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

 

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