Valvular heart disease

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Tarek Nafee, M.D. [2]

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

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 triscuspid 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 valves, among others. Acquired causes of VHD include rheumatic heart disease, infective endocarditis, senile calcification of valves,

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:

• Aortic Valve
  • Aortic stenosis
  • Aortic regurgitation
• Mitral Valve
  • Mitral stenosis
  • Mitral regurgitation
  • Mitral valve prolapse
• Tricuspid valve
  • Tricuspid stenosis
  • Tricuspid regurgitation
• Pulmonary valve
  • Pulmonic stenosis
  • Pulmonic regurgitation

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 Sounds
		Low/High Pitch	Systolic/Diastolic Murmur	Best Heard Location	Other Features	Valsalva Maneuver	Abrupt Standing	Hand Grip	Squatting	Inhalation
Aortic stenosis	Senile calcification Calcification of bicuspid valve Other causes		Systolic	Right second intercostal space
Aortic regurgitation	Calcification of bicuspid valve Senile calcification Rheumatic heart disease Iatrogenic (after valvuloplasty) Other causes	High	Diastolic	Right second intercostal space						decreases
Mitral stenosis	Infective endocarditis Rheumatic heart disease Mitral annular calcification Other causes	Low (rumbling)	Diastolic	Left ventricular apex	Opening snap
Mitral regurgitation	Infective endocarditis Ischemic heart disease Papillary muscle rupture Dilated cardiomyopathy Other causes		Pansystolic	Left ventricular apex
Mitral valve prolapse	Marfan's syndrome Myxomatous degeneration of the valve Papillary muscle injury Other causes		Late Systolic		Mid-systolic click
Tricuspid stenosis	Carcinoid heart disease Cardiac tumors Other causes	Low	Diastolic	Left fourth or fifth intercostal spaces	Opening snap					increases
Tricuspid regurgitation	Pulmonary hypertension Right ventricular failure Iatrogenic Carcinoid heart disease Other causes	Low	Pansystolic	Mid Sternal Border
Pulmonary stenosis	Congenital Rubella Syndrome Tetralogy of Fallot Carcinoid heart disease Other causes		Systolic	Left second intercostal space	Wide split S2
Pulmonary regurgitation	Carcinoid heart disease Pulmonary hypertension Rheumatic heart disease Iatrogenic (Tetralogy of Fallot repair) Other causes	High (blowing)	Diastolic	Left second and third intercostal spaces	Decrescendo configuration					increases