Amal Mattu Cardiology

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

Echo

Treatment

B-blockers

Help with atypical CP & arrhythmias