Valvular Heart Disease

About Valvular Heart Disease

Valvular heart disease encompasses disorders affecting the heart's four valves (aortic, mitral, tricuspid, and pulmonary), which can involve stenosis (narrowing) or regurgitation (leakage). These conditions can be congenital or acquired through processes like rheumatic disease, degenerative changes, or endocarditis. The disease significantly impacts cardiac hemodynamics and can lead to heart failure if left untreated.

Pathophysiology

Valve dysfunction creates abnormal pressure and volume loads on cardiac chambers, triggering compensatory mechanisms including ventricular hypertrophy and chamber dilation. Stenotic valves increase afterload and cause pressure overload upstream, while regurgitant valves create volume overload through backward flow of blood. Over time, these compensatory mechanisms become maladaptive, leading to decreased cardiac output and eventual heart failure.

Clinical Reasoning

Clinical presentation varies by valve affected and severity, ranging from asymptomatic murmurs to severe heart failure symptoms including dyspnea, chest pain, and syncope. Diagnostic workup includes echocardiography to assess valve morphology and function, with severity graded by pressure gradients and regurgitant volumes. Treatment decisions depend on symptom severity, valve dysfunction degree, and ventricular function, ranging from medical management to surgical valve repair or replacement.