Mixed aortic valve lesion

6 Mixed aortic valve lesion



Instruction


Examine this patient’s heart.


Examine this patient’s cardiovascular system.


Examine this patient’s pulse.



Salient features




• Pulse may be bisferious, small volume or large volume depending on the dominant lesion


• There is a displaced apex beat (remember a small LV is inconsistent with chronic severe aortic regurgitation)


• Early diastolic murmur of aortic regurgitation (Fig. 6.1)


• Ejection systolic murmur of aortic stenosis


• Proceed by telling the examiner that you would like to check the BP, in particular to determine the pulse pressure (systolic minus diastolic pressure).


image

Fig. 6.1 Phonocardiogram of the murmurs present in a patient with valvar aortic stenosis and regurgitation. Note the diamond-shaped systolic murmur peaking in early to midsystole and the high-frequency, lower-intensity murmur throughout diastole. 2 R.I.S., second right intercostal space; SM, systolic murmur; DM, diastolic murmur; 1, first heart sound, 2, second heart sound.



Diagnosis


This patient has mixed aortic stenosis with aortic regurgitation (lesion) caused by rheumatic heart disease (aetiology). He has a dominant stenosis and is in cardiac failure (functional status).





Note


In dominant aortic stenosis:



• Pulse volume is small


• BP is normal and pulse pressure is narrow.

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Mixed aortic valve lesion

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