1.

Valvular Stenosis
CONDITION,
- The stiffening of heart valves can narrow the size of the valve opening and
restrict blood flow. The narrowing is called valve stenosis. It keeps the valve from
opening fully and reduces the amount of blood that can flow through. In severe
cases, the valve opening can become so narrow that the rest of the body may
not receive adequate blood flow.

CAUSES,
- Congenital heart defect. Some children are born with the disease

Calcium buildup on the valve. Calcium is a mineral found in your blood. As blood repeatedly
flows over the aortic valve, calcium deposits can build up on the heart valves .

Rheumatic fever. This complication of strep throat infection may result in scaring the tissue
forming on the valve. Rheumatic fever may damage more than one heart valve, and in more
than one way.

CLINICAL MANIFESTATIONS,
- Some if the clinical manifestations include abnormal heart sound that is heard
through a stethoscope,
Chest pain or tightness with activity, Feeling faint or dizzy or fainting with activity, Shortness of
breath, especially when you have been active, Fatigue, especially during times of increased
activity and Rapid, fluttering heartbeat or palpitations

DIAGNOSTIC TEST TO CONFIRM THE CONDITION

- For many people, a routine checkup reveals the first sign of aortic valve stenosis.
A doctor listening to your heart with a stethoscope may hear a “whooshing”
sound or an extra heart beat sound. This is known as a heart murmur. It often
indicates valve trouble, but not always.
After a full exam and a review of your medical history, your doctor may order a few tests. They
include:

Echocardiogram: This imaging test uses sound waves to create a picture of your heart’s
structure.

Electrocardiogram: This measures electrical activity in the heart.

Cardiac catheterization: If there is not yet enough evidence, your doctor may ask you to have
this procedure.

MANAGEMENT/TREATMENT
- Your treatment depends on the severity of your condition. You may need surgery
to repair or replace the valve. Without treatment, severe aortic valve stenosis
can lead to death.

Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure to replace a

narrowed aortic valve that fails to open properly (aortic valve stenosis). In this procedure,
doctors insert a catheter into your leg or chest and guide it to your heart.

2. Valvular Insufficiency/Regurgitation
CONDITION,
Valvular insufficiency results from valve leaflets not completely sealing when a valve is closed so
that regurgitation of blood occurs (backward flow of blood) into the proximal cardiac chamber.
Regurgitation results in turbulence and the generation of characteristic heart murmurs.

CAUSES,
Some cause of Valvular Insufficiency/Regurgitation includes Congenital heart valve disease.
Narrowing of the valve (stenosis).Inflammation of the lining of the heart’s chambers and valves
(endocarditis). And Rheumatic fever.

CLINICAL MANIFESTATIONS,
- Shortness of breath with exercise or when you lie down.
Fatigue and weakness, especially when you increase your activity level.
Heart murmur.
Irregular pulse (arrhythmia).
Lightheadedness or fainting.
Chest pain (angina), discomfort or tightness, often increasing during exercise.
Sensations of a rapid, fluttering heartbeat (palpitations).
Swollen ankles and feet.

DIAGNOSTIC TEST TO CONFIRM THE CONDITION

- Your doctor may order several tests to diagnose valve tests may include:

Echocardiogram. This test can help doctors closely look at the valve of your heart.

Electrocardiogram (ECG or EKG). An ECG can detect enlarged chambers of your heart, heart
disease and abnormal heart rhythms. Chest X-ray,

Exercise tests or stress tests. Exercise tests help doctors see whether you have signs and
symptoms of valve disease during physical activity.

Cardiac catheterization. This test isn’t often used to diagnose valve regurgitation, but it may be
done if other tests aren’t able to diagnose the condition or determine its severity.

MANAGEMENT/TREATMENT
 - Treatment of valve regurgitation depends on how severe your condition is, whether it’s
getting worse and whether you have symptoms. For mild leakage, treatment is usually
not necessary. You may need heart surgery to repair or replace the valve for severe
leakage or regurgitation. Valve regurgitation can cause heart failure or heart rhythm
problems (arrhythmias). Even people without symptoms may need to be evaluated by a
cardiologist and surgeon trained in valve diseases to determine whether early
intervention may be beneficial.

3. Prolapse of the Valves

CONDITION,
- Valve prolapse occurs when the flaps (leaflets) of the heart’s mitral valve bulge
(prolapse) like a parachute into the heart’s left upper chamber (left atrium) as
the heart contracts. Mitral (MY-trul) valve prolapse sometimes leads to blood
leaking backward into the left atrium, a condition called mitral valve
regurgitation.

CAUSES,
- For most people with mitral valve prolapse, the cause is unknown. Mitral valve
prolapse can run in families. It can also be caused by conditions in which
cartilage is abnormal (connective tissue disease).

CLINICAL MANIFESTATIONS,
- Valve prolapse symptoms can vary widely from one person to another. They
tend to be mild and develop gradually. Symptoms may include:

• A racing or irregular heartbeat (arrhythmia).

• Dizziness or lightheadedness
•Difficulty breathing or shortness of breath, often during physical activity or when lying flat
•Fatigue

DIAGNOSTIC TEST TO CONFIRM THE CONDITION

 - Doctors may diagnose mitral valve prolapse at any age. Your doctor is most likely
to diagnose mitral valve prolapse while listening to your heart with a
stethoscope during a physical examination.

Other tests that may be used to evaluate your heart may include:

Echocardiogram. An echocardiogram is a noninvasive ultrasound evaluation of your heart. It’s

usually done to confirm the diagnosis and determine the severity of your condition.

Chest X-ray. A chest X-ray shows a picture of your heart, lungs and blood vessels and can help
your doctor make a diagnosis.

Electrocardiogram (ECG).

Coronary angiogram. This test uses X-ray imaging to see your heart’s blood vessels.

MANAGEMENT/TREATMENT
- For people with symptoms of congestive heart failure caused by valve prolapse
with regurgitation, surgery is usually the best treatment. If no valve regurgitation
is present on echocardiogram, symptoms of valve prolapse rarely pose any risk.
The best treatment for each person may vary, but can include: Exercise, Pain
relievers,
Relaxation and stress reduction techniques, Avoidance of caffeine and other stimulants. Beta-
blockers, which are medications to slow the heart rate, may be helpful in people who have
episodes of palpitations with a rapid heartbeat, known as tachycardia, with valve prolapse.

B. RHEUMATIC HEART DISEASE

1. What is Rheumatic Heart Disease and what casues it?

- Rheumatic heart disease is a condition in which the heart valves have been permanently
damaged by rheumatic fever. The heart valve damage may start shortly after untreated or
under-treated streptococcal infection such as strep throat or scarlet fever. An immune
response causes an inflammatory condition in the body which can result in on-going valve
damage.

2. How can Rheumatic Heart Disease impede with cardiac activities?

The heart valves can be inflamed and become scarred over time. This can result in narrowing or
leaking of the heart valve making it harder for the heart to function normally. This may take
years to develop and can result in heart failure.

4. Which particular structures are affected?

RHD can damage any part of the heart including the valves, the lining of the heart or the heart
muscle, but more often damages the heart valves, especially those on the left side of the heart.
It cab also affect many connective tissues, in the joints, skin, or brain.

4. How can this be treated or managed?

- Treatment depends in large part on how much damage has been done to the heart valves. In
severe cases, treatment may include surgery to replace or repair a badly damaged valve. The
best treatment is to prevent rheumatic fever. Antibiotics can usually treat strep infections and
keep rheumatic fever from developing.

References:

https://www.mayoclinic.org/diseases-conditions/aortic-stenosis/diagnosis-treatment/drc-
20353145

https://www.webmd.com/heart-disease/aortic-valve-stenosis

https://www.mayoclinic.org/diseases-conditions/aortic-stenosis/symptoms-causes/syc-
20353139
https://www.heartandstroke.ca/heart-disease/conditions/valvular-heart-disease

2.
https://www.cvphysiology.com/Heart%20Disease/HD005

https://www.mayoclinic.org/diseases-conditions/aortic-valve-regurgitation/symptoms-
causes/syc-20353129

https://www.mayoclinic.org/diseases-conditions/aortic-valve-regurgitation/symptoms-
causes/syc-20353129

https://www.mayoclinic.org/diseases-conditions/aortic-valve-regurgitation/diagnosis-
treatment/drc-20353135

https://www.mayoclinic.org/diseases-conditions/mitral-valve-regurgitation/symptoms-
causes/syc-20350178

https://www.webmd.com/heart/mitral-valve-prolapse-symptoms-causes-and-
treatment#:~:text=For%20most%20people%20with%20mitral,U.S.%20have%20mitral%20valve
%20prolapse.

https://www.webmd.com/heart/mitral-valve-prolapse-symptoms-causes-and-treatment

https://www.mayoclinic.org/diseases-conditions/mitral-valve-prolapse/symptoms-causes/syc-
20355446

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/rheumatic-heart-disease

https://www.hopkinsmedicine.org/health/conditions-and-diseases/rheumatic-heart-disease
https://www.hopkinsmedicine.org/health/conditions-and-diseases/rheumatic-heart-disease

Identify the CLINICAL/CLASSICAL SIGNS, DIAGNOSTIC TEST TO CONFIRM THE CONDITION and
MANAGEMENT/TREATMENT of the following diseases/disorders of the PERICARDIUM.

1. Pericarditis
CAUSES,
Pericarditis is inflammation of the pericardium, the thin sac that surrounds the heart.
Pericarditis may be caused by infection, autoimmune disorders, inflammation after a heart
attack, chest injury, cancer, HIV/AIDS, tuberculosis (TB), kidney failure, medical treatments
(such as certain medicines or radiation therapy to the chest), or heart surgery.

CLINICAL/CLASSICAL SIGNS
- Some of the the clinical signs of having pericarditis includes:

• Chest pain that: Can especially be felt behind the breastbone, and sometimes beneath the
collarbone (clavicle), neck, and left shoulder. …
• Fever.
• Weakness and tiredness.
• Coughing.
• Trouble breathing.
• Pain when swallowing.
• Pounding feeling when your heart beats (palpitations)

DIAGNOSTIC TEST TO CONFIRM THE CONDITION

- During the exam, the doctor will place a stethoscope on your chest to listen to your
heart sounds. Pericarditis causes a specific sound, called a pericardial rub. The noise
 occurs when the two layers of the sac surrounding your heart (pericardium) rub against
each other.

Blood tests are usually done to check for signs of a heart attack, inflammation and infection.
Other tests used to diagnose pericarditis include:

Electrocardiogram (ECG). An electrocardiogram is a quick and painless test that records the
electrical signals in your heart.

Chest X-ray. The images may show an enlarged heart if excess fluid has collected in the
pericardium.

Echocardiogram. Your doctor can use this test to see how well your heart is pumping blood and
if there is fluid buildup in the pericardium.

Cardiac computerized tomography (CT) scan. The test can be used to look for thickening that
may be a sign of constrictive pericarditis.

MANAGEMENT/TREATMENT
- Treatment for pericarditis depends on the cause and the severity of your symptoms.
Mild pericarditis may get better without treatment.

Pain relievers. Pericarditis pain can usually be treated with over-the-counter pain relievers, such
as aspirin or ibuprofen (Advil, Motrin IB, others). Prescription-strength pain relievers also may
be used.

Colchicine (Colcrys, Mitigare). This drug reduces inflammation in the body. It’s used to treat
acute pericarditis or if your symptoms tend to come back.
Corticosteroids. Corticosteroids are strong medications that fight inflammation.

If your pericarditis is caused by a bacterial infection, you’ll be treated with antibiotics and
drainage, if necessary

If pericarditis causes fluid buildup around the heart, you may need drainage or surgery.
Treatments include: Pericardiocentesis. In this procedure, a doctor uses a sterile needle or a
small tube (catheter) to remove and drain the excess fluid from the pericardial cavity. And
Pericardiectomy. This type of surgery removes the entire pericardium.

2. Cardiac/Pericardial Tamponade
CAUSES,
- Pericardial tamponade, also known as cardiac tamponade, is a medical condition caused
by the compression of the heart due to a build-up of fluid, blood, or air in the
pericardium, which is the double-walled sac surrounding the heart. Normally, the
pericardium is filled with a small amount of fluid that prevents the two layers of the
pericardium from rubbing together as the heart beats. Pericardial tamponade occurs
when there’s an increased amount of fluid, blood, or air inside the pericardial sac.
Pericardial tamponade can develop suddenly as a result of chest trauma like a stab
wound or blunt trauma, rupture of the aorta, rupture of the ventricle after a heart
attack, or as a complication of cardiac surgery.

CLINICAL/CLASSICAL SIGNS
- The classic signs of cardiac tamponade are known as Beck’s triad, which includes low
blood pressure, distension of the jugular veins, and muffled heart sounds.

DIAGNOSTIC TEST TO CONFIRM THE CONDITION

- Your healthcare provider will ask about your past health. You will also need an exam.
Your healthcare provider may note a larger-than-normal drop in blood pressure when
you take a breath. A number of tests can also help with the diagnosis. Some of these
tests might include:
Echocardiogram, to look at the fluid around the heart and heart motion.
Electrocardiogram (ECG), to check the heart’s electrical rhythm
Chest X-ray, to see the heart anatomy and CT or MRI scan.

MANAGEMENT/TREATMENT
- Cardiac tamponade is often a medical emergency and quick removal of the pericardial
fluid is needed. The most common procedure to do so is a pericardiocentesis. A needle
and a long thin tube (a catheter) are used to remove the fluid. In certain cases,
healthcare providers might drain the pericardial sac during surgery instead. In some
cases, the surgeon removes some of the pericardium. That can help diagnose the cause
of the tamponade. It can also prevent the fluid from building up again. This is called a
pericardial window.

References:

https://www.cedars-sinai.org/health-library/diseases-and-conditions/p/pericarditis.html

https://www.cedars-sinai.org/health-library/diseases-and-
conditions/p/pericarditis.html#:~:text=Pericarditis%20may%20be%20caused%20by,chest)%2C
%20or%20heart%20surgery.

https://www.cedars-sinai.org/health-library/diseases-and-conditions/p/pericarditis.html

https://www.mayoclinic.org/diseases-conditions/pericarditis/diagnosis-treatment/drc-
20352514

https://www.cedars-sinai.org/health-library/diseases-and-conditions/c/cardiac-
tamponade.html
https://emedicine.medscape.com/article/152083-treatment

https://www.osmosis.org/answers/pericardial-tamponade