargement, possible right ventricular hypertrophy in severe cases, and possible atrial fibrillation in chronic severe cases |
| Diagnostic Investigations | Echocardiogram |
| Medical Management | Diuretics and sodium restriction for volume overload |
| Intervention | Tricuspid valve repair or replacement |
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