Valvular Heart Disease

Overview

Valvular disease can come to clinical attention due to stenosis, insufficiency (regurgitation/incompetence) or both. Stenosis is the failure of a valve to open completely, which impedes forward flow. Insufficiency results from failure of a valve to close completely, thereby allows reversed flow. Doppler echocardiogram is the best technique for assessing patients with valvular heart disease, but often detects minor, unimportant abnormalities. The clinical consequence of valve dysfunction vary depending on the valve involved, the degree of impairment, the tempo of disease onset, and the rate and quality of compensatory mechanism. Valvular abnormalities can be congenital or acquired.

Acquired Heart Valve Disease

Aortic Valve Disease

Aortic Stenosis
Aortic Regurgitation (Incompetence)

Mitral Valve Disease

Mitral Stenosis
Mitral Regurgitation (incompetence)

Other Heart Valve Disease

Infective Endocarditis
Rheumatic Fever

Aortic and mitral valve stenoses account for approximately 2/3 of all valve disease

Summary of Aortic and Mitral valve disease

Clinical Presentation
	Symptoms	Signs
Mitral Stenosis	Dyspnea, reduced exercise tolerance, productive cough, palpitation, dysphagia (compressed by large left atrium)	Palmar erythmea, Malar flush, tapping apex beat
Mitral Regurgitation	Acute dyspnea and pulmonary congestion	Signs of Left-sided heart failure in late stages
Aortic stenosis	Exertional Syncope, Dyspnea and angina	Pulsus tradeus et parvus, narrow pulse pressure, sustained and powerful apex beat.
Aortic regurgitation	Similar t[[[o aortic stenosis	Waterhammer pulse, wide pulse pressure

Clinical Auscultation
	Murmur	Heart Sound
Mitral Stenosis	High pitched early-diastolic murmur	Loud S1
Mitral Regurgitation	Pansystolic murmur radiates to the axilla	Soft S1 loud S2
Aortic stenosis	Ejection systolic “crescendo decresendo” murmur radiating to the carotids	Soft S2
Aortic regurgitation	Early diastolic murmur	Soft S2