Valvular Heart Diseases Overview

Valvular Heart Diseases Overview

• Valvular heart diseases are primarily categorized into valvular stenosis and regurgitation.
• Stenosis involves thick, sclerotic, and calcified valves that obstruct forward blood flow from atria to ventricles or from ventricles to arteries.
• Regurgitation entails poorly sealed valve leaflets, causing backflow of blood into the heart chambers.

Valvular Stenosis

• Thickening of the valve leads to obstruction of blood flow.
• Left side stenosis causes pulmonary venous congestion; Right side stenosis results in systemic venous congestion.
• Key types include: mitral stenosis, aortic stenosis, pulmonary stenosis, and tricuspid stenosis.

Causes of Mitral Stenosis

• Most commonly caused by rheumatic heart disease, a complication of untreated streptococcal throat infections.
• Antibodies targeting streptococci may attack heart valve antigens leading to fibrosis and narrowed valve lumen.
• Affects valves in sequence: Mitral → Aortic → Tricuspid, rarely impacts the pulmonary valve.

Aortic Stenosis Causes

• Bicuspid aortic valve is a congenital condition leading to early aortic stenosis, affecting younger patients (typically <70 years).
• Calcific aortic valve stenosis occurs due to aging and risk factors like hypertension and high cholesterol, typically presenting in older patients (>70 years).

Pulmonary Stenosis Causes

• Carcinoid syndrome can lead to pulmonary stenosis due to tumor-induced fibrosis from neuroendocrine tumors, often originating from the gastrointestinal tract.
• Clinical presentation may include diarrhea, rash, wheezing, and flushing.
• Tetralogy of Fallot, a congenital disorder, can also cause pulmonary stenosis, characterized by ventricular septal defect (VSD), right ventricular hypertrophy, and a high-riding aorta.

Tricuspid Stenosis

• Tricuspid stenosis is rare and typically occurs in the setting of rheumatic heart disease.
• Inflammation and fibrosis due to rheumatic activity can lead to obstruction from the right atrium to the right ventricle.
• Less common compared to mitral and aortic stenosis.

Summary of Key Valves

• Mitral Stenosis: Caused by rheumatic heart disease, leading to pulmonary congestion.
• Aortic Stenosis: Bicuspid valve (young) and calcific valve (older); obstructs left ventricular outflow.
• Pulmonary Stenosis: Associated with carcinoid syndrome and congenital defects like tetralogy of Fallot.
• Tricuspid Stenosis: Rare; typically due to rheumatic heart disease affecting right atrial blood flow.### Valvular Regurgitation Overview
• Regurgitation occurs when there is a poor seal in heart valves, allowing blood to flow backward, creating regurgitation jets.
• Two main types of mitral regurgitation: primary (involves valve components) and secondary (related to annulus stretching).

Mitral Regurgitation

• Primary Causes:

  • Infective Endocarditis: Pathogen damages valve leaflets, decreasing effective seal.
  • Rheumatic Heart Disease: Fibrosis leads to stiff valves, preventing them from closing properly.
  • Papillary Muscle Rupture: Myocardial infarction can detach papillary muscles, causing ineffective leaflet support.
  • Mitral Valve Prolapse: Degeneration causing leaflet bowing during systole leads to regurgitation.

• Secondary Causes:

  • Annulus Dilation: Conditions like heart failure can stretch the annulus, increasing distance between leaflets.

Aortic Regurgitation

• Blood flows back from the aorta into the left ventricle during diastole due to damaged valves or aortic root diseases.
• Causes:
  • Infective endocarditis and rheumatic disease similar to mitral regurgitation.
  • Bicuspid Aortic Valve: Increases risk for both stenosis and regurgitation.
  • Aortic root dilation due to conditions like hypertension or connective tissue disorders.
  • Aortic Dissection: Creates false lumen compressing the valve structure.

Pulmonary Regurgitation

• Typically occurs after balloon valvuloplasty for tetralogy of Fallot, leading to annulus stretching that results in regurgitation.

Tricuspid Regurgitation

• Similar to mitral regurgitation in pathophysiology.
• Causes: Infective endocarditis, rheumatic disease, carcinoid syndrome leading to fibrosis, or annulus dilation due to right heart failure.

Clinical Features and Physical Examination

• Symptoms can include pulmonary hypertension and heart failure, particularly in mitral stenosis.

• Mitral Stenosis:

  • Left atrial pressure buildup leads to pulmonary congestion and symptoms like orthopnea and paroxysmal nocturnal dyspnea.
  • High left atrial pressure can lead to atrial fibrillation and emboli formation due to stasis.
  • Murmur: Diastolic rumble with opening snap, best heard at the left fifth intercostal space.

• Mitral Regurgitation:

  • Characterized by a holosystolic murmur starting at S1 and progressing into S2, best heard near the left chest and radiating to the axilla.

• Aortic Stenosis:

  • Symptoms: Syncope, angina, exertional dyspnea ("sad" symptoms).
  • Murmur: Systolic ejection click followed by a crescendo-decrescendo murmur, heard at the second intercostal space and may radiate to the carotids.

• Aortic Regurgitation:

  • Can cause acute heart failure symptoms or chronic adaptation.
  • Murmur: Early diastolic murmur after S2, often with a "blowing" quality.

Key Physiological Concepts

• Afterload and stroke volume relationship: Increased afterload leads to decreased stroke volume.
• Left ventricular hypertrophy occurs due to increased afterload in conditions like aortic stenosis.
• Wide Pulse Pressure: Seen in aortic regurgitation due to elevated systolic pressure and low diastolic pressure.

Summary of Important Points

• Focus on understanding the mechanisms leading to regurgitation and corresponding symptoms of heart failure.
• Recognize murmurs and their characteristics as key indicators for diagnosing specific valvular conditions.
• Clinical management often requires addressing the underlying causes and symptoms associated with each type of valvular disease.### Blood Pressure and Physical Exam Findings
• Significant disparities in blood pressure readings can indicate cardiovascular issues, such as extremely high systolic and low diastolic values.
• During the physical examination, observe carotid pulses, which become prominent and then collapse due to the rapid blood flow during systole and subsequent reflux during diastole, noted as Corrigan's pulse.
• Other pulse observations include:
  • Water-hammer pulse: Bounding and collapsible radial artery.
  • Pistol shot pulse: Strong pulse felt in the femoral artery.
  • Uvular pulsations (Müller sign): Visible pulsation of the uvula.
• Important murmurs to recognize in heart failure include diastolic decrescendo murmurs indicative of aortic regurgitation.

Aortic Regurgitation

• The aortic valve fails to close, leading to backflow of blood into the left ventricle during diastole.
• The characteristic murmur is a diastolic decrescendo starting just after S2, with a blowing quality.
• The location for auscultation is the second intercostal space at the parasternal border, radiating to the left sternal border.

Heart Sounds

• The heart sounds, including S1 (closure of mitral and tricuspid valves) and S2 (closure of aortic and pulmonary valves), are vital for diagnosing conditions.
• The presence of S3 heart sounds can indicate rapid filling of the ventricle, while S4 heart sounds can be indicative of atrial hypertrophy.

Murmurs Associated with Other Valvular Disorders

• Pulmonary Stenosis: Characterized by early systolic ejection click followed by a crescendo-decrescendo murmur at the left second intercostal space.
• Pulmonary Regurgitation: Similar to aortic regurgitation with a diastolic decrescendo murmur heard at the same location.
• Tricuspid Stenosis and Regurgitation: Presenting with diastolic and holosystolic murmurs, respectively, near the left fourth intercostal space.

Maneuvers to Alter Murmur Intensity

• Inspiration: Increases right-sided murmur intensity by enhancing venous return to the right heart.
• Expiration: Increases left-sided murmur intensity due to greater blood flow into the left heart.
• Squatting/Passive Leg Raise: Increases venous return, thus increasing intensity of all murmurs except those from HCM and mitral valve prolapse.
• Valsalva Maneuver and Standing: Reduce venous return, diminishing murmur intensity except for HCM and mitral valve prolapse where the intensity increases.

Surgical Intervention and Diagnosis

• Echocardiography is the gold standard for diagnosing valvular heart disease, often supplemented by transthoracic or trans-esophageal modalities for better visualization.
• Surgical options include:
  • Balloon Valvuloplasty: Preferred for stenotic lesions, especially mitral stenosis.
  • Valve Repair/Replacement: Considered when symptoms arise, or when structure significantly declines (e.g., valve area <1.5 cm² for aortic stenosis).

Prosthetic Valve Dysfunction

• Key signs of malfunction in prosthetic valves include:
  • New murmurs can indicate valve dysfunction.
  • Regurgitant dysfunction often tied to dehiscence (paravalvular leak) or thrombus affecting valve closure (transvalvular leak).
  • Stenotic dysfunction predominantly caused by thrombus or structural issues with the valve.
• Symptoms like acute heart failure or changes in hemolytic markers can signify complications following valve replacement.

Valvular Heart Diseases Overview

• Classified into two main categories: valvular stenosis and regurgitation.
• Stenosis involves thickened and calcified valves, hindering blood flow from atria to ventricles or ventricles to arteries.
• Regurgitation results from improperly sealing valve leaflets, leading to backflow of blood within heart chambers.

Valvular Stenosis

• Thick valve structure leads to obstruction of blood flow.
• Left-sided stenosis can cause pulmonary congestion; right-sided stenosis results in systemic congestion.
• Major types include mitral stenosis, aortic stenosis, pulmonary stenosis, and tricuspid stenosis.

Causes of Mitral Stenosis

• Most often due to rheumatic heart disease, stemming from untreated streptococcal throat infections.
• Antibodies may attack heart valve antigens, causing fibrosis and narrowing.
• Typically affects valves sequentially: Mitral → Aortic → Tricuspid, with pulmonary valve rarely impacted.

Aortic Stenosis Causes

• Bicuspid aortic valve, a congenital defect, commonly leads to early onset of aortic stenosis in younger individuals, typically around age 70.

Pulmonary Stenosis Causes

• Associated with carcinoid syndrome due to tumor-related fibrosis from neuroendocrine tumors, often from the gastrointestinal tract.
• Symptoms include diarrhea, rash, wheezing, and flushing.
• Tetralogy of Fallot, a congenital anomaly, also causes pulmonary stenosis with associated conditions like ventricular septal defect (VSD) and right ventricular hypertrophy.

Tricuspid Stenosis

• Rare condition, typically linked with rheumatic heart disease.
• Inflammation prompts fibrosis, obstructing blood flow from the right atrium to the right ventricle.
• Less common compared to mitral and aortic stenosis.

Summary of Key Valves

• Mitral Stenosis: Leading to pulmonary congestion, primarily caused by rheumatic heart disease.
• Aortic Stenosis: Resulting from congenital bicuspid valves in younger patients and calcific degeneration in older patients, impeding left ventricular outflow.
• Pulmonary Stenosis: Often associated with carcinoid syndrome and congenital anomalies like tetralogy of Fallot.
• Tricuspid Stenosis: Uncommon; generally arises from rheumatic heart disease.

Valvular Regurgitation Overview

• Occurs due to insufficient sealing of heart valves, allowing backward blood flow.
• Mitral regurgitation divided into primary (involving valve components) and secondary (due to annular stretching).

Mitral Regurgitation

• Primary Causes: Infective endocarditis (damaging leaflets), rheumatic heart disease (stiff valves), papillary muscle rupture (from myocardial infarction), mitral valve prolapse (leaflet degeneration).
• Secondary Causes: Annulus dilation from conditions like heart failure stretching the annulus.

Aortic Regurgitation

• Blood regurgitates into the left ventricle during diastole due to valve damage or aortic root disease.
• Causes include infective endocarditis, rheumatic disease, congenital bicuspid aortic valve, aortic root dilation, and dissection.

Pulmonary Regurgitation

• Often a consequence of balloon valvuloplasty performed for tetralogy of Fallot, resulting in annular stretching.

Tricuspid Regurgitation

• Shares pathophysiological similarities with mitral regurgitation.
• Causes include infective endocarditis, rheumatic disease, carcinoid syndrome, and annulus dilation due to right heart failure.

Clinical Features and Physical Examination

• Mitral stenosis symptoms often involve pulmonary hypertension and heart failure, with specific markers like high left atrial pressure leading to symptoms such as orthopnea and paroxysmal nocturnal dyspnea.
• Mitral stenosis murmur is a diastolic rumble with an opening snap, best heard near the left fifth intercostal space.
• Mitral regurgitation presents a holosystolic murmur best heard near the left chest, radiating to the axilla.
• Aortic stenosis leads to classic symptoms including syncope, angina, and exertional dyspnea, with a characteristic crescendo-decrescendo murmur radiating to the carotids.
• Aortic regurgitation's murmur is an early diastolic “blowing” murmur that follows S2.

Key Physiological Concepts

• Increased afterload correlates with decreased stroke volume.
• Ventricular hypertrophy can result from increased afterload situations like aortic stenosis.
• Wide pulse pressure is seen in aortic regurgitation due to high systolic and low diastolic pressures.

Summary of Important Points

• Emphasize understanding mechanisms leading to regurgitation and symptoms of heart failure.
• Recognize characteristic murmurs to aid in diagnosing specific valvular conditions.
• Clinical management targets addressing underlying causes and symptomatic relief.

Blood Pressure and Physical Exam Findings

• Blood pressure discrepancies can signal cardiovascular issues, notably wide variances in systolic and diastolic values.
• Carotid pulse assessment may reveal significant pulsations due to rapid systolic blood flow, observable as Corrigan's pulse.

Heart Sounds and Murmurs

• S1 (closure of mitral/tricuspid) and S2 (closure of aortic/pulmonary) are crucial in diagnosis.
• S3 indicates rapid ventricular filling; S4 suggests atrial hypertrophy.
• Murmurs linked to pulmonary stenosis involve early systolic ejection clicks and a crescendo-decrescendo pattern.

Maneuvers to Alter Murmur Intensity

• Inspiration increases right-sided murmurs; Expiration enhances left-sided murmurs.
• Squatting/Leg Raise boosts venous return and intensifies all murmurs except those from hypertrophic cardiomyopathy and mitral valve prolapse.
• Valsalva Maneuver/Standing decrease venous return, diminishing murmur intensity, except in specific conditions where intensity increases.

Surgical Intervention and Diagnosis

• Echocardiography is the primary diagnostic tool for valvular heart disease, often enhanced by transthoracic or transesophageal imaging.
• Surgical treatments include balloon valvuloplasty for stenosis and valve repair or replacement for significant structural decline or symptomatic patients.

Valvular Heart Diseases Overview

• Classified into two main categories: valvular stenosis and regurgitation.
• Stenosis involves thickened and calcified valves, hindering blood flow from atria to ventricles or ventricles to arteries.
• Regurgitation results from improperly sealing valve leaflets, leading to backflow of blood within heart chambers.

Valvular Stenosis

• Thick valve structure leads to obstruction of blood flow.
• Left-sided stenosis can cause pulmonary congestion; right-sided stenosis results in systemic congestion.
• Major types include mitral stenosis, aortic stenosis, pulmonary stenosis, and tricuspid stenosis.

Causes of Mitral Stenosis

• Most often due to rheumatic heart disease, stemming from untreated streptococcal throat infections.
• Antibodies may attack heart valve antigens, causing fibrosis and narrowing.
• Typically affects valves sequentially: Mitral → Aortic → Tricuspid, with pulmonary valve rarely impacted.

Aortic Stenosis Causes

• Bicuspid aortic valve, a congenital defect, commonly leads to early onset of aortic stenosis in younger individuals, typically around age 70.

Pulmonary Stenosis Causes

• Associated with carcinoid syndrome due to tumor-related fibrosis from neuroendocrine tumors, often from the gastrointestinal tract.
• Symptoms include diarrhea, rash, wheezing, and flushing.
• Tetralogy of Fallot, a congenital anomaly, also causes pulmonary stenosis with associated conditions like ventricular septal defect (VSD) and right ventricular hypertrophy.

Tricuspid Stenosis

• Rare condition, typically linked with rheumatic heart disease.
• Inflammation prompts fibrosis, obstructing blood flow from the right atrium to the right ventricle.
• Less common compared to mitral and aortic stenosis.

Summary of Key Valves

• Mitral Stenosis: Leading to pulmonary congestion, primarily caused by rheumatic heart disease.
• Aortic Stenosis: Resulting from congenital bicuspid valves in younger patients and calcific degeneration in older patients, impeding left ventricular outflow.
• Pulmonary Stenosis: Often associated with carcinoid syndrome and congenital anomalies like tetralogy of Fallot.
• Tricuspid Stenosis: Uncommon; generally arises from rheumatic heart disease.

Valvular Regurgitation Overview

• Occurs due to insufficient sealing of heart valves, allowing backward blood flow.
• Mitral regurgitation divided into primary (involving valve components) and secondary (due to annular stretching).

Mitral Regurgitation

• Primary Causes: Infective endocarditis (damaging leaflets), rheumatic heart disease (stiff valves), papillary muscle rupture (from myocardial infarction), mitral valve prolapse (leaflet degeneration).
• Secondary Causes: Annulus dilation from conditions like heart failure stretching the annulus.

Aortic Regurgitation

• Blood regurgitates into the left ventricle during diastole due to valve damage or aortic root disease.
• Causes include infective endocarditis, rheumatic disease, congenital bicuspid aortic valve, aortic root dilation, and dissection.

Pulmonary Regurgitation

• Often a consequence of balloon valvuloplasty performed for tetralogy of Fallot, resulting in annular stretching.

Tricuspid Regurgitation

• Shares pathophysiological similarities with mitral regurgitation.
• Causes include infective endocarditis, rheumatic disease, carcinoid syndrome, and annulus dilation due to right heart failure.

Clinical Features and Physical Examination

• Mitral stenosis symptoms often involve pulmonary hypertension and heart failure, with specific markers like high left atrial pressure leading to symptoms such as orthopnea and paroxysmal nocturnal dyspnea.
• Mitral stenosis murmur is a diastolic rumble with an opening snap, best heard near the left fifth intercostal space.
• Mitral regurgitation presents a holosystolic murmur best heard near the left chest, radiating to the axilla.
• Aortic stenosis leads to classic symptoms including syncope, angina, and exertional dyspnea, with a characteristic crescendo-decrescendo murmur radiating to the carotids.
• Aortic regurgitation's murmur is an early diastolic “blowing” murmur that follows S2.

Key Physiological Concepts

• Increased afterload correlates with decreased stroke volume.
• Ventricular hypertrophy can result from increased afterload situations like aortic stenosis.
• Wide pulse pressure is seen in aortic regurgitation due to high systolic and low diastolic pressures.

Summary of Important Points

• Emphasize understanding mechanisms leading to regurgitation and symptoms of heart failure.
• Recognize characteristic murmurs to aid in diagnosing specific valvular conditions.
• Clinical management targets addressing underlying causes and symptomatic relief.

Blood Pressure and Physical Exam Findings

• Blood pressure discrepancies can signal cardiovascular issues, notably wide variances in systolic and diastolic values.
• Carotid pulse assessment may reveal significant pulsations due to rapid systolic blood flow, observable as Corrigan's pulse.

Heart Sounds and Murmurs

• S1 (closure of mitral/tricuspid) and S2 (closure of aortic/pulmonary) are crucial in diagnosis.
• S3 indicates rapid ventricular filling; S4 suggests atrial hypertrophy.
• Murmurs linked to pulmonary stenosis involve early systolic ejection clicks and a crescendo-decrescendo pattern.

Maneuvers to Alter Murmur Intensity

• Inspiration increases right-sided murmurs; Expiration enhances left-sided murmurs.
• Squatting/Leg Raise boosts venous return and intensifies all murmurs except those from hypertrophic cardiomyopathy and mitral valve prolapse.
• Valsalva Maneuver/Standing decrease venous return, diminishing murmur intensity, except in specific conditions where intensity increases.

Surgical Intervention and Diagnosis

• Echocardiography is the primary diagnostic tool for valvular heart disease, often enhanced by transthoracic or transesophageal imaging.
• Surgical treatments include balloon valvuloplasty for stenosis and valve repair or replacement for significant structural decline or symptomatic patients.

Valvular Heart Diseases Overview

• Classified into two main categories: valvular stenosis and regurgitation.
• Stenosis involves thickened and calcified valves, hindering blood flow from atria to ventricles or ventricles to arteries.
• Regurgitation results from improperly sealing valve leaflets, leading to backflow of blood within heart chambers.

Valvular Stenosis

• Thick valve structure leads to obstruction of blood flow.
• Left-sided stenosis can cause pulmonary congestion; right-sided stenosis results in systemic congestion.
• Major types include mitral stenosis, aortic stenosis, pulmonary stenosis, and tricuspid stenosis.

Causes of Mitral Stenosis

• Most often due to rheumatic heart disease, stemming from untreated streptococcal throat infections.
• Antibodies may attack heart valve antigens, causing fibrosis and narrowing.
• Typically affects valves sequentially: Mitral → Aortic → Tricuspid, with pulmonary valve rarely impacted.

Aortic Stenosis Causes

• Bicuspid aortic valve, a congenital defect, commonly leads to early onset of aortic stenosis in younger individuals, typically around age 70.

Pulmonary Stenosis Causes

• Associated with carcinoid syndrome due to tumor-related fibrosis from neuroendocrine tumors, often from the gastrointestinal tract.
• Symptoms include diarrhea, rash, wheezing, and flushing.
• Tetralogy of Fallot, a congenital anomaly, also causes pulmonary stenosis with associated conditions like ventricular septal defect (VSD) and right ventricular hypertrophy.

Tricuspid Stenosis

• Rare condition, typically linked with rheumatic heart disease.
• Inflammation prompts fibrosis, obstructing blood flow from the right atrium to the right ventricle.
• Less common compared to mitral and aortic stenosis.

Summary of Key Valves

• Mitral Stenosis: Leading to pulmonary congestion, primarily caused by rheumatic heart disease.
• Aortic Stenosis: Resulting from congenital bicuspid valves in younger patients and calcific degeneration in older patients, impeding left ventricular outflow.
• Pulmonary Stenosis: Often associated with carcinoid syndrome and congenital anomalies like tetralogy of Fallot.
• Tricuspid Stenosis: Uncommon; generally arises from rheumatic heart disease.

Valvular Regurgitation Overview

• Occurs due to insufficient sealing of heart valves, allowing backward blood flow.
• Mitral regurgitation divided into primary (involving valve components) and secondary (due to annular stretching).

Mitral Regurgitation

• Primary Causes: Infective endocarditis (damaging leaflets), rheumatic heart disease (stiff valves), papillary muscle rupture (from myocardial infarction), mitral valve prolapse (leaflet degeneration).
• Secondary Causes: Annulus dilation from conditions like heart failure stretching the annulus.

Aortic Regurgitation

• Blood regurgitates into the left ventricle during diastole due to valve damage or aortic root disease.
• Causes include infective endocarditis, rheumatic disease, congenital bicuspid aortic valve, aortic root dilation, and dissection.

Pulmonary Regurgitation

• Often a consequence of balloon valvuloplasty performed for tetralogy of Fallot, resulting in annular stretching.

Tricuspid Regurgitation

• Shares pathophysiological similarities with mitral regurgitation.
• Causes include infective endocarditis, rheumatic disease, carcinoid syndrome, and annulus dilation due to right heart failure.

Clinical Features and Physical Examination

• Mitral stenosis symptoms often involve pulmonary hypertension and heart failure, with specific markers like high left atrial pressure leading to symptoms such as orthopnea and paroxysmal nocturnal dyspnea.
• Mitral stenosis murmur is a diastolic rumble with an opening snap, best heard near the left fifth intercostal space.
• Mitral regurgitation presents a holosystolic murmur best heard near the left chest, radiating to the axilla.
• Aortic stenosis leads to classic symptoms including syncope, angina, and exertional dyspnea, with a characteristic crescendo-decrescendo murmur radiating to the carotids.
• Aortic regurgitation's murmur is an early diastolic “blowing” murmur that follows S2.

Key Physiological Concepts

• Increased afterload correlates with decreased stroke volume.
• Ventricular hypertrophy can result from increased afterload situations like aortic stenosis.
• Wide pulse pressure is seen in aortic regurgitation due to high systolic and low diastolic pressures.

Summary of Important Points

• Emphasize understanding mechanisms leading to regurgitation and symptoms of heart failure.
• Recognize characteristic murmurs to aid in diagnosing specific valvular conditions.
• Clinical management targets addressing underlying causes and symptomatic relief.

Blood Pressure and Physical Exam Findings

• Blood pressure discrepancies can signal cardiovascular issues, notably wide variances in systolic and diastolic values.
• Carotid pulse assessment may reveal significant pulsations due to rapid systolic blood flow, observable as Corrigan's pulse.

Heart Sounds and Murmurs

• S1 (closure of mitral/tricuspid) and S2 (closure of aortic/pulmonary) are crucial in diagnosis.
• S3 indicates rapid ventricular filling; S4 suggests atrial hypertrophy.
• Murmurs linked to pulmonary stenosis involve early systolic ejection clicks and a crescendo-decrescendo pattern.

Maneuvers to Alter Murmur Intensity

• Inspiration increases right-sided murmurs; Expiration enhances left-sided murmurs.
• Squatting/Leg Raise boosts venous return and intensifies all murmurs except those from hypertrophic cardiomyopathy and mitral valve prolapse.
• Valsalva Maneuver/Standing decrease venous return, diminishing murmur intensity, except in specific conditions where intensity increases.

Surgical Intervention and Diagnosis

• Echocardiography is the primary diagnostic tool for valvular heart disease, often enhanced by transthoracic or transesophageal imaging.
• Surgical treatments include balloon valvuloplasty for stenosis and valve repair or replacement for significant structural decline or symptomatic patients.

Valvular Heart Diseases Overview

• Classified into two main categories: valvular stenosis and regurgitation.
• Stenosis involves thickened and calcified valves, hindering blood flow from atria to ventricles or ventricles to arteries.
• Regurgitation results from improperly sealing valve leaflets, leading to backflow of blood within heart chambers.

Valvular Stenosis

• Thick valve structure leads to obstruction of blood flow.
• Left-sided stenosis can cause pulmonary congestion; right-sided stenosis results in systemic congestion.
• Major types include mitral stenosis, aortic stenosis, pulmonary stenosis, and tricuspid stenosis.

Causes of Mitral Stenosis

• Most often due to rheumatic heart disease, stemming from untreated streptococcal throat infections.
• Antibodies may attack heart valve antigens, causing fibrosis and narrowing.
• Typically affects valves sequentially: Mitral → Aortic → Tricuspid, with pulmonary valve rarely impacted.

Aortic Stenosis Causes

• Bicuspid aortic valve, a congenital defect, commonly leads to early onset of aortic stenosis in younger individuals, typically around age 70.

Pulmonary Stenosis Causes

• Associated with carcinoid syndrome due to tumor-related fibrosis from neuroendocrine tumors, often from the gastrointestinal tract.
• Symptoms include diarrhea, rash, wheezing, and flushing.
• Tetralogy of Fallot, a congenital anomaly, also causes pulmonary stenosis with associated conditions like ventricular septal defect (VSD) and right ventricular hypertrophy.

Tricuspid Stenosis

• Rare condition, typically linked with rheumatic heart disease.
• Inflammation prompts fibrosis, obstructing blood flow from the right atrium to the right ventricle.
• Less common compared to mitral and aortic stenosis.

Summary of Key Valves

• Mitral Stenosis: Leading to pulmonary congestion, primarily caused by rheumatic heart disease.
• Aortic Stenosis: Resulting from congenital bicuspid valves in younger patients and calcific degeneration in older patients, impeding left ventricular outflow.
• Pulmonary Stenosis: Often associated with carcinoid syndrome and congenital anomalies like tetralogy of Fallot.
• Tricuspid Stenosis: Uncommon; generally arises from rheumatic heart disease.

Valvular Regurgitation Overview

• Occurs due to insufficient sealing of heart valves, allowing backward blood flow.
• Mitral regurgitation divided into primary (involving valve components) and secondary (due to annular stretching).

Mitral Regurgitation

• Primary Causes: Infective endocarditis (damaging leaflets), rheumatic heart disease (stiff valves), papillary muscle rupture (from myocardial infarction), mitral valve prolapse (leaflet degeneration).
• Secondary Causes: Annulus dilation from conditions like heart failure stretching the annulus.

Aortic Regurgitation

• Blood regurgitates into the left ventricle during diastole due to valve damage or aortic root disease.
• Causes include infective endocarditis, rheumatic disease, congenital bicuspid aortic valve, aortic root dilation, and dissection.

Pulmonary Regurgitation

• Often a consequence of balloon valvuloplasty performed for tetralogy of Fallot, resulting in annular stretching.

Tricuspid Regurgitation

• Shares pathophysiological similarities with mitral regurgitation.
• Causes include infective endocarditis, rheumatic disease, carcinoid syndrome, and annulus dilation due to right heart failure.

Clinical Features and Physical Examination

• Mitral stenosis symptoms often involve pulmonary hypertension and heart failure, with specific markers like high left atrial pressure leading to symptoms such as orthopnea and paroxysmal nocturnal dyspnea.
• Mitral stenosis murmur is a diastolic rumble with an opening snap, best heard near the left fifth intercostal space.
• Mitral regurgitation presents a holosystolic murmur best heard near the left chest, radiating to the axilla.
• Aortic stenosis leads to classic symptoms including syncope, angina, and exertional dyspnea, with a characteristic crescendo-decrescendo murmur radiating to the carotids.
• Aortic regurgitation's murmur is an early diastolic “blowing” murmur that follows S2.

Key Physiological Concepts

• Increased afterload correlates with decreased stroke volume.
• Ventricular hypertrophy can result from increased afterload situations like aortic stenosis.
• Wide pulse pressure is seen in aortic regurgitation due to high systolic and low diastolic pressures.

Summary of Important Points

• Emphasize understanding mechanisms leading to regurgitation and symptoms of heart failure.
• Recognize characteristic murmurs to aid in diagnosing specific valvular conditions.
• Clinical management targets addressing underlying causes and symptomatic relief.

Blood Pressure and Physical Exam Findings

• Blood pressure discrepancies can signal cardiovascular issues, notably wide variances in systolic and diastolic values.
• Carotid pulse assessment may reveal significant pulsations due to rapid systolic blood flow, observable as Corrigan's pulse.

Heart Sounds and Murmurs

• S1 (closure of mitral/tricuspid) and S2 (closure of aortic/pulmonary) are crucial in diagnosis.
• S3 indicates rapid ventricular filling; S4 suggests atrial hypertrophy.
• Murmurs linked to pulmonary stenosis involve early systolic ejection clicks and a crescendo-decrescendo pattern.

Maneuvers to Alter Murmur Intensity

• Inspiration increases right-sided murmurs; Expiration enhances left-sided murmurs.
• Squatting/Leg Raise boosts venous return and intensifies all murmurs except those from hypertrophic cardiomyopathy and mitral valve prolapse.
• Valsalva Maneuver/Standing decrease venous return, diminishing murmur intensity, except in specific conditions where intensity increases.

Surgical Intervention and Diagnosis

• Echocardiography is the primary diagnostic tool for valvular heart disease, often enhanced by transthoracic or transesophageal imaging.
• Surgical treatments include balloon valvuloplasty for stenosis and valve repair or replacement for significant structural decline or symptomatic patients.

Explore the critical aspects of valvular heart diseases including their categorization into stenosis and regurgitation. Understand the mechanisms of mitral stenosis, its causes, and the impact on heart function. This quiz covers essential knowledge for medical students and professionals.