OVERVIEW OF HEART DISEASES

ANATOMY and
PHYSIOLOGY

Any disease on these valves is

called a valvular heart disease
 ANATOMY and PHYSIOLOGY
How Do the Heart Valves
Function?

MAINTAIN ONE-WAY BLOOD

FLOW THROUGH THE HEART

The four heart valves work in a

manner that blood always flows
freely in a forward direction and
that there is no backward
leakage.
 GLOBAL BURDEN OF VALVULAR HEART DISEASE
• Primary valvular heart disease ranks well below coronary heart disease,
stroke, hypertension, obesity, and diabetes as a major threat to the
public health.
• significant morbidity and premature death
• Rheumatic fever is the dominant cause of valvular heart disease in
developing and low-income countries.
• Prevalence and mortality rates vary among communities; and increases
significantly with age for both men and women
• Approximately 15–20 million people live with rheumatic heart disease
worldwide, an estimated prevalence characterized by 300,000 new cases
and 233,000 case fatalities per year, with the highest mortality rates
reported from Southeast Asia (~7.6 per 100,000).
• The global burden of rheumatic heart disease. This world map provides a snapshot of both the change in
prevalence of rheumatic heart disease cases between 1990 and 2013 (upper right legend) and the estimated
number of rheumatic heart disease cases per country (lower right legend). Regions in which the disease is
highly prevalent include sub-Saharan Africa, India, China, and Southeast Asia. (From JR Carapetis et al: Nat Rev
Dis Primers 2:15084, 2016.)
ETIOLOGY AND PATHOGENESIS

Valve doesn’t open all the way, not Valve doesn’t close all the way
enough blood passes through so blood leaks backwards
VALVULAR STENOSIS
• valve leaflets become stiffer,
narrowing the valve opening and
reducing the amount of blood that
can flow through it
• Moderate to severe stenosis can
reduce heart function, and the rest
of the body may not receive
adequate blood flow.
• A narrowed or stenotic valve
requires the heart to pump harder,
which can strain the heart and
reduce blood flow to the body.
VALVULAR REGURGITATION
• Insufficiency (incompetent or "leaky”
valve)
• the leaflets do not close completely,
letting blood leak backward across the
valve
• backward flow or “regurgitant flow”
• causes the heart muscle to work harder
to circulate the right amount of blood
through the body
ETIOLOGY:
ETIOLOGY
Congenital valve disease
• develops before birth Normal =Tricuspid with
• abnormal valve size, leaflets that are not 3 leaflets
properly formed, and abnormal leaflet
attachment
• aortic or pulmonic valve
Bicuspid aortic valve Bicuspid Aortic
• two leaflets (cusps) instead of three Valve - Two Leaflets
• Without the third leaflet, the valve may be:
• stenotic - stiff valve leaflets that can not open
or close properly
• leaky - not able close tightly (regurgitant)
ETIOLOGY
• Acquired Valve Disease
• Infection
• infective endocarditis
• rheumatic fever
• Structural changes
• stretching or tearing of the
chordae tendineae or papillary
muscles
• fibro-calcific degeneration or
dilatation of the valve annulus
ETIOLOGY and
PATHOLOGY:
Rheumatic fever = rheumatic heart disease
• the heart valve leaflets may become inflamed
• the leaflets may stick together and become scarred, rigid,
thickened and shortened
• one or more of the valves (most commonly the mitral valve)
may become stenotic (narrowed) or leaky
• most often in children aged five to fifteen
• untreated streptococcal infection - strep throat
• the body produces antibodies to fight the infection, and they
react with the heart valves, causing inflammation and eventual
scarring
• penicillin prophylaxis
• sometimes takes years for symptoms of valve disease to
develop
ETIOLOGY and PATHOLOGY
Infective endocarditis (also called bacterial endocarditis)
• life-threatening infection of the heart valves or the heart's inner lining
(endocardium).
• bacteria, but occasionally fungi and other microbes enter your blood
stream and attach to the surface of your heart valves -- attack the heart
valve, causing growths on the valve, holes in the valve or scarring of the
valve tissue
• may cause the valve to leak or become stenotic (narrowed)
• The causative organisms can enter the blood stream during:
• dental procedures
• surgery
• intravenous (IV) drug use
• severe infections
• Patients with valve disease or have had valve surgery are at increased
risk
• Endocarditis can be deadly if it is not treated
ETIOLOGY and PATHOLOGY
Other causes of valve disease include:
• coronary artery disease
• heart attacks
• cardiomyopathy (heart muscle disease)
• syphilis
• hypertension
• aortic aneurysms
• connective tissue diseases
• less commonly, tumors
• some types of drugs and radiation
VALVULAR HEART DISEASE
1.Mitral Stenosis
2. Mitral Regurgitation
3. Aortic Stenosis
4. Aortic Regurgitation
5. Pulmonic Stenosis
6. Pulmonic Regurgitation
7. Tricuspid Stenosis
8. Tricuspid Regurgitation
MITRAL STENOSIS
MITRAL REGURGITATION
AORTIC STENOSIS
AORTIC
REGURGITATION
TRICUSPID
STENOSIS
PULMONARY STENOSIS
CLINICAL FEATURES OF
VALVULAR HEART
DISEASE
PHYSICAL
(CHEST)EXAMINATION
DIAGNOSIS OF VHD
• Echocardiography
• assesses the structure of the heart,
the heart valves and the blood flow
through the heart
• close look at the heart valves and
how well they're working (function).
• Transesophageal echocardiogram
• closer look at the heart valves than
is possible with a regular
echocardiogram.
• Electrocardiogram (ECG)
• detect enlarged chambers of your
heart, heart disease and abnormal
heart rhythms.
DIAGNOSIS OF VHD
• Chest X-ray-
• determine whether the heart
is enlarged and the condition
of your lungs
DIAGNOSIS OF VHD
• Cardiac MRI
• detailed images of your heart. This test may be
used to determine the severity of your
condition and assess the size and function of
your lower heart chambers (ventricles).
• Exercise tests or stress tests
• activity tolerance and monitor your heart's
response to physical exertion
DIAGNOSIS OF
VHD
• Cardiac catheterization
• used to diagnose heart valve disease if
other tests aren't able to diagnose the
condition or to determine its severity
• a thin tube (catheter) is threaded
through a blood vessel in the arm or
groin and guided to an artery in the
heart and dye is injected through the
catheter to make the artery visible on
an X-ray
• provides detailed picture of the heart
arteries and how heart functions
• measure the pressure inside the heart
chambers