Cardiology
Valvular Heart Disease
Cardiology

Valvular Heart Disease

AS, AR, MS, MR — diagnosis and surgical thresholds.

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◆Aortic stenosis

  • •Age <70: bicuspid valve; ≥70: senile calcific
  • •Severe AS: late-peaking systolic murmur + soft A2 + narrow pulse pressure + pulsus parvus et tardus
  • •Symptomatic severe AS or LVEF <50% → valve replacement (TAVR or surgical)
  • •Medical therapy does NOT fix obstruction
  • •Avoid vasodilators in severe AS

◆Aortic regurgitation

  • •Marfan + AR from root dilation → risk of dissection
  • •Early diastolic decrescendo murmur
  • •Widened pulse pressure; water-hammer pulse
  • •Annual echo; replace root when >5 cm
  • •BB or ARB to slow dilation

◆Mitral disease

  • •MS: opening snap + mid-diastolic murmur; severe (valve area <1.0) + symptoms → balloon valvotomy
  • •Chronic MR: regurgitant flow → LV dilation; surgical repair when symptoms or EF <60%
  • •Post-MI functional MR (improves with diuretics) vs papillary muscle rupture (does NOT improve, requires surgery)

◆Rheumatic fever prophylaxis

  • •No carditis: 5 years or until age 21 (whichever longer)
  • •Carditis without residual disease: 10 years or until age 21
  • •Carditis with persistent valvular disease: 10 years or until age 40
  • •Benzathine penicillin G IM every 4 weeks

◆Other vascular conditions

  • •Coarctation: arm-leg BP difference + weak femoral pulses → echo to confirm
  • •Young cryptogenic stroke + DVT → bubble study echo for PFO (paradoxical embolism)
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