*3.2.2 Palpitations*

The sensation of a rapid or unusually vigorous heartbeat may signal the development of atrial fibrillation.

## *3.2.3 Angina*

Maybe the initial manifestation of valvular heart disease.

### *3.2.4 Weight gain, oedema, and abdominal discomfort*

In hospitalised patients, excess extra cellular fluid is first presented as pitting oedema overlying the sacrum predominantly; the elevated systemic venous pressure is the cause of all the above.

### **3.3 Physical exam**

### *3.3.1 General appearance*

The toxic appearance of acute infection, wasting of cardiac cachexia, the distressed facial expression, wet cough, accessory muscle use, and diaphoresis of pulmonary oedema, and the cool skin characteristic of poor perfusion.

### *3.3.2 Vital signs*

### *3.3.2.1 Tachycardia*

Skin and mucosa cyanosis of the lips cold sweat (Osler nodes). (Janeway lesions), painless red macule lesions of the palms and soles (Janeway lesions), conjunctive petechial, and subungual hematomas (splinter haemorrhages).

Central venous pulsations jugular venous pulsation and mean central venous pressure (CVP) are often abnormal in valvular heart disease. In most cases, right heart failure is secondary left-sided valve disease-causing left heart failure. Less direct clues to the level of right atrial pressure; include the presence of pedal oedema, sacral oedema, anasarca, tender hepatomegaly, ecchymosis (hepatic synthetic dysfunction), hepatojugular pulsation and ascites.

### *3.3.3 Pulse volume, contour*

### *3.3.3.1 Auscultatory findings*

However, auscultation technical skill like any other and improves with repetition [29]. Therefore, students' physicians-in-training reading this text should lose heart, but rather, should apply themselves diligently to acquire these valuable bedside skills. Listening to patients before and after echocardiographic findings are known is particularly helpful.

### **3.4 Electrocardiography**

In majority of patients with aortic valve disease with have abnormal ECG which commonly non-specific such as left ventricle hypertrophy, with or without repolarization abnormalities is seen on electrocardiography (ECG). Left atrial enlargement, left axis deviation and conduction disorders are also common. Atrial fibrillation can be seen at late state and in older patients or those with hypertension.

**21**

**Figure 2.**

*Cardiomegaly and pulmonary congestion.*

*Aortic Valve Disease: State of the Art*

**3.5 Radiography**

valuable (**Figure 2**).

in this region only.

**3.6 Echocardiography**

*DOI: http://dx.doi.org/10.5772/intechopen.93311*

Pulmonary vascular congestion. Enlargement, valvular calcification, and type position of prosthetic valve may all be ascertained plain radiographs. Comparing changes over time particularly helpful; hence obtaining previous studies is very

Echocardiography is the most valuable tool in valvular heart disease due to its portability, ease of use. Low cost, steadily improving resolution, and its ability to assess hemodynamics, additional ultrasound-based modalities can provide information about cardiac anatomy, function, and hemodynamics. These modalities include two dimensional (2D) or B-mode in which sound waves are in a fan-like distribution, yielding a real wedge-shaped tomographic image of the heart. There are three subtypes of Doppler ultrasound. Continuous-wave Doppler, all velocities along a continuous line through the heart are displayed as a spectrum over time. In pulse wave Doppler, the sample volume is placed on a 2D image, and the spectral splay of velocities represents the blood flow velocities

Tissue Doppler is yet another form of Doppler echocardiography which measures the velocity of anatomic structures rather than red blood cells; it currently has

Hemodynamic assessment. Firstly, the pressure gradient a valve or between two chambers can be estimated by taking advantage of the relationship between pressure (P), and velocity (v) as described in is the conservation of flow and different diameter, the flow of fluid through one section match flow through the other end. Since flow equals the product of orifice area and flow velocity, this principle can be stated as Area 1 × Velocity 1 = Area 2 × Velocity 2. This is used explicitly in the

Another hemodynamic measure important valvular heart disease are the rate of pressure equilibration between two chambers (e.g. pressure half-time, deceleration). Cardiac catheterisation and direct measure of intracardiac pressures, ventriculography, aortography, and assessment of coronary vessels before valve surgery all

continue to be an essential tool in the evaluation of valvular heart disease.

very limited application in valvular heart disease [30, 31].

determination of aortic valve area (**Figure 3**) [30].
