tabel perbedaan kelainan katup

5/22/2018 Tabel Perbedaan Kelainan Katup

1/6

Table 101. DIFFERENTIAL DIAGNOSIS OF VALVULAR HEART DISEASE

Mitral Stenosis Mitral

Re!ritation

Aorti" Stenosis Aorti" Re!ritation Tri"!s#i$

Stenosis

Tri"!s#i$

Re!ritation

Inspection Malar flush,

precordial bulge, and

diffuse pulsation in

young patients.

Usually prominent

and hyperdynamic

apical impulse to left

of MCL.

Sustained PMI,

prominent atrial

filling wave.

yperdynamic PMI to

left of MCL and

downward. !isible

carotid pulsations.

Pulsating nailbeds"#uinc$e%s&, head bob

"deMusset%s&.

'iant awave in

(ugular pulse

with sinus

rhythm.

Peripheraledema or ascites,

or both.

Large vwave in

(ugular pulse) time

with carotid

pulsation.

Peripheral edemaor ascites, or

both.

Palpation *+apping* sensationover area of epected

PMI. -ight

ventricular pulsation

left third to fifth ICS

parasternally when

pulmonary

hypertension is

present. Pmay be

palpable.

/orceful, bris$ PMI)systolic thrill over

PMI. Pulse normal,

small, or slightly

collapsing.

Powerful, heavingPMI to left and

slightly below MCL.

Systolic thrill over

aortic area, sternal

notch, or carotid

arteries in severe

disease. Small and

slowly rising carotid

pulse. If bicuspid 0S

chec$ for delay at

femoral artery toeclude coarctation.

0pical impulse forcefuland displaced

significantly to left and

downward. Prominent

carotid pulses. -apidly

rising and collapsing

pulses "Corrigan%s

pulse&.

Pulsating,enlarged liver in

ventricular

systole.

-ight ventricularpulsation. Systolic

pulsation of liver.

Heart so!n$s%

r&'t&(% an$ bloo$

#ress!re

S1loud if valve

mobile. 2pening snap

following S. +he

S1normal or buried

in early part of

murmur "eception is

0normal, soft, or

absent. Prominent S3.

4lood pressure

S1normal or reduced,

0loud

S1often loud.

0trial fibrillation

may be present.


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Re!ritation


Stenosis

Tri"!s#i$

Re!ritation

worse the disease, the

closer the S5opening

snap interval.

mitral prolapse where

murmur may be late&.

Prominent third heartsound when severe

M-. 0trial

fibrillation common.

4lood pressure

normal. Midsystolic

clic$s may be present

and may be multiple.

normal, or systolic

pressure normal with

high diastolicpressure.

d. 6ide pulse pressure

with diastolic pressure7 89 mm g.

6hen severe, gentle

compression of femoral

artery with diaphragm

of stethoscope may

reveal diastolic flow

":uro;ie;%s& and

pressure in leg on

palpation < 39 mm g

than arm "ill%s&.M!r(!rs

Lo"ation an$

trans(ission

Locali;ed at or near

ape. :iastolic

rumble best heard in

left lateral position)

may be accentuatedby having patient do

sit5ups. -arely, short

diastolic murmur

along lower leftsternal border

"'raham Steell& in

severe pulmonary

hypertension.

Loudest over PMI)

posteriorly directed

(ets "ie, anterior

mitral prolapse&

transmitted to leftailla, left

infrascapular area)

anteriorly directed

(ets "ie, posteriormitral prolapse&

heard over anterior

precordium. Murmur

unchanged after

premature beat.

-ight second ICS

parasternally or at

ape, heard in carotid

arteries and

occasionally in upperinterscapular area.

May sound li$e M-

at ape "'allaverdin

phenomenon&, butmurmur occurs after

S1and stops before

S. +he later the pea$

in the murmur, the

more severe the 0S.

:iastolic= louder along

left sternal border in

third to fourth

interspace. eard over

aortic area and ape.May be associated with

low5pitched

middiastolic murmur at

ape "0ustin /lint& dueto functional mitral

stenosis. If due to an

enlarged aorta, murmur

may radiate to right

sternal border.

+hird to fifth

ICS along left

sternal border

out to ape.

Murmurincreases with

inspiration.

+hird to fifth ICS

along left sternal

border. Murmur

hard to hear but

increases withinspiration. Sit5

ups can increase

cardiac output and

accentuate.


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Re!ritation


Stenosis

Tri"!s#i$

Re!ritation

Ti(in -elation of opening

snap to 0important.+he higher the L0

pressure the earlierthe opening snap.

Presystolic

accentuation before S1if in sinus rhythm.

'raham Steell begins

with P"early

diastole& if associated

pulmonary

hypertension.

Pansystolic= begins

with S1and ends at orafter 0. May be late

systolic in mitralvalve prolapse.

4egins after S1, ends

before 0. +he moresevere the stenosis,

the later the murmurpea$s.

4egins immediately

after aortic secondsound and ends before

first sound "blurringboth&) helps distinguish

from M-.

-umble often

follows audibleopening snap.

0t times, hard to

hear. 4egins withS1and fills

systole. Increaseswith inspiration.

)&ara"ter Low5pitched,

rumbling) presystolic

murmur merges withloud S1.

4lowing, high5

pitched) occasionally

harsh or musical.

arsh, rough. 4lowing, often faint. 0s for mitral

stenosis.

4lowing, coarse,

or musical.

O#ti(!(

a!s"!ltator'

"on$itions

0fter eercise, left

lateral recumbency.

4ell chest piece

lightly applied.

0fter eercise) use

diaphragm chest

piece. In prolapse,

findings may bemore evident while

standing.

Use stethoscope

diaphragm. Patient

resting, leaning

forward, breath heldin full epiration.

Use stethoscope

diaphragm. Patient

leaning forward, breath

held in epiration.

Use stethoscope

bell. Murmur

usually louder

and at pea$during

inspiration.

Patient

recumbent.

Use stethoscope

diaphragm.

Murmur usually

becomes louderduring inspiration.


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Re!ritation


Stenosis

Tri"!s#i$

Re!ritation

Ra$iora#&' Straight left heart

border from enlarged

L0 appendage.>levation of left

mainstem bronchus.

Large right ventricle

and pulmonary artery

if pulmonary

hypertension is

present. Calcification

in mitral valve in

rheumatic mitral

stenosis or in annulus

in calcific mitralstenosis.

>nlarged left

ventricle and L0.

Concentric left

ventricular

hypertrophy.Prominent ascending

aorta. Calcified aortic

valve common.

Moderate to severe left

ventricular

enlargement. 0orticroot often dilated.

>nlarged right

atrium with

prominent S!Cand a;ygous

shadow.

>nlarged right

atrium and right

ventricle.

E)G 4road P waves in

standard leads) broadnegative phase of

diphasic P in !1. If

pulmonary

hypertension is

present, tall pea$ed P

waves, right ais

deviation, or right

ventricular

hypertrophy appears.

Left ais deviation or

fran$ left ventricularhypertrophy. P waves

broad, tall, or

notched in standard

leads. 4road negative

phase of diphasic P in

!1.

Left ventricular

hypertrophy.

Left ventricular

hypertrophy.

+all, pea$ed P

waves. Possibleright ventricular

hypertrophy.

-ight ais usual.

E"&o"ar$iora#&'

T*o+$i(ensional +hic$ened, immobile +hic$ened mitral :ense persistent 0bnormal aortic valve In rheumatic >nlarged right


5/6


Re!ritation


Stenosis

Tri"!s#i$

Re!ritation

e"&o"ar$iora#&' mitral valve with

anterior and posterior

leaflets movingtogether. *oc$ey

stic$* shape to opened

anterior leaflet in

rheumatic mitral

stenosis. 0nnular

calcium with thin

leaflets in calcific

mitral stenosis. L0

enlargement, normal

to small left ventricle.

2rifice can be tracedto approimate mitralvalve orifice area.

valve in rheumatic

disease) mitral valve

prolapse) flail leafletor vegetations may

be seen. :ilated left

ventricle in volume

overload. 2perate for

left ventricular end5

systolic dimension >

important in aortic

valve endocarditis to

eclude abscess. Mitral

inflow pattern

Prolongedpressure half5

time across

tricuspid valve

can be used to

estimate mean

gradient. Severe

tricupid stenosis

present when

mean gradient

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