1- Auscultation:
A- Mitral stenosis:
Durozier rhythm that combines:
* A burst of B1
* A mitral opening snap
* Bearing with diastolic building presystolic *
B- Mitral insufficiency:
– Systolic regurgitation Breath
* Holosystolic
* Max in the tip (axillary irradiation)
* In steam
– Bearing early diastolic, B3 (major IM)
– View disease Barlow
C- Aortic stenosis:
– Systolic murmur éjectionnel
* -> Vessels of the neck; the point
* From rough and raspy timbre
* A maximum mésosystolique
– Increase or abolition of B2 or duplication.
– Click protosystolique
D- Aortic Insufficiency:
– Diastolic murmur (soft aspirative)
– Systolic murmur éjectionnel (functional RA)
– Bearing Flint (bearing apical presystolic) premature closure of the anterior mitral valve.
– Slam mésosystolique (pistol shot) into the right subclavian region (sudden distension of the aorta).
presystolic the building disappears in atrial fibrillation (for effective atrial contraction)
* Note: no change auscultatory inspiration argues against tricuspid valve disease
* The AI breath is best seen along the left sternal border at aortic focus (especially when sitting and expiration)
2- Special Etiology:
A- Mitral insufficiency:
* Disease Barlow:
Myxoid degeneration valves (long ropes, prolapsed valves); “Click mésosystolique” apical systolic breath and IM.
* Other: Marfan disease; Ehlers-Danlos
* Rope Rupture of the posterior valve by fibrosis (degeneration fibroelastic)
B- Aortic stenosis:
* Disease Monckeberg (RA degenerative): limestone deposit
* Bicuspid aortic valve (congenital)
C- Aortic Insufficiency:
* Marfan disease
* Aortic dissection
Carpentier classification (myelosuppression)
– Type 1: valvular play is normal; it is functional IM or valvular perforations
– Type 2: the amplitude of systolic motion of one or both valves is increased. This is a valve prolapse in which the end of the valve is everted into the left atrium systole
– Type 3: the valve set is limited to the origin of insufficient closure of the valve in systole which remains in position ½ hour. There is talk of restrictive IM whose causes are rheumatic or ischemic.
Barlow disease: ballooning of the small valve; appearance hammock on echocardiography; frequency in young women
3- ECG:
A- Mitral stenosis:
* Frequent ACFA (large mesh fibrillation)
* HAG: bifid P wave in D2; duration ≥ 12 s and biphasic in V1; it can be associated to a HAD (increase of the amplitude of the P wave> 2,5 mm)
* Right ventricular overload: right axial deviation, R wave in V1, increased R / S ratio right; incomplete bundle branch block
B- Mitral insufficiency:
* It may be normal even in significant IM; atrial rhythm disorders are common (ACFA in 30-50% of cases)
* HAG (large P double hump); LVH (Sokolow ≥ 35mm) systolic-type (negative T wave in V5, V6) or sometimes diastolic.
C- Aortic stenosis :
* LVH with systolic overload (have negative and asymmetrical T D1, VL, V5V6; convex ST segment up); sometimes BBG; BAV
* The ACFA is rare; it has a poor prognosis (atrial contraction for 40% of ventricular filling)
D- Aortic Insufficiency:
* LVH diastolic types (large and positive T wave in V5, V6, concave ST segment up)
* Conduction disorders (AVB1, BBG); HVG systolic => very advanced AI
4- single X-ray:
A- Mitral stenosis:
* Projection of the AMG (trunk AP OG top and bottom)
* Normal AIG moved left or by HVD (supradiaphragmatic tip)
* Aspect double contour AID (HAG)
B- Mitral insufficiency:
-> Overhang AIG with advanced subdiaphragmatic (LV dilation)
-> Double contour AID (HAG). Systolic expansion of OG fluoroscopy.
C- Aortic stenosis:
-> Globular aspect of the AIG; the cardiothoracic ratio is often normal or slightly high (concentric hypertrophy).
Moderate protrusion of the ascending aorta (ADS).
-> A poststenotic dilatation of the aortic root is common
D- Aortic Insufficiency:
-> Scopie cardio-aortic bell motion and left ventricular hyperkinesis
-> Extended AIG, convex and advanced diving subdiaphragmatic
5- Echocardiography:
A- Mitral stenosis:
A closing time of the earlier valve; attenuation of the wave A; paradoxical movement of the small valve
B- Aortic stenosis:
The amplitude of the systolic opening intersygmoïdienne <8 mm, shows a tight stenosis
C- Aortic Insufficiency:
Diastolic fluttering of the anterior mitral valve and premature closure of the large mitral valve
* In ankylosing spondylitis, aortic regurgitation appears late and is often preceded by atrioventricular conduction disorders
* Post-traumatic aortic insufficiency is rare but is the most common post-traumatic valvular lesions
6- Signs Device aortic regurgitation:
– Enlargement of the differential (decreased diastolic while SAP is kept)
– Large radial pulse and then leaping compressible (pulse Corrigan)
– Blood Hyperpulasatilité: sign of Musset (head movement rhythm of the heartbeat), Hippus pupil (pupil dilation-contraction); capillary pulse subungual
– Intermittent femoris Breath Durozier (auscultation of the femoral artery)
7- Ortner syndrome:
– Paralysis of the left recurrent nerve compression (left atrium ectasia)
– It is due to a tight RM
* Ischemic IM: during an IDM especially lower by breaking pillar or ischemic dysfunction pillar; in chronic angina, it can rise to a pillar with fibrosis of the lower parietal dyskinesia (IM restriction of the small valve).
* Increased atrial pressure => increased pulmonary capillary pressure (PCP) and parallel increase in pulmonary artery pressure (post-pulmonary PAH) => Post-capillary PAH: PAP gradient – PCP <10 mmHg
* The precapillary PAH can occur late after the post-capillary PAH increased arteriolar pulmonary resistance => Self PAH (gradient> 10 mmHg).
* The IM leads to volume overload of the LV => increased left work and stroke volume => LV hypertrophy (systolic overload). In AI
* In acute MI OG is small; the elevation of the left atrial pressure and pulmonary capillary pressure is very important with the appearance of a wave of regurgitation (V) greater.
* Chest X-ray Front: Expansion of the OG => arc left means (AMG) convex aspect double contour of the lower right edge (AID).
8- Disease Barlow:
* It is responsible for mitral valve prolapse by IM; mitral balonisation by myxomatous degeneration; mainly affects the young woman
* Functional signs: chest pain atypical, asthenia, palpitations, exertional dyspnea, faintness, anxiety, dizziness …
* Listening: click mésosystolique often followed by systolic breath
* ECG usually normal; repolarization disorders (negativation T waves, ST segment elevation; arrhythmias
* Doppler: holosystolic decline hammock …
* Evolution benign in most cases; the pill is not outlawed
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