Valve disease

1- Auscultation:

A- Mitral stenosis:

Durozier rhythm that combines:

* A burst of B1

* A mitral opening snap

* Bearing with diastolic building presystolic *

B- Mitral insufficiency:

– Systolic regurgitation Breath

* Holosystolic

* Max in the tip (axillary irradiation)

* In steam

– Bearing early diastolic, B3 (major IM)

– View disease Barlow

C- Aortic stenosis:

– Systolic murmur éjectionnel

* -> Vessels of the neck; the point

* From rough and raspy timbre

* A maximum mésosystolique

– Increase or abolition of B2 or duplication.

– Click protosystolique

D- Aortic Insufficiency:

– Diastolic murmur (soft aspirative)

– Systolic murmur éjectionnel (functional RA)

– Bearing Flint (bearing apical presystolic) premature closure of the anterior mitral valve.

– Slam mésosystolique (pistol shot) into the right subclavian region (sudden distension of the aorta).
presystolic the building disappears in atrial fibrillation (for effective atrial contraction)

* Note: no change auscultatory inspiration argues against tricuspid valve disease

* The AI ​​breath is best seen along the left sternal border at aortic focus (especially when sitting and expiration)


2- Special Etiology:

A- Mitral insufficiency:

* Disease Barlow:

Myxoid degeneration valves (long ropes, prolapsed valves); “Click mésosystolique” apical systolic breath and IM.

* Other: Marfan disease; Ehlers-Danlos

* Rope Rupture of the posterior valve by fibrosis (degeneration fibroelastic)

B- Aortic stenosis:

* Disease Monckeberg (RA degenerative): limestone deposit

* Bicuspid aortic valve (congenital)

C- Aortic Insufficiency:

* Marfan disease

* Aortic dissection

Carpentier classification (myelosuppression)

– Type 1: valvular play is normal; it is functional IM or valvular perforations

– Type 2: the amplitude of systolic motion of one or both valves is increased. This is a valve prolapse in which the end of the valve is everted into the left atrium systole

– Type 3: the valve set is limited to the origin of insufficient closure of the valve in systole which remains in position ½ hour. There is talk of restrictive IM whose causes are rheumatic or ischemic.

Barlow disease: ballooning of the small valve; appearance hammock on echocardiography; frequency in young women

3- ECG:

A- Mitral stenosis:

* Frequent ACFA (large mesh fibrillation)

* HAG: bifid P wave in D2; duration ≥ 12 s and biphasic in V1; it can be associated to a HAD (increase of the amplitude of the P wave> 2,5 mm)

* Right ventricular overload: right axial deviation, R wave in V1, increased R / S ratio right; incomplete bundle branch block

B- Mitral insufficiency:

* It may be normal even in significant IM; atrial rhythm disorders are common (ACFA in 30-50% of cases)

* HAG (large P double hump); LVH (Sokolow ≥ 35mm) systolic-type (negative T wave in V5, V6) or sometimes diastolic.

C- Aortic stenosis :

* LVH with systolic overload (have negative and asymmetrical T D1, VL, V5V6; convex ST segment up); sometimes BBG; BAV

* The ACFA is rare; it has a poor prognosis (atrial contraction for 40% of ventricular filling)

D- Aortic Insufficiency:

* LVH diastolic types (large and positive T wave in V5, V6, concave ST segment up)

* Conduction disorders (AVB1, BBG); HVG systolic => very advanced AI

4- single X-ray:

A- Mitral stenosis:

* Projection of the AMG (trunk AP OG top and bottom)

* Normal AIG moved left or by HVD (supradiaphragmatic tip)

* Aspect double contour AID (HAG)

B- Mitral insufficiency:

-> Overhang AIG with advanced subdiaphragmatic (LV dilation)

-> Double contour AID (HAG). Systolic expansion of OG fluoroscopy.

C- Aortic stenosis:

-> Globular aspect of the AIG; the cardiothoracic ratio is often normal or slightly high (concentric hypertrophy).

Moderate protrusion of the ascending aorta (ADS).

-> A poststenotic dilatation of the aortic root is common

D- Aortic Insufficiency:

-> Scopie cardio-aortic bell motion and left ventricular hyperkinesis

-> Extended AIG, convex and advanced diving subdiaphragmatic

5- Echocardiography:

A- Mitral stenosis:

A closing time of the earlier valve; attenuation of the wave A; paradoxical movement of the small valve

B- Aortic stenosis:

The amplitude of the systolic opening intersygmoïdienne <8 mm, shows a tight stenosis

C- Aortic Insufficiency:

Diastolic fluttering of the anterior mitral valve and premature closure of the large mitral valve

* In ankylosing spondylitis, aortic regurgitation appears late and is often preceded by atrioventricular conduction disorders

* Post-traumatic aortic insufficiency is rare but is the most common post-traumatic valvular lesions

6- Signs Device aortic regurgitation:

– Enlargement of the differential (decreased diastolic while SAP is kept)

– Large radial pulse and then leaping compressible (pulse Corrigan)

– Blood Hyperpulasatilité: sign of Musset (head movement rhythm of the heartbeat), Hippus pupil (pupil dilation-contraction); capillary pulse subungual

– Intermittent femoris Breath Durozier (auscultation of the femoral artery)

7- Ortner syndrome:

– Paralysis of the left recurrent nerve compression (left atrium ectasia)

– It is due to a tight RM

* Ischemic IM: during an IDM especially lower by breaking pillar or ischemic dysfunction pillar; in chronic angina, it can rise to a pillar with fibrosis of the lower parietal dyskinesia (IM restriction of the small valve).

* Increased atrial pressure => increased pulmonary capillary pressure (PCP) and parallel increase in pulmonary artery pressure (post-pulmonary PAH) => Post-capillary PAH: PAP gradient – PCP <10 mmHg

* The precapillary PAH can occur late after the post-capillary PAH increased arteriolar pulmonary resistance => Self PAH (gradient> 10 mmHg).

* The IM leads to volume overload of the LV => increased left work and stroke volume => LV hypertrophy (systolic overload). In AI

* In acute MI OG is small; the elevation of the left atrial pressure and pulmonary capillary pressure is very important with the appearance of a wave of regurgitation (V) greater.

* Chest X-ray Front: Expansion of the OG => arc left means (AMG) convex aspect double contour of the lower right edge (AID).

8- Disease Barlow:

* It is responsible for mitral valve prolapse by IM; mitral balonisation by myxomatous degeneration; mainly affects the young woman

* Functional signs: chest pain atypical, asthenia, palpitations, exertional dyspnea, faintness, anxiety, dizziness …

* Listening: click mésosystolique often followed by systolic breath

* ECG usually normal; repolarization disorders (negativation T waves, ST segment elevation; arrhythmias

* Doppler: holosystolic decline hammock …

* Evolution benign in most cases; the pill is not outlawed