Recurrent GAS Infection (ARF)

Chronic Inflammatory Response

e.g. CEREBROVASCULAR
OCCLUSION (STROKE) Involvement of the
↑ Fibroblast Activity AORTIC REGURGITATION
↑ Macrophage and PMN Cells Activity Aortic Valve

Peripheral Organs
Fibrous thickening and
Calcification of Valve Leaflet Loud “OPENING SNAP” after S2
Fusion of Commissures
THROMBOEMBOLISM DIASTOLIC RUMBLE (low-frequency decrescendo murmur)

MITRAL VALVE STENOSIS

↓ Left Ventricular Pressure Loud S1
Intra-atrial Blood becomes stagnant ↑ Left Atrial Pressure
Thrombus Formation in the Left Atrium

Pulmonary Congestion
↑Stretch of Atrial ↓Left Ventricular Filling PULMONIC REGURGITATION
LEFT ATRIAL ENLARGEMENT
Conduction Fibers
Dyspnea and Severe MS:
↓ Cardiac Output ↓Exercise Capacity Passive PULMONARY HYPERTENSION Orthopnea & Paroxysmal
ATRIAL FIBRILLATION Nocturnal Dyspnea
Reflex Tachycardia
HYPOTENSION

↑ Pulmonary Arterial Pressure ↑ Pulmonary Venous Pressure ↑ Pulmonary Capillary Pressure

Hoarseness
Reactive Pulmonary Hypertension

TRICUSPID VALVE REGURGITATION Opening of collateral channels Transudation of Plasma into the
Compression of Recurrent Arteriolar Medial Hypertrophy to BRONCHIAL VEIN Lung Interstitium & Alveoli
Laryngeal Nerve
& Intimal Fibrosis

↑ Right Ventricular Pressure Rupture of BRONCHIAL VEIN PULMONARY RALES

RVE ↑ Afterload ↓ Blood flow into the
↑ Preload Pulmonary Vasculature
Right Ventricular Hypertrophy HEMOPTYSIS
& Dilation DYSPNEA
JVD
Hepatomegaly
Right-Sided Heart Failure Ascites S3 Gallop
Peripheral Edema