34 Valvular Disease

• children with strep infection
• blood volume goes up in pregnancy, symptomatic

Aortic Stenosis

• exception to aging
• stenosis in 50s: bicuspid valve
• The three major causes of valvular aortic stenosis are a congenitally abnormal valve with calcification (e.g. bicuspid valve), a calcified normal valve, or rheumatic heart disease. Although rheumatic heart disease is the most common cause worldwide, calcific aortic valve disease (in either a bicuspid or tricuspid valve) is more common in the United States.

• 2 leaflets fused together, not opening
• avoid meds that decreases cardiac output (beta blockers, diuretics)
• surgery with anesthesia places pts more at risks by inhibiting sympathetic response

Mitral Stenosis

• ventricle normal but just less blood

• hemoptysis: very high pressure in lung
• afib: dilated atrium due to volume overload, complication = stroke

• mitral valve in middle can't open

Aortic Regurge

• increased preload/stroke volume: ventricle has to pump blood twice

• HTN: thoracic aortic aneurysm
• endocarditis: damaged heart valve

• also occurs with PDA, AV fistula. Anything with leakage of blood out of aorta
• water hammer pulses: strong bounding pulses
• head bobbing: get dizzy when bp low
• Pulsus bisferiens, also known as a biphasic pulse, refers to two strong systolic pulses with a mid-systolic dip, in other words, two pulses during systole. It can be seen in aortic regurgitation with or without aortic stenosis and hypertrophic cardiomyopathy.

Mitral Regurge

• heart has to pump blood twice

• papillary muscle damage
• functional MR: leaflets too far apart

• down syndrome: EDC defect. Affect mitral leaflet
• cleft mitral valve: one of leaflets has a piece missing

• choose medication that lowers afterload, increase forward flow

Tricuspid and Pulmonic

• right sided very rare

Valve surgery

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• not tested