Valvular Heart Disease
Basics
Description
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
Etiology
- Mitral stenosis:
- Rheumatic fever
- Cardiac tumors
- Rheumatologic disorders (lupus, rheumatoid arthritis)
- Myxoma
- Congenital defects: Parachute valve
- 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)
- 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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Citation
Schaider, Jeffrey J., et al., editors. "Valvular Heart Disease." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307093/2.3/Valvular_Heart_Disease.
Valvular Heart Disease. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307093/2.3/Valvular_Heart_Disease. Accessed December 1, 2024.
Valvular Heart Disease. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307093/2.3/Valvular_Heart_Disease
Valvular Heart Disease [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 01]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307093/2.3/Valvular_Heart_Disease.
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