Valvular heart disease

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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

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Tarek Nafee, M.D. [2]
Synonyms and Keywords: VHD, Valve disease, Heart valve disease, Valvular dysfunction

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 tricuspid 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 valve among others. Acquired causes of VHD include rheumatic heart disease, infective endocarditis, senile calcification of valves, or valve deformities secondary to structural changes of the myocardium (e.g. dilated cardiomyopathy). Regardless of the underlying cause, VHD may result in valve stenosis, valve regurgitation or , in some cases, valve prolapse. Valvular heart disease can often be asymptomatic and may go undiagnosed. In patients who develop symptoms suggestive of valvular heart disease, cardiac auscultation for heart murmurs is often the first step of a focused physical examination to rule out valvular heart disease. Echocardiography is the gold standard diagnostic modality for valvular heart disease. In addition to a thorough and focused physical examination, a well-performed echocardiogram aids the clinician in determining the severity of the disease, the prognosis, and the need for surgical intervention.

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 Intensity
Pitch Timing Best Heard Location Shape Other Features Radiation Valsalva Maneuver Abrupt Standing Hand Grip Abrupt Squatting Inhalation
Aortic stenosis High Systolic Right second intercostal spaces Crescendo-Decrescendo Systolic Ejection Click with bicuspid valves Radiates towards the neck

(Gallavardin dissociation)

- -
Subaortic stenosis High Systolic Right second intercostal spaces Crescendo-Decrescendo - No radiation - -
Aortic regurgitation High Diastolic Right third intercostal spaces

(Erb's point)

Decrescendo May present an early diastolic rumble at the apex (Austin-Flint murmur) - - - - -
Mitral stenosis Low (rumbling) Diastolic Left ventricular apex Decrescendo-Crescendo Opening snap No radiation - - - - -
Mitral regurgitation High Systolic Left ventricular apex Holosystolic Blowing sound Usually radiates to the axilla - - -
Mitral valve prolapse High Systolic Complete precordial area Late systolic Mid-systolic click No radiation or may radiate to the axilla -
Tricuspid stenosis Low Diastolic Left fourth or fifth intercostal spaces - Opening snap No radiation - - -
Tricuspid regurgitation Low Systolic Left lower sternal border Holosystolic - No radiation - - - -

(Carvallo's sign)

Pulmonary stenosis High Systolic Left second intercostal spaces Crescendo-Decrescendo Wide split S2 Slight radiation to the neck - - -
Pulmonary regurgitation High Diastolic Left second and third intercostal spaces Decrescendo Blowing sound No radiation - - - -

(Carvallo's sign)

References



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