Valvular Disease

Quick Tips

• Both stenotic murmurs require similar management. Same with regurgitant valves.
• Think physics- What will occur when you are trying to push through a stenotic valve. The chamber pushing against a stenotic valve will enlarge. Hence the concentric hypertrophy with aortic stenosis. If there is backflow due to regurgitation, then the chamber receiving the regurgitant flow will eventually enlarge and dilate leading to eccentric hypertrophy as seen in aortic regurgitation.
• The lack of a closed chamber in regurgitating valvular problems leads to lack of isovolumetric contraction and relaxation as there is constant change in volume in the affected chamber during both systole and diastole. For example, with mitral regurgitation, the impaired valve gets pushed up during systole to allow systolic backflow and relaxes downward during diastole to allow leakage into LV.

Common Clinical Question

• Critical circumference in Aortic stenosis is - 0.7 cm squared. Look for this on an echo to determine severity.