complete detail heart valvular disease

1. MITRAL VALVE DEFECT

2. Heart
• The heart is located in the middle compartment of the
mediastinum in the chest
• Contain body and base of heart
• 2 surface :
Sternocostal surface
Diaphragmatic surface
• 3 borders :
Upper border - start of 3rd rib.
Right border - midclavicular line 0.5 cm
midline 5ICS
Left border - 3,4,5th intercostal space.

3. Heart
• 4 chamber :
a)R&L.atrium
b)R&LVentricle
• superior venacava in the
right atrium.
• In aorta semilunar valve
b/w left atrium and
ventricle is mitral valve.
• b/w left atrium and right
ventrical is tricupsid
valve.

4. • Synchronous contration of heart result from conduction of
impulses generated by SA node progate through conduction
system.
i. SA nd AV node
Both are innervated by sympathetic &
parasympathetic nerve.
INNERVATION:
1.sympathetic
2.parasympathetic nerves
.

5. Sympathetic & parasympathetic
parasympathetic
• along vagus or 10th
cranial nerve
• mediated by acetyl
choline
• slow heart rate and
dec contractility
sympathetic
• descend spinal cord
at level of T1 to T5.
• mediated by noreph
• incre in heart rate and
incre contractility.

6. • Right venticles - anterior cardiac surface.
• Right artium - forms narrow border from
third ti fifth rib to right of sternum.
• Left venticles - lies left and behind the
right ventical.
• Left ventricular apex - 5ICS - MCL
• Apical impulse - called PMI

7. Auscultatory area
• Aortic - 2ICS, right
sternal border.
• Pulmonic - 2ICS, left
sternal border.
• Tricuspid - left lower
sternal border.
• Mitral - cardiac apex
( 5ICS- MCL)
• Additional Erb's point -
third left intercostal space
, can hear pulmonic or
aortic sound.

8. CLINICAL MANIFESTATION
• chest pain
• palpitations
• dyspnea
• syncope
• fatigue
• dependent edema
• hemopysis
• cynosis

9. A.P &M.I
Angina pectoris
• insp - plue colour
• perc - normal
• aus - normal sound
but dull sound (s1 ,s4)
• pulp - tarcardia,extra
beat
Myocardial infraction
• insp - cynosis
• perc - normal
• aus - dull sound
• pulp - bardca

10. Pericardiaties
• 15-150 ml normal fluid in space between pericardium and
myocardium.
• In this >50 ml pain is more sever in full of chest
• patient will feel pain in standing , deep inspiration,
coughing
• Treatment - evacute fluid , use antibotic, use steriods

11. Palpitation
• Feeling of pulsation in heart and feeling of unpleasent.
• Describe palpitation as - " fluttering" "skipped beats" "jumping"
"stopping" "pounding" or "irregularity".
• They are common and do not necessarily indicate serious
heart disease.
• Hyperthyrodism important cause of rhythm disturbance that
orgin outside of cardiovascular system.

12. Dyspnea
• Related to cardiac or pulmonary condition
• Shortness of breathing.
• Develop after physical excercise in 1st and 2nd stage of
heart failure & 3rd nd 4th stage develop even in rest
• PNS : air insufficent pat cannot lye down and uses more
pillow for head
• presence of cardiac asthma often goes near window for
air
• develop during night 1-2hrs after sleep and goes to
windows for air
• Should be treated with o2 , diuretic hormones for more
urination and flurosamid.

13. Dyspnea
• DOE - chronic congenital heart failure or severe
pulmonary disease
• Trepopnea - rare form of positional dyspnea; dec
dyspnea while lying on right or left side

14. Syncope
• Transient loss of consciousness that due
to inadequate cerebral perfussion
• Related to - cardiac as well as non cardiac
causes.

15. Fatigue
• Common symptom of decr cardiac output
• Complain - congestive heart failure and
mitral valvular disease
• Common cause - anxiety and depression
• Other condition - anemia and chronic
disease

16. Dependent edema
• Start from swelling of legs
• Stocks collar / sup vena cava syndrom - caused by
broncogenic tumor, mediastinal tumor which compress
superior vena cava due to its obstruction no blood
passage and cause edema in face, neck and upper
extermities.

17. Cynosis
• Detected by family members
• Subtle bluish discoloration
• Low oxygen, low blood flow, no contraction, hypotropy and
dilation of left venticles.
• Types of cynosis :
- central cynosis.
- peripheral cynosis.

18. Cyanosis
Central cyanosis
• Occurs inadequate
gas exchange in
lungs
• Heart failure, Lung
disease
Peripheral cyanosis
• cold weather
• chz for lymph node
enlarge - conjuncation
incr deoxyhemoglobin
• bulish colour (anemia)

19. Percussion
• Right border - 5ICS or 4ICS to right border
of sternum
• Left border - form mid axillary line in left
and goes to sternum at the level of 5ICS
Compartive dullness- found at 0.5cm from
midclavicular line.
• Upper border - start form1st rib in
parasternal line and percused till
comparative dullness at the starting of 3rd rib

20. MITRAL VALVULAR
DYSFUNCTION
Mitral valve stenosis
Mitral valve regurgitation
Mitral valve prolapse

21. MITRAL STENOSIS
Narrowed valve orifice
a. Rhematic fever
b. Lutembacher's xd
c. Valvular fication
calcification
 C.O
 L.Atrial size (Hypertrophy Dilation)
 Pulmonary venular pressure
 P.Capillary pressure
 Edema

22.  INSCEPTION:
1. Mitral face
2. Dyspnea
3. Edema
PALPATION :
1. palpable 1st S1
 AUSCULTATION:
1. loud S1
2. os
3. midsystolic murmur
4. GRAHAM STELLAR
MURMUR(P2)

23. MITRAL VALVE RERURGITATION
 Rheumatism
 Dilated cardio myopathy
 SLE,Marfan's xd,Ehler's danlo's xd
 Drug:Fenfleuramine
Pathogenesis
 L.ventricle L.atrium
• L.atrial pressure
• stroke volume n
C.O(regulatory)
• Pulmonary venous
pressure(res: Edema)

24.  INSCEPTION:
1. Dyspnea
2.orthopnea
PALPATION:
1. Lateral displacement of PMI
2.systolic thrills
AUSCULTATION:
1.Pansystolic murmur
2.Pathological S3

25. INVESTIGATION:
X RAY: L.atrium N ventricle
ECG : R wave

26. MITRAL VALVE PROPLASE
Barlow's xd/ Floppy mitral valve
ETIOLOGY:
1.large mitral leaflet
2.Enlarged mitral annulus
3.Throtoxicosis
INSCEPTION:
stabbing like pain
 Atypical chest pain
a) LOC:L.submammary

27. AUSCULATION:
a.mid-systolic click
b.late systolic murmur
INVESTIGATION:
a) non specific ST-
segment
b) T-wave
abnormalities

28. Thank You