Valvular Heart Disease - Dr.winda,sp Jp.pptx

Valvular heart disease Tengku Winda Ardini, Sp.JP

CARDIAC ANATOMY AORTA

KATUP AORTA

ATRIUM KANAN

ATRIUM KIRI

KATUP TRICUSPID

KATUP MITRAL

ARTERI PULMONAL

VENTRIKEL KANAN

VENTRIKEL KIRI KATUP PULMONAL

CARDIAC VALVES

CARDIAC CYCLE

LA  LV (Mitral Valve)

LV  Aorta (Aortic Valve) RA  RV (Tricuspid Valve) RV  Arteri Pulmonal (Pulmonic Valve)

HEART SOUNDS (STETHOSCOPE)

S1 = Atrioventricular Valves closure

S2 = Semilunar valves closure

STENOSIS • Tidak terbuka secara penuh atau sempurna

REGURGITASI/INSUFISIENSI • Tidak tertutup secara penuh atau sempurna CARDIAC MURMUR

MITRAL STENOSIS

Symptoms: Fatique, shortness of breath, palpitation, swollen feet, chestpain, coughing of blood

Signs: cardiomegaly, cardiac murmur (mid diastolic murmur)

Etiology: Rheumatic heart disease

MITRAL STENOSIS Mid Diastolic Murmur Cardiomegaly, Pulmonal prominent, LA >, Apex upward

ECG: Sinus rhythm/ atrial fibrillation + Right axis deviation + right ventricular hypertrophy

MITRAL STENOSIS (TREATMENT) Medical therapy (Heart Failure) : Diuretics (furosemide, spironolactone), Rate control (beta blocker, digoxin), anticoagulant (if needed)

Ballon Mitral Valvuloplasty (BMV)

Surgery : Mitral Valve Replacement

MITRAL REGURGITASI

Symptoms: Fatique, shortness of breath, palpitation, swollen feet, chestpain

Signs: cardiomegaly, cardiac murmur (pan systolic murmur)

Etiology: Rheumatic heart disease, mitral valve prolapse, infective endocarditis, cardiomyopathy, ischemic heart disease

Pan Systolic Murmur

MITRAL REGURGITASI Cardiomegaly, LA >, LV >

ECG: Sinus rhythm/ atrial fibrillation + Left atrial enlargement / Left ventricular hypertrophy

MITRAL REGURGITATION (TREATMENT) Medical therapy (Heart Failure) : Diuretics (furosemide, spironolactone), Rate control (beta blocker), Ace inhibitor/Angiotensin receptor blocker, anticoagulant (if needed)

Surgery : Mitral Valve Repair / Replacement

AORTIC STENOSIS Symptoms: Fatique, shortness of breath, palpitation, fainting, chestpain, syncope.

Signs: cardiomegaly, cardiac murmur (ejection systolic murmur)

Etiology: Rheumatic heart disease, calcification, congenital (bicuspid valve)

AORTIC STENOSIS Ejection Systolic Murmur

ECG: Left atrial enlargement + Left ventricular hypertrophy + left ventricular strain

AORTIC STENOSIS (TREATMENT) Medical therapy (Heart Failure) : Diuretics (furosemide, spironolactone), beta blocker, statin, Renin angiotensin aldosterone blocker

Transcatheter Aortic Valve Implabtation (TAVI)

Surgery : Aortic Valve Replacement

AORTIC REGURGITATION Symptoms: Fatique, shortness of breath, palpitation, swollen feet, chestpain.

Signs: cardiomegaly, cardiac murmur (early diastolic murmur), 14 signs

Etiology: Rheumatic heart disease, calcification, congenital, aortic root disease, connective tissue disease

14 SIGS AORTIC REGURGITATION •

CORRIGAN’S PULSE: A RAPID AND FORCEFUL DISTENSION OF THE ARTERIAL PULSE WITH A QUICK COLLAPSE

•

DE MUSSET’S SIGN: BOBBING OF THE HEAD WITH EACH HEARTBEAT (LIKE A BIRD WALKING)

•

MULLER’S SIGN: VISIBLE PULSATIONS OF THE UVULA

•

QUINCKE’S SIGN: CAPILLARY PULSATIONS SEEN ON LIGHT COMPRESSION OF THE NAIL BED

•

TRAUBE’S SIGN: SYSTOLIC AND DIASTOLIC SOUNDS HEARD OVER THE FEMORAL ARTERY (“PISTOL SHOTS”)

•

DUROZIEZ’S SIGN: GRADUAL PRESSURE OVER THE FEMORAL ARTERY LEADS TO A SYSTOLIC AND DIASTOLIC BRUIT

•

HILL’S SIGN: POPLITEAL SYSTOLIC BLOOD PRESSURE EXCEEDING BRACHIAL SYSTOLIC BLOOD PRESSURE BY ≥ 60 MMHG (MOST SENSITIVE SIGN FOR AORTIC REGURGITATION)

•

SHELLY’S SIGN: PULSATION OF THE CERVIX

•

ROSENBACH’S SIGN: HEPATIC PULSATIONS

•

BECKER’S SIGN: VISIBLE PULSATION OF THE RETINAL ARTERIOLES

•

GERHARDT’S SIGN (AKA SAILER’S SIGN): PULSATION OF THE SPLEEN IN THE PRESENCE OF SPLENOMEGALY

•

MAYNE’S SIGN: A DECREASE IN DIASTOLIC BLOOD PRESSURE OF 15 MMHG WHEN THE ARM IS HELD ABOVE THE HEAD (VERY NON-SPECIFIC)

•

LANDOLFI’S SIGN: SYSTOLIC CONTRACTION AND DIASTOLIC DILATION OF THE PUPIL

AORTIC REGURGITATION Early Diastolic Murmur

PULMONARY STENOSIS Symptoms: Fatique, shortness of breath, sianosis. Signs: cardiomegaly, cardiac murmur (ejection systolic murmur)

Etiology : congenital

PULMONARY REGURGITATION

Etiology : pulmonary hypertension

TRICUSPID REGURGITATION Symptoms: Fatique, shortness of breath. Signs: cardiomegaly, cardiac murmur (systolic murmur) Etiology : pulmonary hypertention, rheumatic heart disease

TRICUSPID STENOSIS

ETIOLOGY

ETIOLOGY

RHEUMATIC HEART DISEASE • Streptococcus Beta Haemolytic group A infection  throat (pharynx)  pharyngitis  Rheumatic Fever • Several episodes • Autoimmun inflammatory reaction • Children and young adult • Low - middle income countries, marginal communities in high income countries.

ECHOCARDIOGRAPHY VENTRIKEL KANAN

KATUP TRICUSPID

VENTRIKEL KIRI

KATUP MITRAL

VENTRIKEL KANAN ATRIUM KIRI

TERIMA KASIH

FIGURE 2. THERAPEUTIC ROLES OF RENINANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITION IN AORTIC STENOSIS.

FIGURE 1. THERAPEUTIC ROLES OF STATINS AND OTHER LIPID-LOWERING THERAPY IN AORTIC STENOSIS.