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CORONARY ARTERY DISEASE AORTIC STENOSIS

Epidemiology Etiology

- Atherosclerosis -MC - Congenital bicuspid valve 70 yrs old


- Risk factors: HPN, history, hypercholesterolemia, - Rheumatic fever
smoking, obesity, DM, inactivity - Degenerative stenosis

Pathophysiology Pathophysiology

- Substernal pain and pressure may radiate to - Left ventricular hypertrophy initial response
arms, jaw teeth, back - LV hypertrophy, resistance - cardiac
- Occurs during physical exertion or emotional output, pulmonary HPN, myocardial ischemia
stress
P.E
- Resolves with rest stable angina
- Occurs at rest/not resolves at rest unstable - Angina, syncope, dyspnea - worst prognosis
angina -> pending MI - Midsystolic ejection murmur
- Cardiomegaly, CHF
P.E
- Pulsus tardus et parvus delayed impulse at
- Peripheral vascular disease, diminished pulses carotid
- Ventricular failure, cardiomegaly, CHF
Dx
- S3 or S4 murmur of mitral regurgitation
A decrease in aortic
- Echocardiography valve area from normal
Dx
- Cardiac catherization 3 or 4 cm to <1 cm
- ECG ischemia, old infarct signifies severe disease
Tx
- Xray enlarged heart or pulmonary congestion
- Thalium imaging - Symptomatic aortic valve replacement
- Angiography gold standard in identifying - Asymptomatic surgery >medical
coronary Artery

Tx
AORTIC INSUFFICIENCY
- Coronary bypass internal mammary artery or
saphenous Etiology
- Balloon angioplasty & stent displacement - Rheumatic fever, CT disorders Marfan &
Ehlers-Danlos syndromes, endocarditis, aortic
dissection, trauma

Pathophysiology

- Incompetent valve - output, left ventricular


dilation, myocardial oxygen demand

P.E

- Angina of systolic dysfunction


- Crescendo decrescendo diastolic murmur &
wide pulse pressure, water hammer quality,
point of maximal impulse displaced or diffuse

Dx echocardiography

Tx replacement surgery
MITRAL STENOSIS MITRAL REGURGITATION

Etiology/Epidemiology Etiology/Epidemiology

- Rheumatic heart disease - Rheumatic fever


- Malignant carcinoid - Idiopathic calcification w/ Hpn, DM, AS, RF
- SLE - Mitral valve prolapse
- Female predominace 2:1 - MR > MS, Male predominance

Pathophysiology Pathophysiology

- Fibrosis progress 2- 3 decades causing fusion of - regurgitationLV dilates to preserve C. output


leaflets impeding blood flow - volume is ejected retrograde, cardiac work,
- Increased LA pressure LA hypertrophy LA volumes, and pulmonary venous pressure
atrial fibrillation or pulmonary HPN RV - may lead to LA enlargement and fibrillation
hypertrophy and Right sided HF pulmonary Hpn RV failure

P.E P.E

- Dyspnea, fatigue - Dyspnea, othopnea, and fatigue


- Pulmonary HPN hemoptysis - Cachectic
- Cachexia, CHF symptoms - Irregular pulse, pulmonary rales, sternal heave
- JV distention, pperipheral edema, ascites, RV - Pulse rapid upstroke
hypertrophy - V waves present
- Heart sound opening snap followed by low - Holosystolic murmur that radiates to axilla or
rumbling murmur, splitting 2nd heart sound back
- Atrial fibrillation, HR - irregular pattern - Point of maximal impulse is displaced

Dx Dx

- Xray cardiomegaly, LA hypertrophy, - Xray cardiomegaly, pulmonary edema


pulmonary edema - ECG LV or biventricular hypertrophy, LA
- ECG atrial fibrillation, broad Pwaves enlargement, and P mitrale
- Echocardiography w/ Doppler flow - Echocardiography
- Cardiac catherization measurement of - Cardiac catherization establishing pulmonary
transvalvar pressure gradient pressures and cardiac output

Tx Tx

- Symptomatic valvulotomy or replacement - ACE inhibitors , nitroglycerin, diuretics


- Surgical intervention CHF, pulmonary Hpn, LV
dilation, atrial fibrillation develops
- Ballon pump life threatiening MR from
endocarditis, ischemia, trauma
- Repair or replacement