Valvular heart disease: Difference between revisions
Tarek Nafee (talk | contribs) |
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|[[Subaortic stenosis]] | |[[Subaortic stenosis]] | ||
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|[[Aortic regurgitation]] | |[[Aortic regurgitation]] | ||
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|Decrescendo | |Decrescendo | ||
|May present an early diastolic rumble at the [[Apex of the heart|apex]] ([[Austin Flint murmur|Austin-Flint murmur]]) | |May present an early diastolic rumble at the [[Apex of the heart|apex]] ([[Austin Flint murmur|Austin-Flint murmur]]) | ||
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|[[Mitral stenosis]] | |[[Mitral stenosis]] | ||
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|Decrescendo-Crescendo | |Decrescendo-Crescendo | ||
|Opening snap | |Opening snap | ||
| | |No radiation | ||
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|[[Mitral regurgitation]] | |[[Mitral regurgitation]] | ||
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|Blowing sound | |Blowing sound | ||
|Usually radiates to the [[axilla]] | |Usually radiates to the [[axilla]] | ||
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|[[Systolic click|Mid-systolic click]] | |[[Systolic click|Mid-systolic click]] | ||
|No radiation or may radiate to the [[axilla]] | |No radiation or may radiate to the [[axilla]] | ||
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|[[Tricuspid stenosis]] | |[[Tricuspid stenosis]] | ||
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|Opening snap | |Opening snap | ||
| | |No radiation | ||
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|[[Tricuspid regurgitation]] | |[[Tricuspid regurgitation]] | ||
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|Left lower sternal border | |Left lower sternal border | ||
|Holosystolic | |Holosystolic | ||
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| | |No radiation | ||
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|Wide split S2 | |Wide split S2 | ||
|Slight radiation to the [[neck]] | |Slight radiation to the [[neck]] | ||
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|Decrescendo | |Decrescendo | ||
|Blowing sound | |Blowing sound | ||
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|'''↑''' | |'''↑''' | ||
([[Carvallo's sign]]) | |||
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Revision as of 20:47, 7 March 2017
For patient information click here
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Tarek Nafee, M.D. [2]
Valvular heart disease Microchapters |
Overview
Valvular heart disease (VHD) is the pathological defect affecting one of the four valves of the heart: aortic valve, mitral valve, pulmonic valve, or triscuspid valve. VHD may be congenital or acquired. Congenital causes of VHD include tetralogy of fallot, ebstein's anomaly, noonan syndrome, congenital rubella syndrome, and bicuspid valves, among others. Acquired causes of VHD include rheumatic heart disease, infective endocarditis, senile calcification of valves,
Classification
Valvular heart diseases are typically classified according to the valve that is affected as well as the nature of the pathological defect as follows:
Differential Diagnosis
Clinicians may differentiate among different valvular heart diseases on the basis of the characteristics of the murmur and collecting a thorough patient history, as shown in the following table:
Valvular Disease | Common causes | Murmur Description | Interventions that Change Murmur Sounds | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Pitch | Timing | Best Heard Location | Shape | Other Features | Radiation | Valsalva Maneuver | Abrupt Standing | Hand Grip | Abrupt Squatting | Inhalation | ||
Aortic stenosis |
|
High | Systolic | Right second intercostal spaces | Crescendo-Decrescendo | Systolic Ejection Click with bicuspid valves | Radiates towards the neck | ↓ | ↓ | - | ↑ | - |
Subaortic stenosis | High | Systolic | Right second intercostal spaces | Crescendo-Decrescendo | - | No radiation | ↑ | ↑ | - | ↓ | - | |
Aortic regurgitation |
|
High | Diastolic | Right third intercostal spaces | Decrescendo | May present an early diastolic rumble at the apex (Austin-Flint murmur) | ?? | - | - | ↑ | - | - |
Mitral stenosis | Low (rumbling) | Diastolic | Left ventricular apex | Decrescendo-Crescendo | Opening snap | No radiation | - | - | - | - | - | |
Mitral regurgitation | High | Systolic | Left ventricular apex | Holosystolic | Blowing sound | Usually radiates to the axilla | ↓ | - | ↑ | - | - | |
Mitral valve prolapse | High | Systolic | Complete precordial area | Late systolic | Mid-systolic click | No radiation or may radiate to the axilla | ↑ | ↑ | - | ↓ | ↓ | |
Tricuspid stenosis | Low | Diastolic | Left fourth or fifth intercostal spaces | - | Opening snap | No radiation | - | - | - | ↑ | ↑ | |
Tricuspid regurgitation | Low | Systolic | Left lower sternal border | Holosystolic | - | No radiation | - | - | - | - | ↑ | |
Pulmonary stenosis | High | Systolic | Left second intercostal spaces | Crescendo-Decrescendo | Wide split S2 | Slight radiation to the neck | - | - | - | ↑ | ↑ | |
Pulmonary regurgitation | High | Diastolic | Left second and third intercostal spaces | Decrescendo | Blowing sound | No radiation | - | - | - | - | ↑ |