Dr Ed Wallitt
Podmedics - Founder
Video Duration: 18 minutes
A rumbling mid-diastolic murmur which can radiate to the axilla.
The narrow valve leads to increasing left atria pressure. This then leads to a loud S1 and atrial hypertrophy, leading into Atrial Fibrillation. There is increased pulmonary vascular resistance leading to pulmonary hypertension, giving pulmonary oedema. Due to this there is right ventricular hypertrophy ultimately leading into heart failure.
1. Rheumatic Fever
2. Prosethetic Valve
Symptoms manifest when the valve opening is less than 2cm.
These are suggestive that the patient has decompensated
JVP may be raised late on
Left parasternal heave
Apex: Tapping (palpable S1), non-displaced
Echocardiogram- transthoracic or transoesophageal (To grade the severity of the stenosis. Trans-oesophageal can be used to screen for vegetation on the diseased valve)
Chest X ray (looking for signs of heart failure i.e pulmonary oedema. The valve may also be calcified which would be visible on xray)
ECG (would possibly see Atrial Fibrillation, P mitrale, or a right venticular strain pattern)
If not sympotmatic:
Optimise risk factors for CVD:
For Atrial Fibrillation: rate control and anti-coagulate.
Indicated if moderate or severe
First line is percutaneous balloon valvuloplasty. This depends on the valve being pliable and minimaly calcified.
A valve repair is then considered if not then valve replacement is done.