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Valvular  heart disease Dr. Rehab F. Valvular  heart disease Dr. Rehab F.

Valvular heart disease Dr. Rehab F. - PowerPoint Presentation

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Valvular heart disease Dr. Rehab F. - PPT Presentation

Gwada Normal Valve Function Maintain forward flow and prevent backward of blood flow Valves open and close in response to pressure differences gradients between cardiac chambers What Is ID: 908837

heart valve blood symptoms valve heart symptoms blood disease left pulmonary stenosis mitral aortic failure signs flow valves severe

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Slide1

Valvular heart disease

Dr. Rehab F. Gwada

Slide2

Normal Valve Function

Maintain forward flow and prevent backward of blood flow.Valves open and close in response to pressure differences (gradients) between cardiac chambers.

Slide3

What Is Valvular Heart Disease?

Heart valve disease occurs when your heart's valves do not work the way they should.The disease can affect the valve and derange its function in two ways:

Reduction in the orifice of the valve called

stenosis

which limits the forward blood flow

Backward leak of blood due to inefficient closing of the valve called

regurgitation or insufficiency

.

Slide4

What Are the Types of Valve Disease?

Slide5

Slide6

The valves affected most commonly by the disease are aortic and mitral valves. The pulmonary and tricuspid valves are affected less often

.

Slide7

What Causes Valvular Heart Disease?

idiopathic valvular

degeneration,

unknown cause.

Congenital

valve disease

.

 Most often affects the aortic or

pulmonary valve.

Rheumatic fever

Endocarditis

Other causes of valve disease include

:

coronary artery disease, heart attack,

cardomyopathy

, syphilis, hypertension , and connective tissue diseases.

 

Slide8

Rheumatic fever

Is an inflammatory disease that can develop as a complication of inadequately treated strep throat or scarlet fever.

Which are

caused by a streptococcus bacterium

infection.

Develop

in younger children and adults

.

The cardiac

manifestation

of rheumatic fever

is focal

inflammatory involvement of the interstitial tissue in all 3 layers of the

heart(pan-

carditis

)

The pathognomonic feature of pancarditis is the presence of Aschoff nodules.

Slide9

Aortic Regurgitation

Aortic regurgitation is incompetency of the aortic valve causing blood flow from the aorta into the left ventricle during diastole ..

Slide10

Signs

systolic BP increases while diastolic BP decreases, creating a widened pulse pressurethe LV impulse displaced downward and laterallynormal 1st heart sound (S1)loud, sharp

or slapping 2nd

heart sound (S2)

The

murmur

of AR is blowing, high-pitched

, diastolic

.

Slide11

Symptoms

AR may be acute or chronic.

In chronic AR, left ventricular (LV) volume and stroke volume gradually increase because the LV receives aortic blood regurgitated in

diastole

in addition to blood from

the

pulmonary veins and left atrium leading to

LV hypertrophy

this is

asymptomatic for years.

These changes may ultimately cause

arrhythmias, heart failure (HF), or

cardiogenic

shock.

Progressive exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and palpitations

develop.

Slide12

signs

(Musset's sign) Visible signs include head bobbing(slapping, water-hammer, or collapsing pulse)

Palpable signs include a large-volume pulse with rapid rise and fall.

(Corrigan's sign)

pulsation of the carotid arteries

(Mayne's sign)

BP findings may be a fall in diastolic BP of > 15 mm Hg with arm elevation

(pistol-shot sound, or

Traube's

sign)

Auscultatory

signs include a sharp sound heard over the femoral pulse

Slide13

Aortic Stenosis

Aortic stenosis (AS) is narrowing of the aortic valve obstructing blood flow from the left ventricle to the ascending aorta during systole.A valve area of 0.5 to 1.0 cm2 represents severe stenosis

; an area < 0.5 cm2 represent critical

stenosis

Slide14

Symptoms

The left ventricle (LV) gradually hypertrophies in response to AS. Significant LV hypertrophy and, with progression, may lead to decreased contractility, ischemia, or fibrosis, any of which may cause heart failure (

HF

).

AS produces low

cardic

output ultimately results in

syncope, angina, and

exertional

dyspnea

; heart failure and arrhythmias {

ventricular fibrillation } may develop

Slide15

Signs

A decreased carotid and peripheral pulsation . Systolic ejection murmur

.

. A palpable 4th heart sound (S4), felt best at the apex

Systolic

BP may be high with mild or moderate AS and fall as

AS

becomes more severe.

Slide16

Mitral Regurgitation

Mitral regurgitation (MR) is incompetency of the mitral valve causing blood flow from the left ventricle (LV) into the left atrium during systole

Slide17

Mitral Regurgitation

Regurge of blood into LA during systoleLA dilation and hypertrophyPulmonary congestionRV failure LV dilation and hypertrophy-to accommodate increased preload and decreased CO

Slide18

Symptoms

Most patients with chronic MR are initially asymptomatic and develop symptoms insidiously as the LA enlarges, pulmonary BP increases, and LV remodeling occurs. dyspnea,

fatigue (due to heart failure),

palpitations (often due to AF); rarely,

patients present with

endocarditis

(

eg

, fever, weight loss,….).

Signs develop only when MR becomes moderate to severe affected .

Slide19

Signs

sustained left parasternal movement due to expansion of an enlarged LA.

LV impulse

is

displaced downward and to the left

suggests LV hypertrophy and dilation.

(S1) may be soft or absent

if valve leaflets are rigid but is usually present if the leaflets are not rigid.

(S3), loud at the apex

in proportion to the degree of MR, reflects a greatly dilated LV.

(S4)

is characteristic of recent ruptured

chordae

, when the LV has not had enough time to dilate.

Apansystolic

murmur, heard best at the apex with the diaphragm of the stethoscope when the patient is in the left lateral decubitus position

Slide20

Slide21

Mitral Valve

Stenosis

the narrowing of the orifice of the 

mitral valve

 of the 

heart

]

Slide22

Mitral Stenosis

The normal area of the mitral valve orifice is 4 to 6 cm2

.

An area

of

2

to

1

cm2

reflects

moderate to severe

MS and often causes

exertional

symptoms

. An area < 1 cm2 represents critical stenosis and may cause

symptoms during rest

.

Left

atrial

(LA) size and pressure

increase

progressively

to compensate for MS

;

pulmonary venous and capillary pressures also

increase

and may cause secondary

pulmonary hypertension

, leading to right ventricular (

RV) heart failure

and

tricuspid and

pulmonic

regurgitation.

Valvular

change with LA enlargement predisposes to

atrial

fibrillation (AF), a risk factor for

thromboembolism

.

Slide23

Symptoms

many patients are asymptomatic until they become pregnant or AF develops. Initial symptoms

are usually those of heart failure (

eg

,

exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea, fatigue

). They typically do not appear until 15 to 40 yr after an episode of rheumatic fever

Palpitation

Chest pain

Hemoptysis

Thromboembolism in later stages when the left atrial volume is increased (i.e., dilation). leads to increase risk of 

atrial

fibrillation

, which increases the risk of blood stasis .This increases the risk of coagulation.

Ascites

and edema  and

hepatomegaly (if right-side heart failure develops)Fatigue and weakness increase with exercise and pregnancy.Less common symptoms include:hoarseness due to compression of the left recurrent laryngeal nerve by a dilated LA or pulmonary artery

Slide24

Mitral Valve Prolapse (MVP)

It is a very common condition, affecting 1 to 2 % of the population.

MVP causes the leaflets of the mitral valve to flop back into the left atrium during the heart's contraction.

MVP

also causes the tissues of the valve to become abnormal and stretchy, causing the valve to leak. The condition rarely causes symptoms and usually doesn't require treatment.

Slide25

Slide26

symptoms

MVP is usually asymptomatic, although chest pain, dyspnea, and symptoms of sympathetic excess (eg, palpitations, dizziness, syncope, migraines, anxiety) may develop.

Slide27

Pulmonary regurge

Pulmonic (pulmonary) regurgitation (PR) is incompetency of the pulmonic valve causing blood flow from the pulmonary artery into the right ventricle during diastoleThe most common cause is pulmonary hypertension.

Slide28

Symptoms

PR may contribute to development of right ventricular (RV) hypertrophy and eventually RV dysfunction–induced heart failure (HF), but in most cases, pulmonary hypertension contributes to this complication much more significantlyPR is usually

asymptomatic

. A few patients develop symptoms and signs of RV dysfunction

induced HF

Slide29

Pulmonic stenosis

is narrowing of the pulmonary outflow tract causing obstruction of blood flow from the right ventricle to the pulmonary artery during systole. Pulmonic stenosis (PS) is most often congenital and affects predominantly children;

Slide30

Symptoms

When symptoms develop, they resemble those of aortic stenosis (syncope, angina, dyspnea).

Slide31

Tricusped regurge

is insufficiency of the tricuspid valve causing blood flow from the right ventricle to the right atrium during systole. The most common cause is dilation of the right ventricle

Slide32

Symptoms and signs

are usually absent, but severe TR can cause neck pulsations, a holosystolic murmur, right ventricular–

induced heart failure or

atrial

fibrillation.

TR is usually benign and does not require treatment, but some patients require valve repair or replacement.

Slide33

How Are Valve Diseases Diagnosed?

symptomsphysical examthe doctor may order diagnostic tests. These may include:Echocardiography

Transesophageal

echocardiography

recent advances is the development of probes which can be advanced into the esophagus and take the images from the close proximity of the heart

Cardiac catheterization

 (also called an angiogram)

Radionuclide scans

Magnetic resonance imaging

 (MRI)

Slide34

Goals of treatment

There are three goals of treatment for heart valve disease: protecting the valve from further damage

lessening

symptoms

repairing

or replacing valves.

Slide35

Protecting the valve from further damage.

Patient is still at risk for endocarditis

, even if

his valve

is repaired or replaced through surgery. To protect

himself, give him the following advices:

Know the type and extent of your valve disease.  

Tell all your doctors and dentist you have valve disease.  

Call your doctor if you have symptoms of an infection.  

Take good care of your teeth and gums. 

Take antibiotics before you undergo any procedure that may cause bleeding.    

Take your medications. Follow your doctor's instructions.  

See your heart doctor for regular visits, even if you have no symptoms.

Slide36

Strategies for treatment

Slide37

How Is Heart Valve Disease Treated?

Common Types of MedicationsDiuretics Antiarrhythmic Vasodilators

ACE

inhibitors

A

type of vasodilator used to treat 

high blood

pressure

and

heart failure

Beta

blockers

Treat

high blood pressure and lessen the heart's work by helping the heart beat slower and less forcefully. Used to decrease palpitations in some patients.

Anticoagulants

Slide38

Surgery and Other Procedures

Surgical options include heart valve repair or replacement. Heart valves may also be repaired by other procedures such as percutaneous balloon

valvotomy

.

Slide39

Treatment

Valve Surgery (repair): Various technique can be used: (

eg

:

Leaflet repair, Use of prosthetic rings and etc).

to optimize the valve orifice making sure that the valve is no longer

stenotic

or

regurgitant

.

Generally, repairs are preferred over replacements.

Slide40

Valve replacement:

It occur ,When the valve is severely damaged and it is not possible to repair. The artificial valves are of three types

a mechanical (metallic) valve

a valve made from animal tissue

or a human valve removed from the human cadaver and frozen to preserve its integrity (cryopreservation).

The mechanical valve is the most durable but it has the disadvantage

of the risk of blood clot formation

.

Valve repair or replacement with tissue valves have the advantage that blood clot formation is not a risk.

The decision about the type of the artificial heart valve is made by the cardiologist and surgeon

.

Slide41

Indications for MV Replacement in Severe MR

ANY Symptoms at rest or exercise with (repair if feasible)Asymptomatic:If

EF <60%

If new onset

atrial

fibrillation

Slide42

Indications for Surgical Treatment of AR

ANY Symptoms at rest or exerciseAsymptomatic treatment if:EF drops below 50% or

LV

becomes

dilated

Slide43

Indications for Mitral valve

MS))replacementANY SYMPTOMATIC

Patient with NYHA Class III or IV Symptoms

Asymptomatic

moderate or Severe

MS

Slide44

Indications for Surgery in Aortic Stenosis

Any SYMPTOMATIC patient with severe AS (includes symptoms with exercise)Any patient with decreasing EF

Any patient undergoing CABG with moderate or severe AS

Slide45

Question?