00:01
Valvular heart diseases. Where are we and
what are we doing? My goodness. There is so
much to discuss here, but approaches one
valve at a time. And as we do
so, we will dissect every single aspect of
that valvular heart disease so that by the
time you have gone through this, you know
who your patient is, what they are presenting
with and understand the pathogenesis of what
guide is here in the first place. Let us begin.
00:29
Here once again is the chest. How important
is this chest? Quite. We talked about the
aortic area. I want you to point to it. Where
am I? Right parasternal second intercostal
space. Why? Because in anatomy of your aorta,
take a look at the arch and so therefore,
that is where you normally would hear your
aortic valve. If you are dealing with a systolic
murmur, take a look at aortic stenosis and
I told you about that patient thus feeling
tired, fatigue, maybe a little bit of chest
pain with exertion. Let us talk about that
for one second here. If it is aortic stenosis,
what is causing this chest pain? It is not
myocardial infarction, but it is the fact
that with aortic stenosis, the left ventricle
is having a hard time kicking against that
increased afterload and so therefore the
left ventricle is lifting weights. Once upon
a time, when I was younger and I was lifting
weights, I was undergoing hypertorphy of my
biceps. Nowadays it is more about atrophy.
01:31
But as far as the left ventricle is concerned,
it is also lifting weights. What are the weights
in this environment? The stenotic aortic valve.
So what is the hypertrophy that we were referring
to in the left ventricle? It is the fact that
it is concentric hypertrophy. Is that clear?
And the reason I bring all this up is because
with that increased thickness of the myocardium,
that is a lot of myocardium in which blood
has to continue supplying oxygen. So what
if there was inadequate oxygention? Isn't that
the definition of? Angina. Good. Let us
continue. We also looked at the second intercostal
space, left parasternal and that would be
the pulmonic area. I want you to point it out.
And here would be some type of pulmonic stenosis.
02:20
Here once again reiterate the atrial septal
defect and why it would be a diastolic heart
murmur that would be best heard by the fifth
intercostal space left parasternal or best
heard as a flow murmur through your second
intercostal space, left parasternal because
there is a lot of blood on your right side, right?
Atrial septal defect.
02:44
Common causes, when we talked about ostium
secundum and that would be congenital. But
what if a child was born with unfortunately
one of the most common causes of acquired
intellectual disability in the United States is
alcohol, acquired. So this is called fetal
alcohol syndrome. It could be ASD? Sure it can. And with all
of this blood moving from the left atrium
to the right atrium, you have increased amount
of blood and so the tricuspid valve now feels
overwhelmed. And during your diastole, the
tricuspid valve will open and with all this
blood, which is pathologically being introduced
into the right atrium is now moving forward,
flowing in a turbulent nature into the right
ventricle. Are you seeing this? And, therefore,
atrial septal defect would be a diastolic
murmur. Now at some point with all those blood,
it would also hit the pulmonic valve. Clinically
speaking you'll expect to hear a murmur in the
pulmonic region as well with ASD. So this
is a picture that we looked at earlier and
this is a picture that we are reiterating
what we are going to do throughout this lecture
series is then delineate and distinguish each
valvular heart disease and you will be in good hands.
04:02
Trust me.