Valvular Heart Disease
All left sided valve lesions can produce pulmonary hypertension due to elevated left atrial pressure and subsequent changes in pulmonary vasculature. Anything that causes atrial dilatation can eventually lead to atrial fibrillation which is an important risk factor to pick up on as individuals have an increased risk of strokes and heart attacks.
Stenosis Narrow, obstructive valves, causing pressure overload in the chamber.
- Aortic stenosis produces left ventricular hypertrophy
- Mitral stenosis produces left atrial dilatation
Regurgitation Leaking valves, producing volume overload with resulting dilatation. Think of too much blood being forced into a small space which causes the space to enlarge to compensate.
Investigations for valvular heart disease
ECGs often none specific, but may show evidence of some of the cardiac changes such as hypertrophy or dilatation. Again atrial fibrillation is a very important sign to detect!
Chest x-rays may show signs of cardiac enlargement, calcification of valves and signs of pulmonary oedema.
Echocardiograms can directly asses the valve structure and function. This can also be used to observe changes in the chamber size and function. This is the primary way to diagnose and quantify valvular defects.
Consequences of valvular disease
- Exertional dyspnoea
- Angina like chest discomfort
- Exertional syncope (aortic stenosis)
- Congestive cardiac failure
- Left ventricular pressure/volume overload
- Left ventricular failure
- Pulmonary hypertension due to elevated left atrial pressure
- Right ventricular failure
- Valve replacement/repair in severe cases
- Metal valves require lifetime anti-coagulation
- Prosthetic valves may eventually fail
- Transfemoral TAVI is a minimally invasive valve replacement technique that is similar to stenting only a lot bigger!