Mitral Stenosis (stiff) Aortic Stenosis (entropy) – Cause by rheumatic fever (untreated strep throat), endocarditis, hardening of valve etc – Left atrial pressure increase and cause dilation, this lead to pulmonary hypertension and cause hypertrophy of ventricle – Left side heart failure eventually cause right side heart failure.
As the disease progress, patient will develop right side heart failure symptoms as well. – Asymptomatic or paroxysmal nocturnal dyspnea, dry cough, orthopnea, hemoptysis, and heart palpitation. In the later stage (right side heart failure)-hepatomegaly, neck vein distention, pitting dependent edema. – Rumbling apical diastolic murmur present – Monitor for irregular heart rhythm – Most common cardiac valve dysfunction (wear tear) – Congenital bicuspid is the most common cause, also atherosclerosis and degeneration of valve – Increase afterload, hypertrophy & decrease CO, and eventually cause congestion in left atrium which can lead to pulmonary congestion – Symptoms includes dyspnea, angina, syncope, fatigue, debilitation, peripheral cyanosis – Systolic murmur present Treatment (both) – Diuretics, beta blockers, digoxin, O2 is used to treat heart failure – Vasodilator (Ca+ channel blocker) use to decrease regurgitant flow – Anticoagulation therapy – Cardioversion to reset the cardiac rhythm (assess s&s for stroke, TEE prior), management of atrial fib – rest – Balloon valvuloplasty, direct open commissurotomy (remove Ca & scar tissue), heart valve replacement procedure using xenograft & pulmonary autographs – Mitral valve annuloplasty – Nitrate is used for decreased in preload – Patient who are not surgical candidate, transcatheter aortic valve replacement can be done Mitral Regurgitation (systole) Aortic Regurgitation (diastole) – Increase blood volume & pressure and cause L. atrium &ventricle hypertrophy – Primary cause is degeneration by aging and RH disease – Symptom: asymptomatic until left ventricle fails, fatigue, weakness, dyspnea, orthopnea, anxiety, chest pain, palpitation – Blood flow back in to the left ventricle during diastole causing increase in volume & pressure and hypertrophy – Caused from non-rheumatic condition like infective endocarditis, HTN, Marfan syndrome, congenital anatomic aortic valvular abnormalities – Asymptomatic until left ventricle fails, diaphoresis, bounding pulse, wide pulse pressure Treatment: similar as stenosis Mitral Valve Prolapse – Valve leaf enlarge and prolapse into left atrium during systole – Marfan syndrome and other congenital defects – Asymptomatic, chest pain, palpitation, exercise intolerance, dizziness, syncope – Midsystolic click and murmur present at apex
