AMAL MATTU CARDIOLOGY
VALVULAR HEART DISEASE:
Rheumatic heart disease = Common cause of chronic valve disease
Commonest cause of acute valve dysfunction = ENDOCARDITIS
Commonest congenital cause of AR = Bicuspid aortic valve
MITRAL STENOSIS
Commonest cause = Rheumatic heart disease
Complications:
Pulm HT
Emboli à systemic/brain
Lung infection/infarction
Restrictive lung disease
AF (MS = common cause)
Syx:
Exertional dyspnoea
Atrial arrhythmias – espec AF
Sounds:
Loud (snapping) S1
Low pitched Diastolic rumble
CxR;
L atrial enlargement
ECG:
L atrial enlargement
Pulm HT à RA & RV enlargement à RAD
Incomplete RBB
Tall R V1
Large S in I (RAD)
MITRAL REGURGITATION: SYSTOLIC
Causes:
Chronic
More common
Better rolerated
Cause: Rheum heart disease = commonest
Clinical
Systolic murmur rad to axilla
ECG
LA enlargement, LVH
AF common
CxR:
LA enlargement, LVH
Treatment
Standard CCF/AF Rx
Acute
Post AMI papillary muscle dysfunction (chrodae tendinae rupture)
Often very sick
Clinical:
APO
Hypotensive
New Systolic murmur
1st week post AMI (often Inferior)
Treatment = COMPLEX
Inotropes to support BP 1st
Eg: DA or NA
Then Afterload reduction to unload the heart & empty the lungs
Eg Nitroprusside
But this further drops BP
IABP
Surgery
MITRAL VALVE PROLAPSE:
Young, thin female
Family Hx
Often Hx of anxiety/panic attacks
Myxomatous degenration of mitral valve
Associations
Arrhythmias
AF, SVT
Sudden death
Atypical chest pain
Endocarditis
Systemic emboli (brain/periphery)
Early-mid systolic click
+/- high pitched late systolic murmur (severe)
Can sound like MR
Heart sounds:
As LV volume = murmurs decrease
Eg: Squatting, trendelenberg
Click & murmur moves closer to S2
¯ Intensity & duration
As LV volume ¯ = murmurs increase
Valsalva, standing
Click & murmur moves closer to S1
Intensity & duration
Dx
Echo
Treatment
B-blockers
Help with atypical CP & arrhythmias
¯