Clinical features of valvular heart disease
Clinical features of valvular heart disease Valvular heart disease (VHD) encompasses a range of conditions characterized by damage or defects in one or more of the heart’s four valves: the mitral, aortic, tricuspid, and pulmonary valves. These valves play a crucial role in ensuring unidirectional blood flow through the heart’s chambers. When their function is compromised, it can lead to significant alterations in cardiac hemodynamics, with varied clinical presentations that depend on the specific valve involved and the nature of the lesion—whether stenosis (narrowing) or regurgitation (leakage).
Patients with valvular heart disease may remain asymptomatic for years, especially in mild cases. As the disease progresses, symptoms become more apparent and can include fatigue, shortness of breath, palpitations, syncope, or edema. The most common clinical feature across various types of VHD is exertional dyspnea, which results from increased pulmonary pressures due to backflow or stenotic obstruction. Additionally, orthopnea and paroxysmal nocturnal dyspnea are observed in more advanced disease, reflecting congestive heart failure.
On physical examination, distinct auscultatory findings often help in differentiating between types of valvular lesions. For instance, aortic stenosis typically presents with a systolic ejection murmur best heard at the right second intercostal space radiating to the neck, often accompanied by a delayed and weaker pulsation of the carotid arteries. Conversely, mitral regurgitation often produces a holosystolic, blowing murmur at the apex of the heart, radiating to the axilla. Tricuspid regurgitation may produce a holosystolic murmur loudest at the left lower sternal border, which increases with inspiration. Pulmonary valve abnormalities are less common but may manifest with a systolic ejection murmur along the left upper sternal border.
In addition to murmurs, other signs can include a displaced apical impulse, indicative of ventricular hypertrophy or dilation. In severe cases, signs of right-sided or left-sided heart failure may predominate, such as peripheral edema, hepatomegaly, or crackles on lung auscultation. The presence of a thrill—a palpable vibration—over the precordium can indicate significant valvular stenosis or regurgitation.
Electrocardiography (ECG) findings can provide supportive clues, such as left ventricular hypertrophy in aortic stenosis or atrial fibrillation in mitral stenosis. Echocardiography remains the cornerstone for diagnosis, providing detailed information on valve morphology, function, and the severity of lesions. It can also assess chamber sizes, wall motion, and pulmonary pressures, guiding management decisions.
Understanding the clinical features of valvular heart disease is vital for early detection and intervention. Many patients benefit from medical therapy to control symptoms, but definitive treatment often involves surgical or percutaneous valve repair or replacement. Recognizing the characteristic clinical signs and symptoms enables timely referral and improves overall prognosis.
