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Valvular Heart Disease

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Comprehensive Cardiovascular Medicine in the Primary Care Setting

Part of the book series: Contemporary Cardiology ((CONCARD))

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Abstract

Primary valvular heart disease remains a source of significant morbidity and mortality. Over 5 million Americans are living with valvular heart disease and nearly 100,000 undergo valve surgery each year (1). Valvular heart disease is often first identified after a murmur is appreciated during a primary care visit and subsequently characterized by echocardiography (Fig. 1) (2). Optimal management of valvular heart disease requires close collaboration among primary care physicians, cardiologists, and cardiac surgeons. With timely recognition and appropriate referral to cardiac specialists, in most instances patients with valvular heart disease can lead a normal life span.

Key Points

• Once valvular heart disease is identified, the clinical history and examination as well as serial echocardiography are the crucial elements in ensuring timely referral for valve surgery.

• Compensatory remodeling often allows chronic severe valvular heart disease to have a long latent phase, but onset of clinical symptoms is a turning point marking cardiac decompensation.

• Severe aortic stenosis accompanied by symptoms of angina, syncope, dyspnea, or frank heart failure has a poor prognosis without valve replacement surgery. There is no strict age limit for aortic valve replacement.

• Congenitally bicuspid aortic valve predisposes to early aortic stenosis, aortic regurgitation, and/or aortic root dilatation.

• Aortic regurgitation may be caused by either aortic valve (infective endocarditis, rheumatic disease, bicuspid aortic valve) or aortic root pathology (Marfan syndrome, connective tissue disease, or syphylitic aortitis).

• Mitral regurgitation begets mitral regurgitation and may result from disease affecting any part of the mitral valve apparatus—from the valve leaflets, annulus, and chordae tendinae to the papillary muscles and subadjacent ventricle.

• Though mitral valve prolapse has a generally benign course, it is the most common cause of severe MR requiring surgical treatment in North America.

• Percutaneous balloon mitral valvotomy is now the treatment of choice for appropriate anatomic candidates with rheumatic mitral stenosis.

• The choice between mechanical and bioprosthetic heart valve weighs valve durability against the risks of anticoagulation.

• Antibiotic prophylaxis against infective endocarditis is recommended only for those patients at greatest risk for complications from endocarditis—patients with a prosthetic valve, previous endocarditis, complex congenital heart disease, or cardiac transplantation.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Garrick C. Stewart MD

  2. Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Patrick T. O’Gara MD

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Editors and Affiliations

  1. Sterling Rock Falls Clinic, 101 E. Miller Road, Sterling, 61081, USA

    Peter P. Toth

  2. Brigham & Women's Hospital, Cardiovascular Division, Harvard Medical School, Longwood Ave. 350, Boston, 02115, USA

    Christopher P. Cannon

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Stewart, G.C., O’Gara, P.T. (2011). Valvular Heart Disease. In: Toth, P., Cannon, C. (eds) Comprehensive Cardiovascular Medicine in the Primary Care Setting. Contemporary Cardiology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-963-5_22

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  • DOI: https://doi.org/10.1007/978-1-60327-963-5_22

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