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 |
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:
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 | Interventions that Change Murmur Sounds | |||||||
---|---|---|---|---|---|---|---|---|---|---|
Low/High
Pitch |
Systolic/Diastolic
Murmur |
Best Heard Location | Other Features | Valsalva Maneuver | Abrupt Standing | Hand Grip | Squatting | Inhalation | ||
Aortic stenosis |
|
Systolic | Right second intercostal space | |||||||
Aortic regurgitation |
|
High | Diastolic | Right second intercostal space | decreases | |||||
Mitral stenosis | Low (rumbling) | Diastolic | Left ventricular apex | Opening snap | ||||||
Mitral regurgitation | Pansystolic | Left ventricular apex | ||||||||
Mitral valve prolapse | Late Systolic | Mid-systolic click | ||||||||
Tricuspid stenosis | Low | Diastolic | Left fourth or fifth intercostal spaces | Opening snap | increases | |||||
Tricuspid regurgitation | Low | Pansystolic | Mid Sternal Border | |||||||
Pulmonary stenosis | Systolic | Left second intercostal space | Wide split S2 | |||||||
Pulmonary regurgitation | High (blowing) | Diastolic | Left second and third intercostal spaces | Decrescendo configuration | increases |