– 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)
– 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
