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Heart Valve Disease for PA

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Heart Valve Disease for the Physician Assistant Licensing Exam
Types of Heart Valve Disease
Heart valve disease can include stenosis (narrowing) and regurgitation (backflow) of the four heart valves: aortic, mitral, tricuspid, and pulmonic. This review highlights the primary features and management of the most commonly affected valves.
Aortic Stenosis
  • Etiology:
    • Calcific Degeneration: Common in older adults.
    • Bicuspid Aortic Valve: Congenital defect that causes early calcification.
aortic valve stenosis
  • Pathophysiology: Obstructed LV outflow leads to increased LV pressure and hypertrophy.
  • Clinical Presentation:
    • Symptoms: Dyspnea, angina, and syncope.
    • Heart Sound: Crescendo-decrescendo systolic murmur at the right upper sternal border, radiating to the carotids.
  • Management: Aortic valve replacement for symptomatic or severe stenosis.
Aortic Regurgitation
  • Etiology:
    • Valve Disease: Bicuspid valve, endocarditis.
    • Aortic Root Disease: Marfan syndrome or aortic dissection.
  • Pathophysiology: Regurgitation causes LV volume overload, leading to dilation.
  • Clinical Presentation:
    • Symptoms: Dyspnea and fatigue.
    • Heart Sound: Decrescendo diastolic murmur at the left sternal border.
    • Widened Pulse Pressure: Bounding pulses.
  • Management: Valve replacement if symptomatic or with LV dysfunction.
Mitral Stenosis
  • Etiology: Most commonly caused by rheumatic fever.
  • Pathophysiology: Stenosis increases left atrial pressure, causing dilation and pulmonary hypertension.
  • Clinical Presentation:
    • Symptoms: Dyspnea, orthopnea.
    • Heart Sound: Low-pitched diastolic murmur at the apex with an opening snap.
  • Management: Balloon valvotomy or rate control and anticoagulation if atrial fibrillation is present.
Mitral Regurgitation
  • Etiology:
    • Primary: Mitral valve prolapse, endocarditis.
    • Secondary: LV dilation.
  • Pathophysiology: Regurgitation causes left atrial and LV dilation.
  • Clinical Presentation:
    • Symptoms: Exertional dyspnea, fatigue.
    • Heart Sound: Holosystolic murmur at the apex, radiating to the axilla.
  • Management: Valve repair or replacement if symptomatic or if LV function is impaired.
Key Points
  • Aortic Stenosis: Presents with dyspnea, angina, and syncope; requires valve replacement if symptomatic.
  • Aortic Regurgitation: Causes wide pulse pressure and dyspnea; managed with valve replacement if symptomatic or if LV dysfunction develops.
  • Mitral Stenosis: Commonly from rheumatic fever, presenting with dyspnea and a diastolic murmur; treated with balloon valvotomy or rate control.
  • Mitral Regurgitation: Causes exertional dyspnea and holosystolic murmur; surgery is indicated for symptoms or LV dysfunction.

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