Right heart valve disease

• Causes;
  • Functional (pulmonary hypertension)
  • Rheumatic fever
  • Infective endocarditis (IV drug users)
  • Carcinoid syndrome
  • Congenital
• Symptoms
  • Fatigue
  • Hepatic pain on exertion
  • Ascites
• Signs
  • Murmur – best heard at the lower sternal edge in inspiration
  • Giant V waves and prominent y decent in JVP
  • RV heave
  • Pulsatile hepatomegaly
  • Jaundice
  • Ascites
• Management
  • Treat underlying cause
  • Drugs – diuretics, digoxin, ACEI, valve replacement (20% operative mortality)

Tricuspid stenosis

• Causes
  • Rheumatic fever (almost always with  mitral or aortic valve disease)
• Symptoms
  • Fatigue
  • Ascites
  • Oedema
• Signs
  • Giant a wave and slow y decent in JVP
  • Opening snap
  • Diastolic murmur best heard at the left sternal edge during inspiration
• Diagnosis
  • ECHO
• Treatment
  • Diuretics and surgical repair

Pulmonary stenosis

• Usually congenital;
  • Turner’s syndrome
  • Noonan’s syndrome
  • Williams syndomre
  • Fallot’s tetralogy
  • Rubella
• Acquired causes;
  • Rheumatic fever
  • Carcinoid syndrome
• Symptoms
  • Dyspnoea
  • Fatigue
  • Oedema
  • Ascites
• Signs
  • Dysmorphic facies (congenital causes)
  • Prominent a wave on JVP
  • RV heave
  • Ejection systolic murmur that radiates to the left shoulder
• Tests
  • ECG – RAD, P-pulmonale, RBBB
  • CXR – post-stenotic dilation of pulmonary artery, oligaemic lung fields, RV hypertrophy and right atrial hypertrophy
• Treatment
  • Pulmonary valvuloplasty or valvotomy

Pulmonary regurgitation

• Causes by any cause of pulmonary hypertension
• A decrescendo murmur is heard in early diastole at left sternal edge (Graham Steell murmur)

Cardiac surgery

• Valve replacements
  • Mechanical valves can be;
    • Ball-cage (Starr-Edwards)
    • Tilting disc (Bjork-Shiley)
    • Double tilting disc (St Jude)
  • Patients require lifetime coagulation
  • Xenografts are made from porcine valves or pericardium and don’t last as long but don’t require thromboembolism
• Complications of prosthetic valves;
  • Systemic embolism
  • Infective endocarditis
  • Haemolysis
  • Structural valve failure
  • Arrhythmias