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

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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
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
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
Asymptomatic until left ventricle fails, diaphoresis,
bounding pulse, wide pulse pressure

Treatment: similar as


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




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