Scribd
Upload
30 views7 pages

Clinical Features of Mitral Regurgitation

This document discusses various types of valve diseases including their causes, clinical features, investigations, and management. Mitral regurgitation can be caused by rheumatic heart disease, valve prolapse, or damage to the valve or surrounding structures. It causes symptoms like breathing difficulties and ankle swelling. Examinations may reveal murmurs and signs of heart failure. Investigations include echocardiography and Doppler to detect and quantify the regurgitation. Management involves diuretics, vasodilators, and sometimes valve replacement for severe cases. Aortic stenosis is commonly caused by rheumatic fever or aging and may cause chest pain or fainting. Examinations can detect murmurs and enlarged hearts. Echocardiography

Uploaded by

api-3829364
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
30 views7 pages

Clinical Features of Mitral Regurgitation

This document discusses various types of valve diseases including their causes, clinical features, investigations, and management. Mitral regurgitation can be caused by rheumatic heart disease, valve prolapse, or damage to the valve or surrounding structures. It causes symptoms like breathing difficulties and ankle swelling. Examinations may reveal murmurs and signs of heart failure. Investigations include echocardiography and Doppler to detect and quantify the regurgitation. Management involves diuretics, vasodilators, and sometimes valve replacement for severe cases. Aortic stenosis is commonly caused by rheumatic fever or aging and may cause chest pain or fainting. Examinations can detect murmurs and enlarged hearts. Echocardiography

Uploaded by

api-3829364
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd

Medicine

Dr. Jawad Lec: -2-


2-Oct-06

MITRAL REGURGITATION
 Causes
 Rheumatic heart disease
 Mitral valve prolaps
 Dilatation of MV ring
 Damage to valve cusps and ring
 Damage to papllary muscle
 Myocardial infarction

CLINICAL FEATUERS

 Symptoms

 Acute MVR -symptoms of acute pulmonary oedema


 Chronic MVR
 Exersional dyspnoea,nocturnal dyspnoea,palpitation
 Symptoms of pulmonary oedema (pregnancy or AF)
 Symptoms of diminished cardiac output (fatigue)
 Ankle/leg oedema,abdominal swelling (right heart failure)

 Signs

 Atrial fibrillation
 Cardiomegaly
 Apical pansystolic murmur ±thrill
 Soft s1,apical s3
 Cripitation,pulmonary oedema ,effusion
 Signs of pulmonary hypertension

INVESTIGATIONS

 ECG Left atrial hypertrophy, Left ventricular hypertrophy


 CXR enlarged LA ,enlarged LV,pulmonary venous hypertension ,pulmonary
oedema.
 Echo dilated LA,LV ,dynamic LV.
 Doppler to detect and quantitate regurgitation
 Cardiac catheterization

1
MANAGEMENT
90
80
 Medical 70
 Diuretic 60
 Vasodilator 50 East
 Digoxin 40 West
 Anticoagulant 30 North
 Antibiotic prophylaxis20
10
 Mitral valve replacement
0
 Worsening of symptoms 1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
 Progressive LV dilatation
 Progressive LV dysfunction

AORTIC STENOSIS
 Aetiology and pathophysiology
 Causes
 Congenital
 Bicusped aortic valve
 Rheumatic heart disease
 Senile degenerative aortic stenosis

CLINICAL FEATURES

 Symptoms
 Mild to moderate aortic stenosis usually asymptomatic
 Exersional dyspnea
 Angina
 Pulmonary oedema
 Exersional syncope
 Sudden death

 Signs
 Ejection systolic murmur
 Slow-rising carotid pulse,reduced pulse pressure
 Left ventricular hypertrophy-thrusting apex beat
 Left ventricular failure (cripitation,pulmonary oedema)

2
INVESTIGATIONS

 ECG---LVH (usually),LBBB
 CXR---normal ,enlarged LV,dilated ascending aorta,calcified AV on [Link]
 Echo---calcified AV,LVH
 Doppler ---to measure the gradient
 Cardiac cath.---to measure the gradient,post stenotic dilatation of the
aorta,regurgiatation ,associated coronary artery disease

MANAGEMENT
 Symptoms---(angina ,syncope ,heart failure)
 Baloon aortic valvuloplasty---usually indicated in adulscent ,elederly as
apalliative measure in high surgical risk patients.
 Aortic valve replacement

AORTIC REGURGITATION

 Causes

 Acquired
 Rheumatic disease
 Infective endocarditis
 Trauma
 Aortic dilatation: Marfan syndrom ,Atheroma ,Syphilis ,Ankylosing
spondylitis

CLINICAL FEATURES

 Symptoms

 Mild-moderate AR
 Often asymptomatic
 Awareness of heart beat (palpitation)
 Sever AR
 Symptoms of heart failure
 angina

 Signs

3
 Large-volume pulse (collapsing)
 Bounding peripheral pulses (corrigan)
 Capillary pulsation in nail beds (quinckes)
 Femoral bruit (duroziez)
 Head nodding with pulse (de Musset)

 Murmurs
 Early diastolic murmur
 Systolic murmur of increased stroke volume
 Austin flint murmur (soft mid diastolic)
 Other signs
 Thrusting apex,S4 ,ENLARGED LV
 Signs of heart failure

INVESTIGATIONS

 ECG-- Intially normal ,later LVH


 CXR—cardiac dilatation,may be aortic dilatation ,Features of left heart failure
 Echo—dilated LV ,hyperdynamic ventricle ,flttering anterior mitral
leflet,doppler detect reflux
 Cardiac cath.—dilated LV,aortic regurgitation ,dilated aortic root

MANAGEMENT

 Treatment of the underlying cause


 Vasodilator may prevent progressive LV dilatation
 AVR:
 Symptomatic
 Progressive LV dilatation
 Progressive LV dysfunction

PULMONARY VALVE DISEASE

PULMONARY STENOSIS

 SYMPTOMS
 Right sided heart failure
 That of carcinoid syndrome

 SIGNS
 Giant a wave in JVP

4
 RVH and dilatation
 Ejection systolic murmur ±thrill
 P2 soft and delayed

INVESTIGATIONS
 CXR---prominent PA with post stenotic dilatation
 ECG---RA and RV hypertrophy
 Echo---abnormal PV,outflow gradient on doppler

MANAGEMENT
 Mild –moderate PS is very common and usually asymptomatic ,low risk for
endocarditis need no treatment
 Sever PS defined as gradient >50 mm hg treated by balloon valvuloplasty ,or
rarely by surgery.

PULMONARY REGURGITATION

 Rarely an isolated lesion


 Associated with pulmonary hypertension
 Early diastolic murmur to left parasternal area(graham steell murmur
 Trivial PR is afrequent echo finding and its of not clinical significant

TRICUSPED STENOSIS
 Usually rheumatic in origin
 Nearly always occur with rheumatic mitral and aortic valve disease
 Significant TS occur in 5%
 Isolated TS is very rare
 TS and TR may be associated with carcinoid syndrom

CLINICAL FEATURES

 SYMPTOMS
 SYMPTOMS OF associated MV and AV disease
 Symptoms of right sided heart failure (abdominal swelling ,hepatic discomfort
,peripheral oedema ,fatigue)

 Signs

5
 Raised JVP ,prominent a wave
 Mid-diastolic murmur—increased by inspiration
 Signs of right sided heart failure

INVESTIGATIONS
 CXR—enlarged right atrium
 Echo---fused thickened TV leaflets ,dilated RA ,doppler features of TS

MANAGEMENT
 Balloon valvuloplasty for symptomatic isolated TS
 Surgical valvotomy or TVR ,when the patient need surgery for other
associated valve disease

TRICUSPED REGURGITATION
CAUSES

 PRIMARY
 Rheumatic
 Endocarditis (i.v. drug abuser)
 Ebstien’s anomaly
 SECONDARY
 Right sided dilatation secondary to chronic left sided failure
 Right ventricular infarction
 Pulmonary hypertension

CLINICAL FEATURES

 SYMPTOMS---usually non specific ,tiredness, edema


 SIGNS:
 Raised JVP,large systolic wave c-v
 Systolic hepatic pulsation
 Pansystolic murmur louder on inspiration

INVESTIGATIONS

 CXR---dilated RA,RV
 Echo---RV dilatation,TV may be structurally abnormal,estimate PA pressure
by Doppler

6
MANAGEMENT
 Treatment of the underlying causes
 Few patients with TR and abnormally elevated PA pressure need surgical
correction or replacement

Written By:
Rand Aras Najeeb

Common questions

Powered by AI

Clinically, aortic regurgitation can manifest with symptoms such as awareness of heartbeat or palpitation in mild to moderate cases, and heart failure or angina in severe cases . Diagnostic assessments include ECG, which initially may be normal but later show left ventricular hypertrophy; CXR, which may reveal cardiac or aortic dilatation and features of left heart failure; echocardiography, showing a dilated left ventricle and fluttering anterior mitral leaflet; and cardiac catheterization, detecting aortic regurgitation and left ventricular dilation .

Pulmonary stenosis is characterized by symptoms and signs of right-sided heart failure and may be associated with carcinoid syndrome, featuring a giant 'a' wave in the jugular venous pulse, right ventricular hypertrophy, and an ejection systolic murmur possibly accompanied by a thrill, with a soft and delayed P2 . In contrast, pulmonary regurgitation typically presents with an early diastolic murmur (Graham Steell murmur) at the left parasternal area, often associated with pulmonary hypertension and trivial regurgitation is frequently detected by echocardiography without clinical significance .

The management of severe aortic stenosis typically involves aortic valve replacement, which is indicated when symptoms like angina, syncope, or heart failure develop . Balloon aortic valvuloplasty may be used as a palliative measure in adolescents or the elderly who are at high surgical risk .

In tricuspid stenosis, symptoms of right-sided heart failure include abdominal swelling, hepatic discomfort, peripheral edema, and fatigue, which are directly linked to impeded venous return and increased systemic venous pressure . This contrasts with other valvular conditions where right-sided heart failure symptoms might also include significant pulmonary issues due to left-sided heart failure, highlighting the isolated venous congestion typical of tricuspid stenosis.

Tricuspid regurgitation manifests with non-specific symptoms such as tiredness and edema, and specific signs like raised JVP with a large systolic c-v wave and systolic hepatic pulsation, accompanied by a pansystolic murmur louder on inspiration . Primary causes include rheumatic disease, endocarditis (commonly in intravenous drug users), and Ebstein's anomaly, while secondary causes involve right-sided dilatation due to chronic left-sided failure, right ventricular infarction, and pulmonary hypertension .

Mild to moderate pulmonary stenosis is often asymptomatic and typically requires no treatment due to its low risk for endocarditis . Severe pulmonary stenosis, defined by a gradient greater than 50 mm Hg, requires treatment with balloon valvuloplasty or surgery in rare cases .

In acute mitral regurgitation, symptoms are primarily those of acute pulmonary edema, reflecting a rapid and severe impact on hemodynamics due to the sudden incompetence of the mitral valve . In contrast, chronic mitral regurgitation presents with exertional dyspnea, nocturnal dyspnea, palpitation, and symptoms of diminished cardiac output such as fatigue, along with right heart failure symptoms such as ankle/leg edema and abdominal swelling . These differences reflect the body's adaptation over time in chronic regurgitation versus the abrupt pathophysiological changes in acute cases.

Investigative modalities for tricuspid stenosis include CXR, which shows an enlarged right atrium; echocardiography, which reveals fused thickened tricuspid valve leaflets and a dilated right atrium, with Doppler features confirming tricuspid stenosis . These investigations help in assessing the structural integrity and function of the tricuspid valve and the impact on the adjacent cardiac structures, confirming the presence and severity of the stenosis.

Vasodilators may play a preventative role in the management of aortic regurgitation by preventing progressive left ventricular dilatation, thus reducing symptoms and slowing disease progression . Surgery, specifically aortic valve replacement, becomes necessary when patients present with symptoms, progressive left ventricular dilatation, or left ventricular dysfunction, indicating that medical treatment is no longer sufficient to manage the condition .

Primary causes of mitral regurgitation include rheumatic heart disease, mitral valve prolapse, dilatation of the mitral valve ring, damage to valve cusps and ring, damage to the papillary muscle, and myocardial infarction . These conditions can lead to improper closure of the mitral valve, resulting in the backflow of blood from the left ventricle into the left atrium. This regurgitation increases the workload on the left side of the heart, leading to symptoms such as acute pulmonary edema in acute cases or exertional dyspnea, nocturnal dyspnea, and palpitation in chronic cases .

You might also like