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Toronto Notes 2019 Valvular Heart Disease Cardiology and Cardiac Surgery C45 ECG: ECG: ECG:
150LV 130LV 110LV
90 70 50 30 10
HEART SOUNDS:
AORTA
TIME
90 70 50 30 10
HEART SOUNDS:
S1 S2
AORTIC PRESSURE DROP
TIME
90 70 50 30 10
HEART SOUNDS:
LA –
TALL V-WAVE
TIME
S1 S2
Figure 42. Hemodynamics of aortic stenosis
Stenosis across the aortic valve results in the generation of a significant pressure gradient between the left ventri- cle and the aorta and a crescendo-decrescendo murmur during systolic contraction. The stenosis decreases the intensity of aortic valve closure hence diminishing S2
Figure 43. Hemodynamics of aortic regurgitation
Regurgitation across the aortic valve during diastole caus- es the aortic pressure to rapidly decrease and a decre- scendo murmur can be heard at the onset of diastole (after S2 is audible). The presence of regurgitant blood from the aorta increases left-ventricular end-diastolic volume
S1 S2
Figure 44. Hemodynamics of acute mitral regurgitation
During systolic contraction, blood regurgitates from the left ventricle into the left atrium across the incompetent mitral valve resulting in an audible holosystolic murmur between S1 and S2. The portion of left ventricular end diastolic volume that regurgitates into the left atrial myocardium increases left atrial pressures resulting in a tall V-wave (in the JVP)
ECG:
110 90 70 50 30 10
HEART SOUNDS:
Figure 45. Hemodynamics of mitral stenosis
LA LV
TIME
S1 S2 OS
S1 S2
First note that the left atrial pressure exceeds the left ventricular pressure during diastole due to mitral stenosis and the consequent generation of a pressure gradient across the left atrium and left ventricle. In diastole the stenotic mitral valve opens which corresponds to the opening snap (OS) and the passage of blood across the mitral stenosis results in an audible decrescendo murmur. Left atrial contraction prior to S1 increases the pressure gradient resulting in accentuation of the murmur before S1 is audible
PRESSURE (mmHg)
© Young M. Kim 2010
PRESSURE (mmHg)
PRESSURE (mmHg)
PRESSURE (mmHg)
© Young M. Kim 2010
© Young M. Kim 2010
© Young M. Kim 2010