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Calcification with functional and structural stenosis or Destruction of the leaflets with resultant insufficiency
Causes 1. Senile calcific stenosis 2. Calcification of a congenital (bicuspid) valve 3. Rheumatic heart disease (secondary to RFi)
The pathology is that of CONCENTRIC LEFT VENTRICULAR HYPERTROPHY due to ventricular dilatation as a result of outflow obstruction Symptoms include 1. SOB 2. Angina 3. Syncope 4. Those of CHF orthopnoea, PND, oedema
Signs include a 1. Holosystolic murmur at the right second ICS radiating to the carotids 2. 3. Weak and delayed peripheral pulses
CXR shows minimal changes initially but cardiomegaly later. Diagnosis is by ECHO and if +ve then cardiac catheterisation (inc pressure across valve) Indications for surgery: 1. Symptoms 2. Increase in left ventricular end systolic volume
Procedure of choice is Aortic Valve Replacement (AVR), repair may be done rarely and with poor short term results. AVR may be accomplished with either a mechanical or bioprosthetic heart valve. Prognosis poor life expectancy 2-3 years, the greatest risk is that of sudden cardiac death.
Casues include (>40) aortic degeneration, (<40 y/o) Marfan's syndrome. Most frequently presents in combination with Aortic Stenosis. Other etiologies incl:
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endocarditis aneurysm congenital (bicuspid) luetic traumatic rheumatic atherosclerotic ankylosing spondylitis dissection iatrogenic SOB Palpitations Angina. Diastolic murmur Bobbing head Wide pulse pressure (collapsing pulse) Slow rising pulse
Signs include:
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CXR shows signs of congestive heart failure or/and cardiomegaly (cor bovinum) Indications for surgery include:
1. 2.
The usual etiology for pathology is post-rheumatic heart disease. The next most common etiology and growing is myxomatous degeneration. The mitral valve sits anatomically between the aortic valve, the circumflex artery and the coronary sinus.
Usual etiology is RHD. Symptoms are: 1. SOB 2. Angina 3. PND, orthopnoea, oedema, syncope - all part of CHF.
Left atrium will progressively dilate until very large, this can lead to atrial fibrillation and clot formation. Historically, pregnant females with MS at delivery would have cardiovascular collapse and require left thoracotomy and closed commissurotomy. Diagnosis is by ECHO and cardiac cath. Indications for surgery include symptoms, presence of transvalvular gradient by cath of > 4 mm Hg. Surgical correction involves: 1. open commissurotomy or repair plus annular ring 2. mitral valve replacement
Usual etiology is rheumatic heart disease, endocarditis, but most commonly now in the US is myxomatous degenertion and prolapse (floppy valve disease). Patient will present with symptoms of CHF. Eventually LV will become compromised because of regurgitant fraction creating a progressive cardiac dilatation. A systolic murmur will be heard at the apex radiating to axilla Indications for surgery are symptoms of CHF. Surgery may include: 1. Valvuloplasty with implantation of annular ring 2. Mitral valve replacement.
Even with surgery, LV may be so compromised that patient may not come off CPB or continue with symptoms of CHF.
Rheumatic Fever condition affecting children aged 5-15. It follows Group A Streptococcal pharangeal infection. Due to antibody-mediated autoimmune where antibodies against the bacteria cross react to cause multi-organ failure, particularly pancarditis and rheumatism. Pancarditis may cause valvular damage that predisposes to bacterial endocarditis later in life.