Valvular Heart

Disease
BSN 3-B Group Green
 Valvular Heart Disease
Any of the heart’s valves are
damaged or diseased, it is
referred to as valvular heart
disease. This damage can
mean the valves fail to close
properly, causing blood to leak
back through them. Or it could
mean the valves narrow and
stiffen, decreasing blood flow
through the heart.
2 main types of Valvular Heart Disease
Stenosis (or narrowing of the valve)
Stenosis means that a heart valve opening is too small. When the valve(s)
opening becomes narrowed, it limits the flow of blood out of the ventricles
or atria. This can make it hard for blood to pass through the heart and force
the heart to work harder to pump the blood
Regurgitation (or leakage of the valve).
Regurgitation is sometimes known as backflow or insufficiency. When the valve(s) do
not close completely, it causes blood to flow backward through the valve. This
reduces forward blood flow and can lead to volume overload in the heart. It occurs
when a heart valve can’t close tightly, and some of the blood flows backward.

Heart valves can develop both regurgitation and stenosis at the same time. When
heart valves fail to open and close properly, the effects on the heart can be
serious, possibly hampering the heart's ability to pump enough blood through
the body. Heart valve problems are one cause of heart failure.
Anatomy and
Physiology
Anatomy and physiology
Your heart is a muscle that pumps blood
throughout your body. Heart valves are
parts of your heart that act like doors.
They open and close to let blood flow
from one area of your heart to another.
They help ensure that blood moves at
the right time and in the correct
direction.

Leaflets - In a healthy heart, the leaflets

open wide to allow blood to flow
through. Then, they come tightly
together to prevent backflow.
 The four valves of the heart:
Aortic valve - This valve has three leaflets. They open
to let blood flow from your heart’s left ventricles to the
aorta. The aorta is the largest blood vessel in your
body. It brings oxygenated blood from your heart to Aortic
valve
the rest of your body.

Mitral valve - This valve has two leaflets. They allow

blood to flow from the lungs into the left atrium. And
they prevent backward flow from the left ventricle to
the left atrium.
 The four valves of the heart:
Pulmonary valve (or pulmonic valve) - This valve also has
three leaflets. They allow blood to pump from the right
ventricle to the pulmonary artery. This artery leads to the
lungs, where the blood picks up oxygen. The pulmonary Pulmonary
Aortic
valve

valve prevents blood from going backward from the valve

pulmonary artery to the right ventricle.

Tricuspid
valve

Tricuspid valve - This valve has three leaflets. They allow

blood to flow from the right atrium to the right ventricle.
They also prevent blood from flowing backward from the
right ventricle to the right atrium.
 MITRAL VALVE STENOSIS

An obstruction of blood flowing from the left atrium

into the left ventricle. It is most often caused by
rheumatic endocarditis, which progressively thickens
the mitral valve leaflets and chordae tendineae. The
leaflets often fuse together. Eventually, the mitral
valve orifice narrows and progressively obstructs
blood flow into the ventricle.
 Modifiable Risk Factors Non-Modifiable Risk Factors
Rheumatic Heart Fever Radiation exposure Aging
Illegal drug use Congenital Heart Defect
Use of certain medicines (Ergot alkaloids) Rheumatic heart fever

Recurrent inflammation

Fibrous deposition and calcification of Fusion of the commissures

Opening snap Thickening and shortening
the mitral valve leaflets and chordae (junction between the valve
of the chordae tendineae
tendineae leaflets)

Intensity of S1 (in
Thickened and stiff leaflets
early stages)
Forceful opening of area of mitral valve orifice
valve
blood flow is opportunity for
Mild diastolic slowed crossing bacteria to attach to Infective
rumble (with pre Turbulent flow across thickened mitral
pressure gradient Obstructed blood flow across endothelium endocarditis
systolic valve in ventricular across the mitral valve the mitral valve leaflets
accentuation) diastole

Impaired
Plasma emptying of
Dyspnea transudate flows Pulmonary left atrium
into interstitium PV vasculature
and then alveoli resistance hydrostatic
Left paresternal = pulmonary pressure
lift edema Compression of
in left atrial Left atrial
enlargement
surrounding Esophagus Dysphagia
pressure structures
Recurrent
Right sided heart Hoarseness (rarely
Hypertrophy in right ventricular pressure Stretch of laryngeal
failure happens)
of right (NOTE: left ventricular atrial nerve
ventricle pressure is normal)
conduction
Cardiogenic fibers in atrial muscle conduction time
and of atrial muscle refractory Atrial
shock/death impaired filling of
stroke volume and cardiac period reentrant circuits fibrillation
output left ventricle
Congestive heart
failure
Loss of atrial kick

Legends Pathophysiology Mechanism Signs and Symptoms/Lab findings Complications

 MITRAL
REGURGITATION
A heart valve condition in which the flaps of
the mitral valve do not close properly,
causing a backward flow of blood back to
the heart. The flaps of the mitral valve (also
called valve leaflets or cusps) control the
flow of blood from the left atrium to the left
ventricle through the valve. If not closed
tightly enough or if the valve’s size and
shape are altered, blood may leak in the
wrong direction. This leak is also referred to
as mitral regurgitation (MR) or mitral valve
insufficiency.
 Modifiable Risk Factors
Non-Modifiable Risk Factors
High blood pressure
Age
Diabetes
Gender
Heart disease (CAD)
Family history
Obesity
Genetics
Smoking
Alcohol consumption
 AORTIC STENOSIS

A narrowing of the orifice between the left

ventricle and the aorta. In adults, the stenosis
may involve congenital leaflet malformations or
an abnormal number of leaflets (i.e. one or two
rather than three), or it may result from
rheumatic endocarditis or cusp calcification of
unknown cause. The leaflets of the aortic valve
may fuse
AORTIC STENOSIS
Modifiable Risk Factors
High blood pressure
Nonmodifiable Risk Factors
High cholesterol
Older age (>70 years old)
Smoking
Bicuspid aortic valve
Rheumatic Fever
Radiation Therapy
AORTIC REGURGITATION
It is caused by inflammatory lesions that
deform the flaps of the aortic valve, preventing
them from completely sealing the aortic orifice
during diastole and thus allowing backflow of
blood from the aorta into the left ventricle
 Diagnostic
Procedures
Transesophageal Exercise or stress
Echocardiogram test
(TEE)

Cardiac
Electrocardiogram
catheterization

Chest x-ray Cardiac MRI

 Treatment
and
Management
Pharmacologic
Management
1. ACE inhibitors and ARBs
2. Anti-arrhythmic
3. Anti-coagulant
4. Beta-blockers
5. Diuretics
6. Vasodilators
 Surgical Management
Valvuloplasty
Commissurotomy
Closed commissurotomy (balloon
valvuloplasty)
Open commissurotomy (annuloplasty,
leaflet repair, chordoplasty)
Valve replacement
Valve Prostheses (mechanical and biologic valves)