Valvular Heart Disease 4,5,6

Aortic Stenosis

 

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

 

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

 

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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