Valvular Disease
Objectives
- Identify common valvular lesions and be able to describe their associated typical murmurs
- Identify compensated physiology from decompensated in valvular heart disease
- Identify severe valvular pathology and describe principals of medical management, surgical management and follow up
Introduction
- Valvular lesions are commonly encountered in both inpatient and outpatient practice
- Classifying valvular lesions is done initially via history and physical exam and subsequently the findings are correlated to echocardiographic findings
- Valvular pathology may be acute or chronic (depending on the etiology)
Differential Diagnosis
- The differential diagnosis for a murmur is broad, and each valvular lesion has different characteristics important in diagnosis.
- Timing
- Location of Maximal Intensity
- Radiation
- Quality
- Associated Heart Sounds
- Change in intensity with certain maneuvers
Aortic Stenosis:
- Hemodynamic Consequences
- Etiologies:
- Senile Calcific AS (most common cause in North America)
- Bicuspid Aortic Valve
- Rheumatic Valve Disease
- Congenital Aortic Stenosis
- Rheumatoid Aortic Stenosis
- Differential Diagnosis:
- Aortic sclerosis (calcification but peak velocity < 2.5 m/s)
- HCM (dynamic obstruction)
- Supravalvular aortic stenosis: strong A2; murmur radiates to the right carotid; BP right arm > BP left arm; associated with Williams syndrome
- Subvalvular aortic stenosis: membrane or tunnel; combined with AR; absence of systolic anterior motion (SAM) of mitral leaflet