Valvular Heart Disease

Basics

Description

  • Mitral stenosis:
    • Obstruction of diastolic blood flow into the left ventricle (LV)
  • Mitral regurgitation:
    • Inadequate closure of the leaflets allows retrograde blood flow into the left atrium (LA)
    • Acute: Pressure overload in LA and pulmonary veins causing acute pulmonary edema
    • Chronic: LV volume overload with dilatation and hypertrophy with LA enlargement
  • Aortic stenosis:
    • Obstruction of LV outflow with increased systolic gradient
    • Progressive increase in LV systolic pressure and concentric hypertrophy
  • Aortic regurgitation:
    • Acute LV pressure and volume overload leading to left-heart failure and pulmonary edema
    • Chronic volume overload with LV dilation and hypertrophy

Pregnancy Considerations

Pregnancy is associated with significant hemodynamic changes that can aggravate valvular heart disease and increase the risk of thromboembolic events

Geriatric Considerations

  • Degenerative valvular disease is most common (aortic stenosis and mitral regurgitation)
  • Aortic valve replacement is the most common surgical procedure

Etiology

  • Mitral stenosis:
    • Rheumatic fever
    • Cardiac tumors
    • Rheumatologic disorders (lupus, rheumatoid arthritis)
    • Myxoma
    • Congenital defects: Parachute valve
    • Mitral annular calcification
  • Mitral regurgitation (acute):
    • Ruptured papillary muscle (infarction, trauma)
    • Papillary muscle dysfunction (ischemia)
    • Ruptured chordae tendineae (trauma, endocarditis, myxomatous)
    • Valve perforation (endocarditis)
    • Weight-loss medications (fenfluramine, dexfenfluramine)
    • Parkinson medications (carbegoline, pergolide)
  • Aortic stenosis:
    • Congenital aortic stenosis: Male > female (4:1)
    • Congenital bicuspid valve (1–2%)
    • Rheumatic aortic stenosis
    • Calcific aortic stenosis
  • Aortic regurgitation:
    • Infective endocarditis
    • Rupture of sinus of Valsalva
    • Acute aortic dissection
    • Chest trauma
    • Following valve surgery
    • Bicuspid aortic valve
    • Rheumatic fever
    • Weight-loss medications (fenfluramine, dexfenfluramine)
    • Collagen vascular or connective-tissue diseases
    • Systematic lupus erythematosus
    • Marfan syndrome
    • Pseudoxanthoma elasticum
    • Ankylosing spondylitis
    • Ehlers–Danlos syndrome
    • Polymyalgia rheumatica

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