valvular heart diseases - final year lecture
TRANSCRIPT
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ByMr. Adeel ABBAS
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Valvular Heart Disease is defined as any disease process involving one or more of the four valves of the heart, resulting in deranged blood flow through the heart chambers.
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Rheumatic Fever
What is the Common Age of Presentation?
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In developing countries, common age of presentation is 5 to 15 years.
In developed countries, common age of presentation is middle age.
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How Rheumatic Fever Starts?
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Rheumatic Fever starts after infection with
Group A α-Hemolytic Streptococcus leading
to pharyngitis. Then there is Immune-
mediated acute inflammation affecting heart
valves due to cross-reaction between antigens
of bacteria and cardiac protiens.
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What are the Pathological Effects?
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May make Orifice Smaller…May make Orifice Unable to Close Properly…
Stenosis causes Pressure Load…Regurgitation causes Volume Load…
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Jones Criteria
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Cardiac SequelaeMitral Valve 70%.Aortic Valve 28%.Tricuspid Valve 10%.Pulmonary Valve 2%.
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PreventionPrompt treatment for a sore throat that lasts
longer than 48 hours, especially if accompanied by a fever.
Timely administration of antibiotics may prevent the development of rheumatic fever which can cause valvular heart disease.
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Let’s first understand Cardiac Cycle along-
with Venous Wave, EKG and Heart Sounds….
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Mitral RegurgitationCauses;
Degenerative.Rheumatic Fever.Infective Endocarditis.
Presentation;Dyspnoea.Chronic Fatigue.Palpitation.Pulmonary Edema.
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Apex Laterally Displaced.
Apical Pansystolic Murmur Radiating to Axilla
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Mitral StenosisCauses;
Rheumatic Fever.Congenital.
Presentation;Paroxysmal Nocturnal Dyspnoea.Malar Flush.Pulmonary Hypertension.Atrial Fibrillation.
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Aortic RegurgitationCauses;
Congenital.Rheumatic Fever.Infective Endocarditis.
Presentation;Dyspnoea.Palpitation.Wide Pulse Pressure.Water Hammer Pulse
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Aortic StenosisCauses;
Senile Degenration.Rheumatic Fever.Congeital.
Presentation;Angina Pectoralis.Dizziness/Syncope.LHFSlow Rising Pulse.
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InvestigationsECG.Chest X-Ray.Echocardiogram.
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Dilated Right Atrium
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Massively Dilated Right Atrium
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ManagementMedical.
SurgicalRepair.Replacement.
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Medical TreatmentHeart-healthy Lifestyle;
Don’t smoke.Avoid excessive alcohol consumption.Avoid Excessive salt intake.Reduce Exercise.
Symptomatic;Long-term antibiotic therapy.Antithrombotic Medications (Aspirin).More potent anticoagulants (Warfarin).Treat Cardiac Failure.Digitalis (for Atrial Fibrillation).
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Surgical TreatmentIndicatons;
Symptomatic Status, Occurrence of Thromboembolic episodes or
Endocarditis, Deterioration in Pulmonary Haemodynamics,Deterioration in Myocardial function.
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Surgical OptionsValve Repair (Possible only in A/V valves);
Valvotomy.Balloon Dilatation.
Valve Replcement;Mechanical Valves (Require Lifelong
Anticoagulation).Biological Valves (Last for 10-15 years & Donot
Require Lifelong Anticoagulation).
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Metallic Valves
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Biological Valve
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Operative Picture of Valve Replacement
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