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Flashcards in Valvular disease Deck (18):

Main causes of mitral Regurgitation

  1. Annular dilatation (functional regurgitation)
  2. Mitral valve prolapse
  3. Myxomatous degeneration
  4. Ischaemic (papillary muscle dysfunction)
  5. Chronic rheumatic disease
  6. HCM (functional regurgitation)
  7. Endocarditis
  8. COllagen disorders: Marfan;s syndrome, Ehler's danlos
  9. Autoimmune: SLE  
  10. Iatrogenic: centrally acting appetite supresants (fenfluramine), dopamine agonists (cabergoline)


Presentation of mitral regurgitation

Can be asymptomatic for years and cardiac dimensions increase greatly

Dyspnoea + orthopnea due to pulmonary HTN
Fatigue + lethargy due to ↓CO

In late stages, R heart failure and eventually congestive heart failure

Cardiac cachexia may develop

Subacute IE very common



Laterally displaced thrusting apex
Soft S1 due to incomplete closure of the valve
• Pansystolic murmur radiating to axial, heard throughout precordium
Prominent S3 (early diastole) due to the sudden rush of blood into dilated LV
• The more severe, the larger the left ventricle.


pathology in MR

Regurgitation into LA causes dilatation but little increase in pressure as the flow is accommodated.
In acute MR→↑↑pulmonary pressure → pulm oedema
To maintain sufficient CO → LV enlarges (hypertrophy+dilatation)


Mitral stenosis presentation

Sx: mainly palpitations, breathlessnes + marked exertional Sxs.

+haemoptysis (due to pulmonary HTN)

dysphagia (due to atriomegaly)


• Malar flush(due to ↓ CO)
• Left parasternal heave if pulmonary HTN
• Pulmonary HTN → haemoptysis
• AF due to dilated LA → emboli
• Sx of Right Hear failure: ↑JVP, ascites, hepatomegaly, peripheral oedema, dyspnea, weakness, fatigue


causes of MS

1. Rheumatic fever 2o A Beta-hemolytic strep
2. Lutembacher’s syndrome
3. Congenital
4. In elderly: calcification + fibrosis
5. Carcinoid tumour

6. SLE


pathology in MS

Normal orifice 4-6cm2
To maintain sufficient CO ↑LA pressure → LA hypertrophy + dilatation → ∴↑pulmonary pressure (pulmonary HTN) →↑R heart pressure →  RV hypertrophy + dilatation →→pulm. oedema, esp when AF develops



• Malar flush(due to ↓ CO)
• Left parasternal heave if pulmonary HTN
• Pulmonary HTN → haemoptysis
Localised tapping apex (palpable S1)
• Mid-diastolic murmu
r (bell, best in expiration, with pt on left side)
Loud S1 initially. Softens when valve is immobile
Loud S2 if Pulmonary HTN
AF due to dilated LA → emboli
• Sx of Right Hear failure: ↑JVP, ascites, hepatomegaly, peripheral oedema, dyspnea, weakness, fatigue
• Length of diastolic murmur is proportional to severity
• The more severhe closer the opening snap is to S2
Graham Steell murmur – pulmonary regurg due to pulm artery dilatation caused by ↑pulm pressure


complications of MS


  1. Pulmonary HTN;
  2. emboli,
  3. pressure from large LA on local structures, eg hoarseness (recurrent laryngeal nerve), dysphagia (oesophagus), bronchial obstruction;
  4. IE.


Aortic stenosis presentation

TRIAD: angina, dyspnea, syncope

sometimes sudden death



Causes of Aortic Stenosis




  1. Degeneration and calcification
  2. Congenital abnormality and faster degeneration (bicuspid)
  3. Rheumatic fever
  4. Chronic kidney disease
  5.  Paget’s disease of bone
  6.  Previous radiation exposure
  7. Homozygous familial hypercholesterolemia






Pathology in AS

Obstructed LV emptying →∴↑LV pressure → compensatory LV hypertrophy → relative ischemia of LV myocardium


Sx of AS

• Pulse: small volume, slow-rising
• Apex not displaced
• May be ejection click unless valve immobile and calcified
• Soft A2/inaudible when valve immobile
• Reversed splitting of S2 (on expiration splits) rare
S4 caused by atrial contraction unless concurrent MS prevents this
• Systolic ejection murmur,+/- radiates to carotids

Aortic sclerosis
is senile degeneration of the valve. There is an ejection systolic murmur, no carotid radiation, and normal pulse (character and volume) and S2.


Causes of Aortic REGURGITATION

ACUTE: IE, ascending aorta dissection, chest trauma


  1. Collagen disease: Marfans, Ehlers-Danlos
  2. RF
  3. akayasu arteritis, rheumatoid arthritis,SLE; pseudoxanthoma elasticum,
  4. appetite suppressants (eg fenfluramine, phentermine), seronegative arthritides (ankylosing spondylitis, Reiter’s syndrome, psoriatic arthropathy),
  5. hypertension,
  6. osteogenesis imperfecta,
  7. syphilitic aortitis.


AR presentation

predominantly breathlessness

• Sx occur late not until LV failure develops.



• Pounding of the heart due to hypertrophy
• Angina pectoris, dyspnea
• Pulse: bounding or collapsing
• Quincke’s sign – capillary pulsation in nail beds
• De musset’s sign – head nodding with each heart beat
• Duroziez’s sign – to-and-fro murmur when femoral a. is auscultated in severe AR
• Apex displaced laterally and downwards, forceful
• High-pitched early diastolic murmur best heard at LSE with pt leaning forward in expiration
• Volume overload frequently cuases ejection systolic flow murmur
Austin Flint rumble – impinged anterior mitral valve cusp by regurgitant jet


HCM\definition and presentation

≈lv outflow tract (LVOT) obstruction from asymmetric septal hypertrophy. leading cause of sudden cardiac death in the young.
0.2% Autosomal dominant, 50%  sporadic. 70% have mutations in genes encoding β-myosin, α-tropomyosin, and troponin t. ? FHx  of sudden death.
Sudden death  may be the first manifestation, , angina, dyspnoea, palpitation, syncope, ccf.



• Jerky pulse;
• a wave in JVP;
• double-apex beat;

• systolic thrill at lower left sternal edge;
harsh ejection systolic murmur.