34 Valvular Disease

Rheumatic

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• children with strep infection

• blood volume goes up in pregnancy, symptomatic

Aortic Stenosis

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• exception to aging

• stenosis in 50s: bicuspid valve

• The three major causes of valvular aortic stenosis are a congenitally abnormal valve with calcification (e.g. bicuspid valve), a calcified normal valve, or rheumatic heart disease. Although rheumatic heart disease is the most common cause worldwide, calcific aortic valve disease (in either a bicuspid or tricuspid valve) is more common in the United States.

• 2 leaflets fused together, not opening

• avoid meds that decreases cardiac output (beta blockers, diuretics)

• surgery with anesthesia places pts more at risks by inhibiting sympathetic response

Mitral Stenosis

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• ventricle normal but just less blood

• hemoptysis: very high pressure in lung

• afib: dilated atrium due to volume overload, complication = stroke

• mitral valve in middle can't open

Aortic Regurge

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• increased preload/stroke volume: ventricle has to pump blood twice

• HTN: thoracic aortic aneurysm

• endocarditis: damaged heart valve

• also occurs with PDA, AV fistula. Anything with leakage of blood out of aorta

• water hammer pulses: strong bounding pulses

• head bobbing: get dizzy when bp low

• Pulsus bisferiens, also known as a biphasic pulse, refers to two strong systolic pulses with a mid-systolic dip, in other words, two pulses during systole. It can be seen in aortic regurgitation with or without aortic stenosis and hypertrophic cardiomyopathy.

Mitral Regurge

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• heart has to pump blood twice

• papillary muscle damage

• functional MR: leaflets too far apart

• down syndrome: EDC defect. Affect mitral leaflet

• cleft mitral valve: one of leaflets has a piece missing

• choose medication that lowers afterload, increase forward flow

Tricuspid and Pulmonic

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• right sided very rare

Valve surgery

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• not tested