Valve disease
- Aortic valve disease
- Mitral valve disease
- Tricuspid valve disease
Aortic valve disease
Aortic stenosis
Causes
- Congenital bicuspid valve
- Senile calcification
- Rheumatic fever
- Prosthetic valve failure
Symptoms
- Asymptomatic
- Angina
- Syncope
- Dyspnoea
- Sudden death
Signs
- Pulse slow rising, low volume
- BP narrow pulse presure
- Heaving apex (pressure overload). Apex not displaced.
- Systolic thrill
- Soft A2
- Ejection systolic murmur radiating to neck
- LVF
Increasing severity sees in order: slow rising pulse, inaudible S2,
low BP, heart failure.
Aortic regurgitation
Causes
Valvular causes:
- congenital bicuspid valve
- rheumatic fever
- subacute infective endocarditis
- collagen vascular disease (RhA,
SLE)
- Prosthetic valve failure
Aortic root causes:
- type A aortic root dissection
- syphilis
- heritable connective tissue disorders (Marfan's, Ehlers-Danlos,
adult polycystic kidney disease)
- seronegative arthopathies (ank spond,
Reiter's)
Symptoms
- asymptomatic
- dyspnoea, fatigue
- angina
- syncope
- aortic dissection
- LVF
Signs
- water hammer pulse (Corrigan's sign),
head nodding (de Musset's sign),
nail bed pulsation (Quincke's sign),
'pistol shot' femoral pulses (Traube's sign), etc.
- BP pulse pressure wide
- apex thrusting (volume overload), displaced
- diastolic thrill
- soft S2, S3, S4
- early diastolic murmur
- systolic flow murmur
Increasing severity sees: ↓of murmur,
LVF,
displaced apex.
Mitral valve disease
Mitral stenosis
Causes
- Rheumatic Fever
Symptoms
- progressive exertional dyspnoea
- symptoms of pulmonary congestion: orthopnoea,
paroxysmal nocturnal dyspnoea, cough, haemoptysis
- pulmonary oedema precipitated by exertion
- recurrent bronchitis
- RVF
- palpitations (AF)
Signs
- pulse, small volume, AF
- mitral facies
- central cyanosis
- apex tapping, not displaced
- loud S1, opening snap, mid-diastolic murmur with presystolic accentuation if in sinus rhythm
- basal crackles
- pulmonary hypertension–RV heave, loud P2,
secondary TR,
RVF
Increasing severity sees increasing duration of murmur.
Mitral regurgitation
Causes
- mitral prolapse
- rheumatic fever
- posterior infarct (papillary muscle rupture)
- SBE (cause or complication)
- LVF →
dilated ventricle → stretching of
AV ring
- carcinoid heart disease
- cardiomyopathy, dilated or hypertrophic
- ergotamine therapy
- Kawasaki disease
- chronic renal failure
Symptoms
- asymptomatic
- dyspnoea
- palpitations, AF
- non-specific chest pain
- fatigue
- cor pulmonale
Signs
- pulse, small volume, may be collapsing
- AF (atrial fibrillation)
- apex thrusting (volume overload), displaced
- systolic thrill
- MVP–midsystolic click,
late systolic murmur
MR–soft S1,
pansystolic murmur radiating to axilla
- S3, S4
- diastolic flow murmur
- RV heave, loud P2 (pulmonary hypertension)
Tricuspid valve disease
Tricuspid regurgitation
Causes
- bacterial endocarditis (esp. IV drug users)
- pulmonary hypertension
- rheumatic fever
- RVF → AV ring stretched
Symptoms
Mitral stenosis often co-exists and predominates
- exertional dyspnoea
- GI upset
Signs
- ↑JVP with large v waves
- pulsatile hepatomegaly
- ascites
- dependent oedema
- pansystolic murmur over tricuspid area, louder on inspiration