Valvular Heart Disease

1. By
Dr Muhammad Saeed
MBBS, FCPS ( Cardiology)
Consultant Cardiologist Holy Family Hospital/Hamza Cardiac
Centre
Valvular Heart Disease

2. Normal Heart

4. TOF, TGA

5. Normal Heart

6. Mitral Valve Apparatus
 1)Annulus
 2) Leaflets
 3)ChordaeTendinae
 4)Papillary Muscles

7. Rheumatic Valvular Heart Disease --
Acute Rheumatic Fever
 Acute rheumatic fever is a connective tissue disease involving
many organs primarily heart, the joints and the central
nervous tissue.
 Clinical features of acute rheumatic fever occurs
approximately 03 weeks after group A streptococcal infection
of tonsillo pharynx.
 GroupA streptococcal bacteria has antigens which cross react
with human connective tissue particularly heart valve
glycoprotein.
 Initial attacks of rheumatic fever occurs between the age of 6
to 15 years.

8. Clinical Features
 1) Carditis: It occurs in at
least 50 % of patients,
rheumatic process involve
valves,myocardium,pericar
dium. Mitral valve involves
mostly leading to mitral
regurgitation.Aortic valve
also involves leading to
aortic regurgitation.

9.  2) Arthritis: Poly arthritis
occurs in 70 % of patients.
It is almost always
asymmetrical and
migratory involves major
joints
(knees,ankles,elbows,wrist
s). Joints are swollen, red,
severly painful, has
limitation of motion and
tender to touch.

10.  3) Sydenham chorea: It
occurs in 20 % of patients. It
is purposeless and involuntary
movements, muscle
incordintion and weakness. It
occurs when patient is awake
and under stress and may
diasappear during sleep.
 4) Erythema
Marginatum: This skin rash
occurs in less than 5 %
patients. It occurs as non
itching, rounded skin lesion
on trunk and proximal
extremities.

11.  5) Subcutaneous
nodules: Occur in 03 %
patients.They are firm,
painless, freely movable
nodules on extensor
surfaces of joints.
 6) Fever

12. Chronic Rheumatic Heart Disease---
Mitral Stenosis
 The most common cause of
mitral stenosis is
rheumatic fever.
 In rheumatic mitral
stenosis mitral valve orifice
is slowly diminished by
progressive fibrosis and
calcification of valve
leaflets, fusion of cusps and
subvalvular apparatus.

13.  The flow of blood from the
left atrium to the left
ventricle is therefore
restricted and the left atrial
pressure rises, leading to
pulmonary venous
congestion and
breathlessness.
 There is dilatation and
hypertrophy of the left
atrium

14. Symptoms
 Asymptomatic
 Breathlessness
 Cough due to pulmonary
congestion.
 Hemoptysis
 Stroke due to distal
embolization.
 Fatigue due to pulmonary
hypertension and low
cardiac output.

15. Investigations
 ECG
 X- Rays Chest
 Echocardiography

16. Treatment
 MedicalTreatment
 MitralValve Ballooning
 Surgery

17. Mitral Regurgitation.
 In mitral regurgitation blood
is pushed into aorta and left
atrium during systole as
mitral valve remained open
during systole.
 Mitral regurgitation may
occur due to damage of any
part of mitral valve apparatus
ie mitral annulus, mitral
leaflets, chordae tendinae,
papillary muscles.

18. Causes
 MitralValve prolapse
 Dilatation of mitral valve ring
(eg rheumatic fever, coronary
artery disease,
cardiomyopathy)
 Damage to valve leaflets and
chordae tendinae ( eg
rheumatic heart disease,
endocarditis)
 Angina and Myocardial
infarction due to decrease
blood supply to papillary
muscles.

19. Symptoms
 MR may be acute or chronic.
 1)ACUTE MR: Symptoms of
acute pulmonary edema and
reduced cardiac output.
 2)CHRONIC MR:
 Asymptomatic
 Dyspnea ( breathlessness)
 Palpitation due toAF, increased
stroke volume
 Symtoms of low cardiac output eg
fatigue.
 Ankle edema, abdominal swelling
due to pulmonary hypertension and
right heart failure.

20. Investigations
 ECG
 X-Rays Chest
 Echocardiography

21. Treatment
 MedicalTreatment
 Surgical treatment like
mitral valve repair or
mitral valve replacement
with artificial valve.

22. Mitral Valve Prolapse
 Mitral valve prolapse is
usually is congenital
abnormality of connective
tissue.
 Pathologically in classic MVP
there is myxomtous
proliferation of mitral leaflets
which become grossly
abnormal, redundant and
prolapsed.
 Mitral regurgitation may or
may not be present.

23. Symptoms
 Palpitation
 Pricking type of chest pain.
 When mitral regurgitation
is severe symptoms of
congestive heart failure.

24. Treatment
 Reassurance if no MR.
 Medical treatment
 Surgery --- Mitral valve
repair.