Leads to volume overload; both situations can culminate in heart failure

Etiology: isolated, Tetralogy of Fallot or Great arteries transposition

Causes RVH which leads to symptoms of RHF such as: Hypoxia, JVD, Hepatomegaly, Ascites and pedal edema.

Type of a. stenosis that leaflets may be hypoplasic with infundibular obstruction due to ventricular endocardial fibroelastosis, dysplasic or in anomalous number.

Type of a. stenosis that is related to elastin in chomosome 7: hypercalcemia and characteristic facies of Williams –Beuren syndrome

Type of A. stenosis that presents thrill and LV hypertrophy.

Obstruction of left ventricular systolic outflow due to thickening/calcification.

A. stenosis Symptoms typically appear when the valve orifice decreases to

Murmur: Harsh midsystolic, crescendo-decrescendo murmur best heard at base of heart and radiating into neck vessels; with a thrill or ejection click.

Signs of severe stenosis include:

1. absent or diminished intensity of the S2 sound

2. slow-rising carotid upstroke with delayed amplitude (pulsus parvus et tardus), presence of S4

3. reverse splitting of the S2 sound.

Early symptoms: ⬇ exercise tolerance, dyspnea on exertion,

syncope, and angina with exercise.

Late symptoms: Concentric LVH that may progress to HF.

Occurs due to backflow from the aorta into the LV during diastole.

At risk AR is stage:

Progressive AR with mild regurgitation and moderate regurgitation is stage:

Asymptomatic severe with LVEF > 55 % AR is stage:

Asymptomatic severe with LVEF < 55 %or LV dilation >50 mm AR is stage:

Symptomatic severe AR is stage:

Manifests primarily with hypotension -> ⬇CO -> cardiogenic shock.

Presents with Widened pulse pressure, Bounding, “water hammer,” or collapsing pulse ( Corrigan pulse), Head “bobbing” with each heartbeat,“Pistol shot femorals” ( Traube sign), Capillary pulsations ( Quincke sign), and Popliteal systolic pressure

increased >20 mm Hg over the brachial systolic pressure (Hill sign)

Pulse that can can be palpated at the wrist or femoral artery and is caused by the rapid rise and sudden collapse of arterial pressure during late systole.

Head “bobbing” with each heartbeat

Describes a loud sound over the femoral artery with systole and diastole.

Capillary pulsations on the lips or at the base of the nail beds.

To-and-fro intermittent femoral murmur may be heard

with slight compression of the femoral arteries.

Popliteal systolic pressure increased >20 mm Hg over the brachial systolic pressure.

Results in LV dilation and eccentric hypertrophy.

Cardiac auscultation reveals:

i. Displacement of cardiac impulse downward and to the patient’s left

ii. S3 heard over the apex

iii. Decrescendo, blowing diastolic murmur heard (LSB)

iv. Low-pitched apical diastolic rumble ( Austin Flint murmur)

v. Early systolic ejection sound and systolic ejection murmur

Obstruction leads to increased pressure in the left atrium, pulmonary

vasculature, and the right side of the heart.

MS Symptoms usually develop with _____ when the orifice measures <2.5

cm²

MS Symptoms usually develop with _____ when the orifice measures <1.5

cm²

Clinical features:

1. Dyspnea

2. Fatigue and decreased exercise capacity

3. pinkish-purple patches on the cheek

4. PND and orthopnea

5. Acute pulmonary edema

6. RHF

7. Hemoptysis

8. Systemic emboli

9. Atrial fibrillation

Murmurs:

OS with diastolic rumble and thrill at apex.

Characterized by Deposits in the fibrous ring and Irregular stone consistance nodules, ulcerated (2-5 mm).

Definition: ballooning of the valve into the left atrium during systole.

Caused by Myxomatous degeneration (deposition of dermatan sulfate)

In MVP have ⬇ posterior prolapse (22% vs. 31%), ⬇ flail (2% vs. 8%), ⬆ leaflet thickening (32% vs. 28%), and ⬇ frequent severe mitral regurgitation (MR) (10% vs. 23%).

Reflux of blood from LV into LA during systole.

Murmur: Holosystolic, high-pitched, “blowing” murmur is most easily audible

at apex with radiation to base, left axilla, or back.

Presents as: LHF: fatigue, dyspnea, orthopnea, PND, edema, Hemoptysis and Atrial fibrillation

Due to elevated mean right atrial pressures presents with systemic venous congestion, jugular venous distention, ascites, and

peripheral edema.

Symptoms of RHF include fatigue, right upper quadrant

abdominal pain (from hepatic congestion), ascites, hepatomegaly, and

peripheral edema. Some complain of a fluttering discomfort in the neck

caused by the tall “a” waves.

Murmur: Holosystolic with increase intensity with inspiration.