Valvular heart disease

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Tarek Nafee, M.D. [2]

Valvular heart disease Microchapters
Patient Information
Classification Aortic stenosis Aortic regurgitation Mitral stenosis Mitral valve prolapse Mitral regurgitation Tricuspid stenosis Tricuspid regurgitation Pulmonary stenosis Pulmonary regurgitation
Differential Diagnosis

Overview

Valvular heart disease (VHD) is the pathological defect affecting one of the four valves of the heart: aortic valve, mitral valve, pulmonic valve, or triscuspid valve. VHD may be congenital or acquired. Congenital causes of VHD include tetralogy of fallot, ebstein's anomaly, noonan syndrome, congenital rubella syndrome, and bicuspid valves, among others. Acquired causes of VHD include rheumatic heart disease, infective endocarditis, senile calcification of valves,

Classification

Valvular heart diseases are typically classified according to the valve that is affected as well as the nature of the pathological defect as follows:

• Aortic Valve
  • Aortic stenosis
  • Aortic regurgitation
• Mitral Valve
  • Mitral stenosis
  • Mitral regurgitation
  • Mitral valve prolapse
• Tricuspid valve
  • Tricuspid stenosis
  • Tricuspid regurgitation
• Pulmonary valve
  • Pulmonic stenosis
  • Pulmonic regurgitation

Differential Diagnosis

Clinicians may differentiate among different valvular heart diseases on the basis of the characteristics of the murmur and collecting a thorough patient history, as shown in the following table:

Valvular Disease	Common causes	Murmur Description
		Low/High Frequency	Systolic/Diastolic Murmur	Best Heard Location	Other Features
Aortic stenosis	Senile calcification Calcification of bicuspid valve Other causes		Systolic	Right second intercostal space
Aortic regurgitation	Calcification of bicuspid valve Senile calcification Rheumatic heart disease Iatrogenic (after valvuloplasty) Other causes
Mitral stenosis	Infective endocarditis Rheumatic heart disease Mitral annular calcification Other causes
Mitral regurgitation	Infective endocarditis Ischemic heart disease Papillary muscle rupture Dilated cardiomyopathy Other causes
Mitral valve prolapse	Marfan's syndrome Myxomatous degeneration of the valve Papillary muscle injury Other causes				Mid-systolic click
Tricuspid stenosis	Carcinoid heart disease Cardiac tumors Other causes	Low	Diastolic	Lower Left Sternal Border
Tricuspid regurgitation	Pulmonary hypertension Right ventricular failure Iatrogenic Carcinoid heart disease Other causes	Low	Pansystolic	Mid Sternal Border
Pulmonary stenosis	Congenital Rubella Syndrome Tetralogy of Fallot Carcinoid heart disease Other causes
Pulmonary regurgitation	Carcinoid heart disease Pulmonary hypertension Rheumatic heart disease Iatrogenic (Tetralogy of Fallot repair) Other causes