Summary of Valvular Disorders
- Acute: aortic dissection, valve perforation (usually due to MI or endocarditis), traumatic valve leaflet rupture
- Chronic: leaflet abnormalities (bicuspid valve, endocarditis, RHD) or root dilation (HTN, CTD, dissection, syphilis)
• Clinical - Cardiogenic shock (acute), angina, left-sided HF. Thirty-one eponyms for signs in chronic AI, most due to large initial SV
• Exam - ↑ pulse pressure (bounding pulses, bouncing head/uvula, nail bed capillary pulse, etc.). High-pitched, blowing diastolic decrescendo murmur along LSB. Longer = more severe/chronic. May also hear low-pitched diastolic murmur at apex due to regurgitant jet displacing anterior leaflet (Austin-Flint )
• Etiology - 80% due to RHD (only 50-70% report h/o rheumatic fever); endocarditis, annular calcification (rarely significant), congenital, autoimmune valvulitis (SLE), carcinoid, endomyocardial fibroelastosis, XRT-assoc (10-20 yrs after Hodgkin’s treatment)
• Clinical - Dyspnea (most common symptom), pulmonary edema, hemoptysis, thromboembolism even w/o AFib, RV failure
• Exam - Loud S1, high-pitched opening snap (earlier more severe, indicating higher LAP), lowpitched diastolic rumble heard best at apex at end-expiration
• Etiology - Dilated annulus (“functional MR”), MVP, ischemic papillary muscle dysfunction, ruptured chordae, endocarditis, RHD, CTD
- Acute: flash pulmonary edema, HTN, shock
- Chronic: DOE, orthopnea, PND, edema, AF
• Exam - Holosystolic murmur at apex radiating to axilla, S3, displaced PMI. Early diastolic rumble and S3 may be the only signs in acute MR.
• Etiology - Dilated annulus, pulmonary hypertension (“functional TR”), Direct valve injury, endocarditis, RHD, carcinoid, ischemic papillary muscle dysfunction, CTD, drug-induced
• Clinical - Right-sided HF: Hepatosplenomegaly, ascites, edema
• Exam - Holosystolic murmur at left mid or lower sternal border that increases with inspiration, S3.
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