Valvular Diseases Basics

with Georgios Alexandros Lazaridis

Template created using Canva

Contents

Heart Anatomy and Physiology

Pulmonary Valves Diseases

Mitral Valve Diseases Aortic Valve Diseases

Tricuspid Valve Diseases

Heart Anatomy and Physiology

The heart is a muscular organ that acts like a pump to con2nuously send blood throughout the human body body.

The four main func2ons of the heart are:

• Pumping oxygenated blood to the other body parts.• Pumping hormones and other vital substances to different parts of the body.• Receiving deoxygenated blood and carrying metabolic waste products from the body and

pumping it to the lungs for oxygena2on.• Maintaining blood pressure

Cardiac Chambers and ValvesThe heart has two “sides.” Each side of the heart has two chambers, for a total of four chambers, more specifically, 2 atrias and 2 ventricles.

The chambers of the heart are interconnected through the heart valves: • The tricuspid valve connects the

right atria to the right ventricle• The pulmonary valve connects

the right ventricle to the pulmonary artery

• The mitral valve connects the left atrium to the left ventricle

• The aortic valve connects the left ventricle to the aorta

Cardiac CycleCardiac events that occur at the beginning of each heartbeat until the beginning of the next are called the cardiac cycle.

The cardiac cycle begins with atrial systole

Atrial systole is followed by the delayed contraction of the more powerful lower chambers, termed ventricular systole

Filling of the ventricles occurs during atrial contraction (diastole) when the AV valves (mitral and tricuspid) are open while ejection occurs during ventricular contraction (systole) when the semilunar valves (aortic and pulmonary) are open

Auscultation points

The aortic area: 2nd right intercostal space, adjacent to the sternum.

The pulmonary area: 2nd left intercostal space

The tricuspid area: 4th & 5th intercostal spaces, adjacent to the left sternal border

The mitral area at the cardiac apex: 5th left intercostal space, on themedioclavicular line.

Physiological sounds: S1 by closure of the AV valves and S2 by closure of the semilunar valves

All Patients Take Medicine

Mitral Valve Stenosis

OverviewStenosis occurs when the valve opening becomes narrow during diastole. This means that not enough blood can pass into the left ventricle .

Typically caused by scarring from rheumatic fever. Usually a childhood disease, rheumatic fever results from the body’s immune response to a streptococcal bacterial infection. Rheumatic fever is a serious complication of strep throat or scarlet fever.

Various parts of the heart can become inflamed and lead to these potentially serious heart conditions, including:

endocarditis: inflammation of the lining of the heartmyocarditis: inflammation of the heart musclepericarditis: inflammation of the membrane surrounding the heart

Pathophysiology

The obstruction leads to elevated blood pressure in the left atrium (pulmonary hypertension), which becomes even more elevated in increased HR.

RVH and systemic venous obstructionare also encountered

Signs and Symptoms• Shortness of breath during activity or when the patient lies down• Severe tiredness• Swollen feet or ankles• Fast heartbeat• Coughing up bloody mucus• Dizziness or fainting• Headache and stroke symptoms

Diagnosis• Blood tests may show an infection or other cause of mitral stenosis• Echocardiograms can show how blood flows through the heart and they may also show how well the heart is pumping• Chest x-rays shows the size of the heart and may also show if fluid is around the heart and lungs.• ECGs• Stress tests• Cardiac catheterization

Mitral Valve Prolapse and Regurgitation

Overview

Mitral valve prolapse occurs when the flaps (leaflets) of the heart's mitral valve bulge (prolapse) like a parachute into the heart's left upper chamber (left atrium) as the heart contracts.

Mitral valve prolapse sometimes leads to blood leaking backward into the left atrium, a condition called mitral valve regurgitation, occuring during cardiac systole

Pathophysiology

Both the volume and the pressure of the LA increase (pulmonary hypertension)

The LV becomes dilated, which may lead to reversible or irreversible LV dysfunctionInsert content here

RV failure by evolution of pulmonary hypertension is also encountered

Signs and SymptomsSymptoms can vary from person to person are usually mild with an evolution over time, while many people that have this condition remaining asymptomatic.

• Chest pain (most frequent); does not increase the risk of heart attack, death, or other heart problems.

• A racing or irregular heartbeat (arrhythmia)• Dizziness or lightheadedness• Difficulty breathing or shortness of breath, often during physical activity or when lying flat• Fatigue• Systolic murmur and S3 gallop

Risk Factors• Marfan syndrome• Ehlers-Danlos syndrome• Ebstein anomaly• Muscular dystrophy• Graves' disease• ScoliosisSymptoms tend to occur in men over 50 years old

Diagnosis• Auscultation• Echocardiogram• Cardiac Magnetic Resonance Imaging (CMR), also known as cardiac

MRI• Chest X-ray• ECGs• Stress tests• Coronary angiograms

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Aortic Valve Stenosis

Title of Topic Area

Overview�

Aortic valve stenosis — or aortic stenosis — occurs when the heart's aortic valve narrows; the valve doesn't open fully, which reduces or blocks blood flow from the heart into the main artery to the body (aorta) and to the rest of your body.

This can be caused by a congenital abnormality of the valve and thus may be detected in childhood or young adulthood.

Aortic stenosis can also be acquired, caused by progressive calcium and scar tissue buildup on an abnormal congenital valve or from the damage of an episode of rheumatic fever, both of which become apparent in middle age.

The most common cause of aortic stenosis today is a buildup of calcium on the valve cusps that occurs with age (senile degenerative stenosis).

Pathophysiology

Elevated LV pressure and wall stress

LV hypertrophy and as a consequence LV dysfunction may occur

Signs and SymptomsMany pa2ents with aor2c stenosis will not have any symptoms, and the diagnosis is made on the basis of a heart murmur heard on examina2on

• Shortness of breath (dyspnea)• Chest pain (angina)• Dizziness (near-syncope)• Swollen ankles• FaGgue• Rapid pulse• Sudden death may occur if the stenosis is severe

Risk Factors

• Older age• Certain heart condi2ons present at birth (congenital heart disease) such as a bicuspid aorGc valve• History of infecGons that can affect the heart• Having cardiovascular risk factors, such as diabetes, high cholesterol and high blood pressure• Chronic kidney disease• History of radiaGon therapy to the chest

Complications

• Heart failure• Stroke• Blood clots• Bleeding• Heart rhythm problems (arrhythmias)• Infections that affect the heart, such as endocarditis• Death

Diagnosis

• Electrocardiogram• Echocardiogram• Chest X-ray• Cardiac catheterizaGon• Cardiac magneGc resonance imaging test• Exercise stress test

Aortic Valve Regurgitation

Title of Topic Area

Overview

AorGc regurgitaGon (AR, also termed aor2c insufficiency) results in diastolic blood flow from the aorta back into the leS ventricle and may be caused by a variety of acquired or congenital e2ologies preven2ng complete coapta2on of the aor2c valve leaflets

Aor2c regurgita2on can be acute or chronic, occuring mostly by rheumaGc fever, ankylosing spondyli2s, congenital heart defect, endocardi2s and aorGc valve stenosis

Aortic regurgitation can be acute or chronic.

ortic regurgitation can be acute or chronic.

Pathophysiology

Pulmonary congestion occurs, with increased pressure in the left atrium and ventricle

The left ventricle can become dilated and hypertrophied, followed by LV dysfunction

Signs and Symptoms

• Shortness of breath with exercise or when you lie down• FaGgue and weakness, especially when you increase your ac2vity level• Heart murmur• Irregular pulse (arrhythmia)• Lightheadedness or fain2ng• Chest pain (angina), discomfort or 2ghtness, oSen increasing during exercise• Sensa2ons of a rapid, fluVering heartbeat (palpitaGons)• Swollen ankles and feet

Risk Factors

• Older age• Certain heart condi2ons present at birth (congenital heart disease)• History of infecGons that can affect the heart• Certain condi2ons that can affect the heart, such as Marfan syndrome• Other heart valve condi2ons, such as aorGc valve stenosis• High blood pressure

Complications

• FainGng or feeling lightheaded• Heart failure• Infec2ons that affect the heart, such as endocardi2s• Heart rhythm problems (arrhythmias)• Death

Diagnosis

• Auscultation• Echocardiography:Transthoracic echocardiography (TTE) and in case of suboptimal acoustic

windows Transoesophageal echocardiography (TEE)• Cardiac magnetic resonance (CMR)• Chest X-ray• Cardiac catheterization

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Tricuspid Valve Stenosis

Title of Topic Area

Overview

Tricuspid stenosis is a narrowing of the tricuspid valve opening (rare condi2on). Tricuspid stenosis restricts blood flow between the upper (atrium) and lower (ventricle) part of the right side of the heart.

The most common cause of tricuspid valve stenosis is rheumaGc fever, which develops from untreated strep throat.

Although it is rare, tricuspid valve stenosis can also occur during fetal development as a congenital heart defect, from a tumor or from connec2ve 2ssue disorder.

Pathophysiology

Blood volume and pressure are increased in the right atrium

Signs and Symptoms

• Discomfort in the neck• Irregular heart beat• Cold skin• FaGgue• Shortness of breath with ac2vity• Enlarged liver

Diagnosis

• Echocardiogram — the most common test used to confirm and access the diagnosis of tricuspid stenosis.

• Electrocardiogram — can detect heart rhythm abnormalities, which are a sign of tricuspid valve stenosis.

• Chest x-ray — will take pictures of the heart to determine if there are heart abnormalities.

Tricuspid Valve Regurgitation

Title of Topic Area

OverviewTricuspid valve regurgitation is a condition in which the valve between the two right heart chambers (right ventricle and right atrium) doesn't close properly. The malfunctioning valve allows blood to flow back into the heart's upper right chamber (right atrium).

Tricuspid valve regurgitation can be the result of a congenital heart disease, or it can occur due to valve abnormalities caused by other conditions.

Etiologies include rheumatic fever, infective endocarditis and association with mitral valve disease

Pathophysiology

Blood flows back into the right atrium, increasing volume and pressure

Signs and Symptoms

• Fatigue• Declining exercise capacity• Swelling in the abdomen, legs or veins in your neck• Abnormal heart rhythms• Pulsing in the neck• Shortness of breath with activity

Diagnosis• Echocardiogram• Cardiac MRI• Electrocardiogram (ECG)• Chest X-ray• Exercise tests or stress tests• Cardiac catheterization

Risk Factors• Infections such as infective endocarditis or rheumatic fever• A heart attack.• Heart failure• Pulmonary hypertension. • Heart disease. • Congenital heart disease. • Use of certain medications: fenfluramine (no longer sold on the market) or some

medications for Parkinson's disease, such as pergolide (no longer sold in the United States) or cabergoline, or certain migraine medications (ergot alkaloids)

• Radiation. Chest radiation may damage the tricuspid valve and cause tricuspid valve regurgitation.

Complications• Heart failure: in severe tricuspid valve regurgitation, pressure can rise in the right

ventricle due to blood flowing backward into the right atrium and less blood flowing forward through the right ventricle and into the lungs. The right ventricle can expand and weaken over time, leading to heart failure.

• Atrial fibrillation: some people with severe tricuspid valve regurgitation also may have a common heart rhythm disorder called atrial fibrillation.

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Pulmonary Valve Stenosis

Title of Topic Area

OverviewPulmonary valve stenosis is a narrowing of the valve located between the lower right heart chamber (right ventricle) and the lung arteries (pulmonary arteries). In a narrowed heart valve, the valve flaps (cusps) may become thick or stiff. This reduces blood flow through the valve

Usually, pulmonary valve disease results from a heart problem that develops before birth (congenital heart defect). However, adults may develop pulmonary valve stenosis as a complication of another illness.

Elevated pressure and volume in the right ventricle

Pathophysiology

Signs and Symptoms

• A whooshing sound (murmur) that can be heard with a stethoscope• Fatigue• Shortness of breath, especially during activity• Chest pain• Loss of consciousness (fainting)

Risk Factors• German measles (rubella). • Noonan syndrome.• Rheumatic fever. • Carcinoid syndrome

Complications• Infection of the lining of the heart (infective endocarditis)• Irregular heartbeat (arrhythmia) • Thickening of the heart muscle• Heart failure• Pregnancy complications

Diagnosis• Electrocardiogram (ECG or EKG). • Echocardiogram.• Cardiac catheterization..• Other imaging tests: magnetic resonance imaging (MRI) and computed tomography (CT)

scans are sometimes used to confirm the diagnosis of pulmonary valve stenosis.

Pulmonary Valve

RegurgitationTitle of Topic

Area

OverviewPulmonary regurgitation is a condition where the pulmonary valve, which regulates blood flow from the right side of the heart to the lungs, doesn't close properly and a portion of it leaks back to the right side of the heart.

It is most usually caused by congenital heart defect

Elevated pressure and volume in the right ventricle

Pathophysiology

Signs and Symptoms

• Difficulty breathing and fatigue, especially during exercise• Chest pain, such as squeezing, pressure or tightness• Sensation of rapid or irregular heartbeat (palpitations)• Swelling of the legs or feet• Dizziness or fainting• Bluish discoloration of the nails and lips (cyanosis)

Diagnosis• Chest X-ray• Echocardiogram• Cardiac catheterization• Holter monitor

Summary1 2

Lesson Recap 1Valvulopathies are

conditions affecting the flow of blood from the atria to the ventricles

and from the ventricles to the arteries

Lesson Recap 2The diseases are most

usually either the result of congenital heart defect or

the complication of rheumatic fever

Lesson Recap 3Most conditions have

similar signs and symptoms, imagistic

methods are necessary for diagnosis

1 2 3

Additional Resources

Guyton and Hall: Medical

Physiologymayoclinic.orgBates’ Guide

to Clinical examination

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