{"id":9537,"date":"2021-12-26T13:50:24","date_gmt":"2021-12-26T11:50:24","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/acquired-valvulopathy-aortic-valve-diseases\/"},"modified":"2022-01-17T17:53:36","modified_gmt":"2022-01-17T15:53:36","slug":"acquired-valvulopathy-aortic-valve-diseases","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/acquired-valvulopathy-aortic-valve-diseases\/","title":{"rendered":"Acquired valvulopathy: aortic valve diseases"},"content":{"rendered":"<span class=\"block-heading\" id=\"header_1\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Aortic stenosis (AS)<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<p class=\"wp-block-paragraph\">During aortic stenosis, the cusps of the aortic valve fail to open completely, decreasing blood flow capacity. The cusps are hardened, commissures are fused and the orifice is narrowed.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>AS initially leads to LVH (concentric hypertrophy as a compensatory mechanism) and later dilation (once it can no longer compensate). <ul><li>The dilated LV may lead to <strong>mitral regurgitation<\/strong>, reduced ejection fraction and cardiac output, and left heart failure.<\/li><\/ul><\/li><li>Once the output is low enough, it presents as syncope, angina, and dyspnea during exertion, and sometimes arrhythmias and heart failure.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Etiology<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<ul class=\"wp-block-list\"><li><strong>Age-related calcification (aortic sclerosis).<\/strong> Fibrosis and calcification of the valves, similar to atherosclerosis. <ul><li>Most common cause of AS in older adults.<\/li><li>HTN, elevated lipoprotein A levels, smoking, and psoriasis are risk factors.<\/li><\/ul><\/li><li><strong>Congenital bicuspid valve calcification.<\/strong> The presence of two cusps instead of three. It is the most common congenital cardiovascular abnormality.<ul><li>Most common cause of AS in young adults (10-20 yo).<\/li><\/ul><\/li><li><strong>Rheumatic fever<\/strong> (see below)<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Rheumatic fever<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<p class=\"wp-block-paragraph\">Rheumatic fever (RF) occurs after group A streptococcal infection, due to immune activity against M protein and molecular mimicry, leading to arthritis, cardiac and valvular disease, glomerulonephritis, skin, and neurologic disorders.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>The mitral valve is affected in most cases, but the aortic valve can also be affected, resulting in either stenosis or regurgitation.<\/li><li>The cardiac manifestations are evident many years after the episode of the RF.<\/li><li>Diagnosis based on serology along with <strong>Jones criteria<\/strong> (presence of 2 out of 5 specific symptoms).<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<ul class=\"wp-block-list\"><li><strong>Physical examination<\/strong>. During auscultation, a systolic diamon-shaped cresendo-decresendo murmur can be heard (S1-S2). <ul><li>Heard best at the right 2nd sternocostal joint on the right.<\/li><li>The murmur radiates into the carotids.<\/li><\/ul><\/li><li><strong>ECG<\/strong>. Shows LV hypertrophy.<\/li><li><strong>Echocardiography<\/strong>.<\/li><li><strong>Cardiac catheterization.<\/strong><\/li><li><strong>Exercise stress-testing.<\/strong><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_5\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_5\">\n\n\n<ul class=\"wp-block-list\"><li>There is no pharmaceutical therapy for AS.<\/li><li>Aortic valve replacement is indicated in all symptomatic patients (can be done using a catheter).<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_6\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Aortic regurgitation<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_6\">\n\n\n<p class=\"wp-block-paragraph\">During aortic regurgitation (aortic insufficiency) the cusps of the aortic valve fail to close fully, allowing backflow of blood back into the right atrium during ventricular systole.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Aortic regurgitation can be classified as <strong>acute<\/strong> (emergency) or <strong>chronic<\/strong>; chronic AR can be classified as <strong>primary valvular <\/strong>and <strong>aortic root disease<\/strong>.<\/li><li>Simialr to AS, AR causes initial LVH (concentric hypertrophy as a compensatory mechanism) and later dilation (once it can no longer compensate).<\/li><li>Chronic AR is initially asymptomatic; patient may develop dyspnea and angina on exertion, palpirations. Later decompensation leads to arrhythmias and heart failure.<\/li><li>In acute AR, the left ventricle does not have enough time to compensate, leading to pulmonary edema, and decreased CO.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_7\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Etiology<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_7\">\n\n\n<ul class=\"wp-block-list\"><li>Acute (emergency)<ul><li><strong>Aortic dissection<\/strong><\/li><li><strong>Infective endocaditis<\/strong>. Microbial infection of the endocardium and the destruction of the valves typically caused by Streptococcus viridans.<\/li><li><strong>Trauma and failed prosthetic valve<\/strong><\/li><\/ul><\/li><li>Chronic<ul><li>Primary valvular<ul><li><strong>Rheumatic fever<\/strong> (see above)<\/li><li><strong>Connective tissue disease<\/strong> (Marfan syndrome, Ehler-Danlos syndrome)<\/li><li><strong>Spondyloarthropathies and inflammatory diseases<\/strong><\/li><\/ul><\/li><li>Aortic root disease<ul><li><strong>Tertiary syphillis<\/strong><\/li><li><strong>Osteogenesis imperfecta<\/strong><\/li><li><strong>Myxomatous degeneration<\/strong><\/li><li><strong>Aortic dissection<\/strong><\/li><li><strong>Aortic HTN<\/strong><\/li><li><strong>Reiter syndrome<\/strong><\/li><\/ul><\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_8\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_8\">\n\n\n<ul class=\"wp-block-list\"><li><strong>Physical examination.<\/strong> Increased systolic BP with decreased diastolic BP. <ul><li>Diastolic decresendo murmur heard best at the left sternal border.<\/li><\/ul><ul><li>Widened pulse pressure.<\/li><li><strong>Austin Flint murmur<\/strong> heard at the apex of the heart (diastolic rumble due to competing flows from the LA and aorta).<\/li><\/ul><\/li><li><strong>ECG<\/strong>. LVH<\/li><li><strong>Echocardiography<\/strong><\/li><li><strong>Cardiac catheterization<\/strong><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_9\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_9\">\n\n\n<ul class=\"wp-block-list\"><li>In the case of symptomatic AR, aortic valve replacement is indicated (TAVI). Acute AS is a medical emergency requiring urgent valve replacement.<\/li><li>In patients with LV dysfunction, ACEi\/ARBs, BB, CCB, diuretics, digoxin.<\/li><\/ul>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Aortic stenosis (AS)<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Etiology<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Rheumatic fever<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Diagnosis<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Treatment<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Aortic regurgitation<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Etiology<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Diagnosis<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Treatment<\/h4><\/div>","protected":false},"excerpt":{"rendered":"<p>Aortic stenosis (AS) During aortic stenosis, the cusps of the aortic valve fail to open completely, decreasing blood flow capacity. The cusps are hardened, commissures are fused and the orifice is narrowed. AS initially leads to LVH (concentric hypertrophy as a compensatory mechanism) and later dilation (once it can no longer compensate). The dilated LV [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":410,"menu_order":4,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-9537","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Acquired valvulopathy: aortic valve diseases &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/acquired-valvulopathy-aortic-valve-diseases\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/cardiology\\\/acquired-valvulopathy-aortic-valve-diseases\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/cardiology\\\/acquired-valvulopathy-aortic-valve-diseases\\\/\",\"name\":\"Acquired valvulopathy: aortic valve diseases &#8211; 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