Lecture 2.2b - Common valve pathologies

Auscultation of Heart Valves

• Aortic valve: right eternal border, 2nd intercostal space
• Pulmonic valve: left eternal border, 2nd intercostal space
• Tricuspid valve: lower left sternal border, 5th intercostal space
• Mitral valve: apex, 5th intercostal space, mid-clavicular line

Abnormal Valve Function

• Stenosis: valve doesn't open enough, resulting in murmurs
• Regurgitation: valve doesn't close properly, resulting in murmurs
• Common causes: rheumatic fever, infective endocarditis, myocardial infarction, congenital
• Common valves affected: aortic and mitral

Aortic Valve Stenosis

• Pathophysiology:
  • Reduced blood flow through valve to outflow tract
  • Increased LV pressure
  • LV hypertrophy and increased left ventricular afterload
  • Left-sided heart failure, leading to syncope and angina
  • Microangiopathic haemolytic anaemia due to shear stress
• Murmur:
  • Ejection systolic murmur loudest over the aortic area
  • Narrow pulse pressure - crescendo decrescendo murmur

Aortic Valve Regurgitation

• Pathophysiology:
  • Blood leaks back to ventricles in diastole
  • Increased stroke volume for subsequent cardiac cycles
  • LV hypertrophy due to increased workload
• Murmur:
  • Early diastolic murmur loudest over aortic area
  • Wide, bounding pulse
  • Displaced apex beat

Mitral Valve Stenosis

• Pathophysiology:
  • Reduced blood flow from LA to LV
  • Increased LA pressure, leading to pulmonary hypertension and RV hypertrophy
  • LA dilation, leading to atrial fibrillation and thrombus formation
  • LA dilation, leading to oesophagus compression

Learn the locations for auscultating heart valves and the types of abnormal valve functions, including stenosis and regurgitation, and their causes.