Makindo Medical Notes"One small step for man, one large step for Makindo" |
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Related Subjects: |Aortic Anatomy |Acute Coronary Syndrome (ACS) General |Aortic Dissection |Acute Heart Failure and Pulmonary Oedema |Aortic Regurgitation (Incompetence) |Aortic Stenosis |Aortic Sclerosis |Transcatheter aortic valve implantation (TAVI)
Form of Aortic Valve Disease | Clinical Presentation | Important Clinical Signs | Investigations | Management |
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Aortic Stenosis | Dyspnea, chest pain, syncope, heart failure |
- Ejection systolic murmur radiating to carotids
- Slow-rising pulse (pulsus parvus et tardus) - Soft or absent second heart sound (S2) - Narrow pulse pressure |
ECG, Echocardiogram, Cardiac MRI, Cardiac catheterization | Valve replacement (surgical or TAVI), Balloon valvuloplasty (palliative), Medical therapy (symptom control) |
Aortic Regurgitation | Dyspnea, palpitations, wide pulse pressure, heart failure |
- Early diastolic murmur (decrescendo)
- Wide pulse pressure - Collapsing "water-hammer" pulse - Quincke’s sign (capillary pulsations in nail beds) - De Musset’s sign (head bobbing with heartbeat) |
Echocardiogram, ECG, Chest X-ray, Cardiac MRI | Medical therapy (ACE inhibitors, diuretics), Surgical valve repair/replacement |
Aortic Sclerosis | Usually asymptomatic, may have systolic murmur |
- Ejection systolic murmur (without radiation to carotids)
- Normal pulse pressure - No significant hemodynamic compromise |
Echocardiogram, ECG, Chest X-ray | Monitoring, risk factor modification (e.g., control hypertension), usually no intervention needed unless progresses to stenosis |
Form of Mitral Valve Disease | Clinical Presentation | Important Clinical Signs | Investigations | Management |
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Mitral Stenosis | Dyspnea, fatigue, atrial fibrillation, hemoptysis |
- Mid-diastolic murmur with opening snap
- Loud first heart sound (S1) - Malar flush (facial appearance due to low cardiac output) - Signs of right heart failure (e.g., raised JVP, peripheral edema) |
ECG, Echocardiogram, Chest X-ray | Medical therapy (diuretics, beta-blockers), Balloon valvuloplasty, Surgical valve repair/replacement |
Mitral Regurgitation | Dyspnea, fatigue, palpitations, atrial fibrillation |
- Pansystolic murmur radiating to axilla
- Soft first heart sound (S1) - Displaced apex beat - Signs of left heart failure (e.g., pulmonary edema, orthopnea) |
Echocardiogram, ECG, Chest X-ray, Cardiac MRI | Medical therapy (vasodilators, ACE inhibitors), Surgical repair/replacement, MitraClip (in select patients) |