Common Valve Pathologies Lecture Notes PDF

Auscultation of heart valves: ◦Aortic: right eternal border, 2nd intercostal space ◦Pulmonic: left eternal border, 2nd intercostal space ◦Tricuspid: lower left sternal border, 5th intercostal space ◦Mitral: apex, 5th intercostal space, mid-clavicular line Abnormal valve func...

Auscultation of heart valves: ◦Aortic: right eternal border, 2nd intercostal space ◦Pulmonic: left eternal border, 2nd intercostal space ◦Tricuspid: lower left sternal border, 5th intercostal space ◦Mitral: apex, 5th intercostal space, mid-clavicular line Abnormal valve function: ◦Stenosis - valve doesn’t open enough ◦Regurgitation - valve doesn’t close properly ◦Results in ‘murmurs’ ◦Most common causes: rheumatic fever, infective endocarditis, myocardial infarction (chordinae tendinae affected), congenital ◦Common valves affected: aortic and mitral Aortic valve stenosis: ◦Pathophysiology: ‣ Less blood can get through valve to outflow tract ‣ Increased LV pressure ‣ LV hypertrophy, and so left ventricular afterload increases ‣ Left sided heart failure -> syncope (fainting, since blood can no longer flow to the body), angina (chest pain due to heart, as cardiac output is low) ‣ Microangiopathic haemolytic anaemia (from shear stress, so RBCs are broken down) ◦Murmur: ‣ Ejection systolic murmur loudest over the aortic area (hence waves between S1 and S2) ‣ Narrow pulse pressure - crescendo decrescendo murmur Aortic valve regurgitation: ◦Pathophysiology: ‣ Blood leaks back to ventricles in diastole ‣ This increases stroke volume for subsequent cardiac cycles ‣ LV hypertrophy - as heart is working hard to pump blood around the body ◦Murmur: ‣ Early diastolic murmur loudest over aortic area ‣ Wide, bounding pulse (head bobbing, Quincke’s sign) ‣ Displaced apex beat Mitral valve stenosis: ◦Pathophysiology: ‣ Harder for blood flow from LA to LV ‣ Increased LA pressure -> pulmonary hypertension -> RV hypertrophy ‣ LA dilation -> atrial fibrillation -> thrombus formation ‣ LA dilation -> oesophagus compression -> dysphagia (difficuty swallowing) ◦Murmur: ‣ Mid-diastolic murmur heard at apex  ‣ Irregularly irregular pulse (due to atrial fibrillation) Mitral valve regurgitation: ◦Pathophysiology: ‣ Backflow of blood from LV to LA ‣ Increase LV preload -> LV hypertrophy ◦Murmur: ‣ Pansystolic murmur heard at apex - hear the murmur throughout the systolic phase ‣ Displaced apex beat