Pathophysiology of Valvular Heart Disease

For the pathophysiology of valvular heart disease, we have its modifiable and
non-modifiable risk factors. Under modifiable risk factors; first is the metabolic risk
factors, such as high blood sugar, high blood pressure, high levels of triglycerides, low
level of HDL (good) cholesterol, and obesity. These factors can raise your risk of heart
disease, including certain heart valve conditions.

Next, is certain health conditions that can cause problems with your heart valves
including, ineffective endocarditis, or inflammation in your heart caused by infection,
rheumatic fever, which can develop from untreated strep throat (which is a bacterial
infection that can make your throat feel sore and scratchy), or scarlet fever, (a bacterial
illness that develops in some people who have strep throat), and injury to the heart.
Also you are more likely to develop a heart valve condition if you have a history of
other heart conditions, chronic kidney disease, diabetes, autoimmune conditions, such
as lupus, Marfan syndrome, carcinoid tumor, and elevated lipoprotein(a).

Next is certain medical treatments including pacemaker or internal defibrillator,

( which are used to regulate heartbeat that are too slow, too fast or irregular, however
there is also a chance the device will damage the heart valve. Then, a radiation therapy
on your chest, this can also raise your risk of a having a heart valve condition, as it can
cause heart valve to thicken or narrow.

And lastly for the modifiable risk factors, is the lifestyle habits, these habits
include: not eating a well-balanced diet, not getting enough exercise, smoking, and
heavy alcohol use, which can weaken the heart muscle, Additionally, poor skin or
dental hygiene may also raise your risk of having heart valve condition by increasing
your risk of infections.

Let’s move on to the non-modifiable risk factors, including older age, or greater
than or equal to 60 years old. Many heart valve conditions are more common with
older adults. As you age, your heart valves may degenerate or deteriorate. In some
cases, calcium deposits may accumulate on your valves. This can stop your valves
from working properly.

And lastly, the family history. Some heart valve conditions run in families. You’re
more likely to have one of those conditions if another member of your family has it too.
You can also include congenital defects or conditions present at birth, which are caused
by inheritable genetic mutations that may pass from parents to children or
malformation of the heart in utero.
 For the continuation, heart valves play a vital role in the function of the heart. Its
function is to promote coordinated forward blood flow during the cardiac cycle.
Cardiac cycle events can be divided into systole and diastole.

Due to modifiable and non-modifiable risk factors associated during systole

process, the flaps of the heart valve may thickened, stiffen, or fused together, resulting
to valve cannot fully open. When the valve doesn’t fully open, blood has to flow
through a smaller opening. So the heart muscle has to work harder to push the blood
through the valve.

As valve gets narrow, blood flow or pumping of the blood to the rest of the body
decreases or may be blocked. And if this condition happens that the leaflets or cusps of
your valve that have thickened or scarred and doesn’t open all the way, valvular
stenosis occurs. If not addressed, this form of heart valve disease may lead to heart
failure.

Then, during diastole process, due also to the given risks factors, there is a
presence of build up sediments inside of the valve, which causes the heart to work
harder to pump enough blood to the body.

The extra effort causes the heart’s chamber or the ventricle to get bigger, thus
making the valve’s leaflets or cusps to not close properly, leaving a gap, and lets the
blood flow back through the valve. As this condition happens, valvular regurgitation
occurs. If left untreated, the heart muscle becomes weak, thus can cause heart failure.

Let’s continue it with the symptoms leading to right-sided heart failure which are
the backward heart failure (where we talk about back up of blood that’s trying to get
into the heart) and forward heart failure (which means right side’s ability to pump
blood out of the heart to the lungs)

Backward heart failure, this causes aortic stenosis to limits the forward flow of the
blood from the left ventricle, and the aortic regurgitation permits blood flow back into
the left ventricle from the aorta. And on the other hand mitral stenosis limits forward
flow of blood into the left ventricle, and mitral regurgitation permits blood flow back
into the left atrium from the left ventricle.

The aortic stenosis and regurgitation, and mitral stenosis and regurgitation results
to not enough blood flows through the aorta to meet the body’s needs or a decreased
cardiac output, manifesting the signs and symptoms such as angina pectoris (which is a
type of chest pain caused by reduced blood flow to the heart), postural hypotension
(this is when the blood pressure drops when you go from lying down to sitting up, or
from sitting to standing), fatigue, and dizziness. This under the forward heart failure.
 And also the aortic stenosi and regurgitation leads to increased in blood volume
and pressure in the left ventricle. Causing left ventricular hypertrophy (which is a
thickening of the wall of the heart’s main pumping chamber) and dilation (the heart’s
main pumping chamber is enlarged). Thus, blood from the left atrium cannot get into
the left ventricle.

If blood from the left atrium cannot get into the left ventricle, and mitral stenosis
or regurgitation occurs, this will leads to increased blood volume in the left atrium.
Causing left atrium hypertrophy ( or heart’s upper chambers is handling high pressure
and too much blood), and eventually gets dilated or become bigger than normal. this
will lead to increased in blood volume and pressure in the pulmonary veins.

That can end up to pulmonary congestion (that will lead to a person to have
shortness of breath and pulmonary edema), and also increased pulmonary vascular
pressure. This increases the work for the right ventricle (that receives deoxygenated
blood from the right atrium and pumps it under low pressure into the lungs via the
pulmonary artery.) thus resulting to right ventricular strain (where the heart muscle of
the right ventricle is deformed ). That ends up with the right ventricular failure, ( due to
the failure the right ventricle is too weak to pump enough blood to the lungs.

And this will lead to signs and symptoms: Such as whooshing sound or heart
murmur when the doctor is listening to the heart with a stethoscope, abdominal
swelling (more common with advanced triscupid regurgitation), swelling of your
ankles and feet, shortness of breath, chest pain, fatigue, dizziness or fainting, fever,
rapid weight gain, and irregular heartbeat. After the signs and symptoms it will lead to
valvular heart disease, and it will lead to many possible complications including: heart
failure, stoke, and blood clots.