Valvular Diseases

Valvular Diseases

Mitral Stenosis:

• Cause: Rheumatic fever.
  o Diagnosis: Echo.
• Murmur: Mid-diastolic murmur.

• Mitral Regurgitation:
  • Murmur: Pan-systolic murmur.
  • Causes: Congenital, rheumatic fever, mitral valve prolapse, ventricular dilation, endocarditis, cardiomyopathy, rheumatoid arthritis.
• Mitral Valve Prolapse:
  o Murmur: Late systolic murmur over the apex.
• Aortic Sclerosis:
  • Causes: Congenital, rheumatic fever, bicuspid valve, degenerative calcification, hypertrophic cardiomyopathy.
  • Murmur: Systolic murmur loudest in the aortic area, radiates to the carotids.
• Aortic Regurgitation:
  • Murmur: High-pitched early diastolic murmur.
  • Causes: Congenital, ventricular septal defect, bicuspid aortic valve, rheumatic fever, thyroid dissection, endocarditis, cardiomyopathy, syphilis, hereditary diseases (Marfan’s and Ehlers-Danlos syndrome).
• Right Heart Valve Diseases:
  • Tricuspid Stenosis: Early diastolic murmur.
    o Tricuspid Regurgitation:

Pan-systolic murmur, associated with IV drug users.

• Pulmonary Stenosis: Ejection systolic murmur, loudest in the left upper sternum, radiates to the left shoulder.
  o Pulmonary Regurgitation: Decrescendo early diastolic murmur.

Structural Abnormalities

• Coarctation of the Aorta:
  • Description: Local narrowing of the descending aorta, usually distal to the origin of the left subclavian artery.
  • Presentation: Heart failure, increased BP, ejection systolic murmur on the left side, radiating to the back, lack of femoral pulse or radial-femoral delay.
  • Referral: Cardiology for surgery.
• Atrial Septal Defect:
  • Description: Hole connecting the two atria.
  • Types:
    • Secondary Ostium: Most common, symptoms rare in infancy, detected as a systolic murmur.
    • Primary Ostium: Associated with AV abnormalities, presents with heart failure in infancy and childhood.
  • Diagnosis: Echo.
• Ventricular Septal Defect:
  • Description: Congenital or acquired (e.g., post-MI).
  • Types:
    • Small: Asymptomatic, harsh pansystolic murmur.
    • Moderate: Symptoms in infancy, breathlessness, recurrent chest infections, pansystolic murmur.
    • Large: Presents with heart failure at 3 months and requires paediatric assessment and possible surgery.
  • Marfan Syndrome:

• Description: Abnormal neurotic tissue disorder. o Features: Long fingers, high arch palate, aortic dilation, lens dislocation, unstable iris.
  o Complications: Aortic incompetence, aortic dissection, and sudden death.
  o Referral: Cardiology or genetics.

Valve Diseases Reference