This document discusses different types of valvular heart disease. It begins by explaining that valvular heart disease is characterized by damage or defects to the heart's valves, which normally ensure proper blood flow. Stenotic valves become narrowed and prevent full opening, while incompetent valves do not close completely and allow blood to leak back. Over time, the heart compensates by enlarging and thickening, losing efficiency. The document then examines specific valve diseases in more detail, outlining their causes, effects on heart function, symptoms, diagnostic tests, and treatment options. Diseases covered include mitral stenosis, mitral regurgitation, aortic stenosis, aortic regurgitation, tricuspid regurgitation

2. Heart
Valves

4. Valvular heart disease is characterized by damage to or a
defect in one of the four heart valves: the mitral, aortic,
tricuspid or pulmonary.
Normally functioning valves ensure that blood flows with
proper force in the proper direction at the proper time. In
valvular heart disease, the valves become too narrow and
hardened (stenotic) to open fully, or are unable to close
completely (incompetent).
A stenotic valve forces blood to back up in the adjacent
heart chamber, while an incompetent valve allows blood to
leak back into the chamber it previously exited.
To compensate for poor pumping action, the heart muscle
enlarges and thickens, thereby losing elasticity and
efficiency. In addition, in some cases, blood pooling in the
chambers of the heart has a greater tendency to clot,
increasing the risk of stroke or pulmonary embolism.

5.  the valve opening narrows
 the valve leaflets may become fused or thickened that the
valve cannot open freely  obstructs the normal flow of blood
EFFECTS: the chamber behind the stenotic valve is subject to
greater stress  must generate more pressure or work
hard to force blood through the narrowed opening
 initially, the compensates for the additional workload by
gradual hypertrophy and dilation of the myocardium  heart failure

6.  scarring and retraction of valve leaflets or weakening of
supporting structures  incomplete closure of the valve
 result to leakage or backflow of blood from the previous
chamber
EFFECTS: causes the to pump the same blood twice (as the
blood comes back into the chamber)
 the dilates to accommodate more blood (the usual blood
it needs to pump + regurgitated blood)

7.  Congenital heart disease
 Rheumatic heart disease
 Heart attack – damage to the heart muscle, papillary muscles
High blood pressure and atherosclerosis may damage the aortic
valve.
 Weakening of supporting structures of the heart
 Weakening of the heart muscle
 Infections – bacterial endocarditis
Methysergide, a medication used to treat migraine headaches,
and some diet drugs may promote valvular heart disease.
Radiation therapy (used to treat cancer) may be associated

8.  most common valvular disorder
in rheumatic fever
 may also be caused by bacterial
infection, thrombus formation,
Rarely, other factors can cause
mitral stenosis in adults. These
include:
Calcium deposits forming around
the mitral valve
Radiation treatment to the chest

10. Narrowing of mitral valve
 CO
O2/CO2 exchange
(fatigue, dyspnea,
orthopnea)
Left ventricular
atrophy
pulmonary
congestion
 pulmonary
pressure
 left atrial
pressure
Hypertrophy
left atrium
 blood flow to
left ventricle
Right-sided
failure
Fatigue

11.  exertional dyspnea and fatigue (most common)
 orthopnea, paroxysmal nocturnal dyspnea, cough,
hemoptysis
 cyanosis
 Right-sided heart failure – distended neck veins,
peripheral edema, hepatomegaly, abdominal discomfort


12. Exams and Tests
Narrowing or blockage of the valve or swelling of the upper heart chambers may
be seen on:
Auscultation: S1 followed by murmur (apex)
 CXR- left atrial enlargement
 ECG – atrial fibrillation may develop (50-80% of pts.)
- pulses becomes irregular & faint,  BP
 Echocardiogram (2D Echo) – most sensitive in diagnosis
Chest x-ray
CT scan of the heart
MRI of the heart

13.  Na+ restriction, diuretics – to relieve pulmonary congestion
 bed rest, sitting position
 Digitalis – improve cardiac contraction,  HR,
Anticoagulants (blood thinners) – coumadin, aspirin,
ticlopidine (Ticlid), Plavix, dipyridamole
Nitrates, beta-blockers
Calcium channel blockers
ACE inhibitors
Angiotensin receptor blockers (ARBs)
 Surgical interventions:
 Mitral commissurotomy – separation or incision of the stenosed valve
leaflets at their borders or commissures
 Balloon mitral valvuloplasty
 Mitral valve replacement – when stenosis is severe

14. Balloon
mitral
valvuloplas
ty

15.  incomplete closure of the mitral valve
 rheumatic disease is the predominant cause
 may also be due to congenital anomaly, infective endocarditis,
rupture of papillary muscle following MI

16.  a leaking mitral valve -  Stroke volume,  CO
- Left atrial hypertrophy
- Pulmonary congestion

18. Incomplete closure of
mitral valve
 vol. of blood ejected by
left ventricle
 Left atrial pressure
Right-sided heart failure
Left atrial hypertrophy CO
 Pulmonary pressure
Backflow of blood to the
left atrium
 Right ventricular
pressure

19.  Fatigue & weakness – due to  CO – predominant complaint
 exertional dyspnea & cough – pulmonary congestion
 palpitations – due to atrial fibrillation (occur in 75% of pts.)
 Right-sided heart failure – distended neck veins, edema,
ascites, hepatomegaly
 Auscultation: blowing, high-pitched systolic murmur (apex)
- S1 is diminished
- S3 –severe regurgitation

20.  restrict physical activity – to prevent fatigue & dyspnea
  Na+ intake, diuretics – relieve congestion
 Digitalis, vasodilators – promote adequate ventricular
emptying and prevent or decrease regurgitation
 ACE inhibitors – arterial dilation,  afterload
 Surgery:
- Valvuloplasty (repair or reconstruction)
- Valve replacement

21. Mitral Valve Prolapse

22.  when 1 or both of the valve leaflets bulge into the left
atrium during ventricular contraction
 more common in women
 Cause: due to an inherited connective tissue disorder 
enlargement of one or both valve leaflets
 Elongates/stretches the chordae tendinae & papillary
muscles  regurgitation may occur
 usually asymptomatic
 Extra heart sound (Mitral click) – an early sign that a valve
leaflet is ballooning into the left atrium
 fatigue, shortness of breath
 arrhythmias may develop – dizziness, chest pain, dyspnea,
palpitations, syncope
 high-pitched late systolic murmur

23. Interventions:
 antibiotic prophylaxis to prevent endocarditis
 If w/ dysrhythmia – avoid caffeine, alcohol, stop
smoking
 anti-arrhythmic drugs
 for chest pain – nitrates, calcium channel blockers,
beta blockers

24.  may be due to rheumatic heart disease, atherosclerosis,
congenital valvular disease or malformations
 narrowing of the aortic valve
  flow of blood from the left ventricle to the aorta
  blood volume and pressure in the left ventricle
Left ventricle hypertrophy develops as a
compensatory mechanism to continue pumping blood
through the narrowed opening

25. Aortic Stenosis

26. Aortic
Stenosis

27. Stiffening/Narrowing of
Aortic Valve
Incomplete emptying of
left atrium
Left ventricular hypertrophy
Pulmonary congestion
Compression of
coronary arteries
Right-sided heart failure
 CO
 Myocardial
O2 needs
Myocardial ischemia
(chest pain)
 O2 supply

28.  fatigue & exertional dyspnea – 1st
symptoms – due to  CO
and pulmonary congestion
 chest pain (angina) – most common symptom
- occurs during exercise – due to inability of the heart to
increase coronary blood flow to cardiac muscle
 exertional syncope, vertigo, periods of confusion --  CO
 weakness, orthopnea, PND, pulmonary edema (severe cases)
 signs of right-sided heart failure –- end-stage symptoms
- if untreated, survival rate: 1.5-3 years
 Auscultation: harsh, rough, mid-systolic murmur

29.  restrict activity
 digitalis
 Na+ restriction, diuretics
 Nitroglycerin – for chest pain
 Surgical:
 Balloon aortic valvuloplasty
 Aortic valve replacement – if not done –- poor prognosis

30.  may be due to
rheumatic fever –
most common cause
 other causes:
connective tissue
disease , severe
hypertension,
congenital anomaly

32. Incomplete closure of the
aortic valve
Backflow of blood to Left
ventricle
Left ventricular
hypertrophy & dilation
 Left atrial pressure
Left-sided heart failure
(late stage)
Left atrium hypertrophy
 CO
 Pulmonary pressure
Right-sided heart failure
 Right ventricular
pressure

33.  pt. may remain asymptomatic for years --- heart
compensates by hypertrophy & dilation
 1st s/sx- heightened awareness of the heart beat &
palpitations esp. when pt. lies on left lateral position
 tachycardia, PVC  assoc. w/ left ventricular dilation
 bounding pulse, marked carotid artery pulsation,  apical
pulse   force and volume of contraction of the
hypertrophied left ventricle
 Decompensation occurs (cardiac muscle fatigue)
 exertional dyspnea
 chest pain – myocardial ischemia
 left-heart failure – fatigue, orthopnea, PND
 right-heart failure – peripheral edema
 Auscultation: soft, blowing diastolic murmur

34.  antibiotic prophylaxis before any invasive or dental
procedures
 avoid physical exertion, competitive sports
 vasodilators, calcium channel blockers, ACE inhibitors
Aortic valvuloplasty or valve replacement

35.  usually occurs together w/ aortic or mitral stenosis
 may be due to rheumatic heart disease
  blood flow from right atrium to right ventricle
  right ventricular output
  left ventricular filling   CO
 blood accumulates in systemic circulation
  systemic pressure
 S/Sx: symptoms of right-sided heart failure
- hepatomegaly
- peripheral edema
- neck vein engorgement
-  CO – fatigue, hypotension

36.  uncommon, may be caused by RF, bacterial endocarditis
 may also be caused by enlargement of right ventricle
 an insufficient tricuspid valve allows blood to flow back
into the right atrium  venous congestion &  right
ventricular output   blood flow towards the lungs

37.  may not produce any symptoms
 moderate-to-severe tricuspid regurgitation exist, the ff.
may result:
 Active pulsing in the neck veins
 Swelling of the abdomen
 Swelling of the feet and ankles
 Fatigue, tiredness
 Weakness
 Decreased urine output
 on palpation, there may be a lift (beating of enlarged right
ventricle)
 murmur on auscultation

38.  rare, usually congenital in origin
  flow of blood to the pulmonary artery due to narrowing

blood flows back to right ventricle and right atrium

right ventricle hypertrophy to compensate for
 blood volume and force blood to the pulmonary artery
S/Sx:
 harsh systolic murmur
 fatigue, dyspnea on exertion, cyanosis
 poor weight gain or failure to thrive in infants
 hepatomegaly, ascites, edema

39.  a rare condition caused by infective endocarditis,
tumors or RF
 blood flows back into Right ventricle  Right ventricle
and atrium hypertrphy  symptoms of Right-sided
heart failure

40.  Valvuloplasty is repair of cardiac valve
• pt. does not require continuous anti-coagulant medication
• usually require cardiopulmonary bypass machine
1.Commissurotomy – to separate the fused leaflets
 Balloon Valvuloplasty – performed in the cardiac cath. lab.
- balloon inflated for 10-30 secs., w/ multiple
inflations
- common used for mitral and aortic stenosis
 Closed surgical valvuloplasty – done in the under GA
- midsternal incision, a small hole is cut into the
heart,
the surgeons finger or a dilator is used to open the
commissure
 Open Commissurotomy – done w/ direct visualization of
the valve, thrombus and calcifications may be identified
and removed

41. 2. Annuloplasty is repair of valve annulus (junction of the valve leaflets
and the muscular heart wall)
- narrows the diameter of the valve’s orifice, useful for
valvular regurgitation
3. Chordoplasty is repair of chordae tendineae
- done for mitral valve regurgitation – caused by stretched,
torn or shortened chordae tendineae

44.  Mechanical valves – Ex. Caged ball valve, Tilting-disk valve
- more durable, used for younger pts.
- risk of thromboembolism – long-term use of anti-coagulants
 Tissue or biological valves:
- xenografts – porcine or bovine heterografts (7-10 yrs
viability)
- homografts – from cadaver tissue donations (10-15 yrs)
- autografts – excising the pts.’s own pulmonic valve and
portion of pulmonary artery for use as the artic valve
 Long-term anticoagulant therapy
 Antibiotic prophylaxis

51. 1. Valvular heart disease includes:-
a.Stenosis of valve
b.Prolapse of valve
c.Protusion of valve
d.All of the above
2. A mitral stenosis means:-
a.Leakage of blood in atrium
b.Narrowing of valve
c.Abnormal closing of valve
d.Mitral septal defect

52. 3. Causes of Valvular Disorders include all except:-
a.Rheumatic heart disease
b.High blood pressure I
c.infections to endocardium
d.Arthritis
4. Mitral stenosis leads to :-
a.Increase cardiac output
b.Pulmonary hypertension
c.Increase blood sugar level
d.Abdominal pain
5. Surgical interventions performed for mitral stenosis all exept :-:
a. Mitral commissurotomy –
b. Balloon mitral valvuloplasty
c. Mitral valve replacement
d. craniotomy