V–W

valvular heart disease The collective term for
the malformations and disorders that can affect
the valves of the HEART. Valvular heart disease may
affect any of the heart’s four valves: mitral, pul-
monary, aortic, and tricuspid. The most common
forms of valvular heart disease are

• stenosis, in which the valve does not open
  completely


• regurgitation, also called incompetence or
  insufficiency, in which the valve does not close
  completely


• prolapse, affecting primarily the mitral valve, in
  which the valve leaflets are irregularly shaped
  such that they bulge when they close

POSSIBLE CAUSES OF VALVULAR HEART DISEASE

ANKYLOSING SPONDYLITIS atrial septal defect (ASD)
bicuspid aortic valve calcification
CONGENITAL ANOMALY CORONARY ARTERY DISEASE(CAD)
ENDOCARDITIS GRAVES’S DISEASE
HEART ATTACK hypertrophicCARDIOMYOPATHY
MARFAN SYNDROME MUSCULAR DYSTROPHY
PULMONARY HYPERTENSION RHEUMATIC HEART DISEASE
RHEUMATOID ARTHRITIS SICKLE CELL DISEASE
SYSTEMIC LUPUS ventricular septal defect
ERYTHEMATOSUS(SLE) (VSD)

Until the 1950s, valvular heart disease was the
leading cardiovascular cause of death, and RHEU-
MATIC HEART DISEASE, a complication of streptococ-
cal INFECTIONsuch as STREP THROAT, was the most
frequent cause of valvular heart disease. As ANTIBI-
OTIC MEDICATIONSbecame the standard of treatment
for strep throat and other infections, rheumatic
heart disease and correspondingly valvular heart
disease declined dramatically. Though rheumatic

heart disease still accounts for about half of valvu-

lar heart disease, other causes include congenital

malformations and degenerative effects that

accompany aging.

Symptoms and Diagnostic Path

Many people who have valvular heart disease do

not have symptoms until damage to the heart

becomes significant, progressing to HEART FAILURE,

CARDIOMYOPATHY, and ARRHYTHMIA. When symptoms

are present, they may include

• tiredness or fatigue


• shortness of breath, especially with exertion


• periods of lightheadedness


• chest tightness or discomfort


• PALPITATIONS

Often, the underlying valve malformation

(congenital or acquired) exists for years to decades

before affecting the valve’s function to the extent

of causing symptoms. Sometimes the doctor

detects valvular heart disease before symptoms are

present, commonly by hearing a HEART MURMUR

during a ROUTINE MEDICAL EXAMINATION. Though

many heart murmurs are occasional and innocent

(not indicating any disease), certain valve disor-

ders produce distinctive murmurs. Other proce-

dures likely along the diagnostic path include

ELECTROCARDIOGRAM (ECG), ECHOCARDIOGRAM, and

COMPUTED TOMOGRAPHY(CT) SCANor MAGNETIC RESO-

NANCE IMAGING(MRI). Depending on the person’s

general cardiovascular status, the cardiologist may

also recommend CARDIAC CATHETERIZATION.

Treatment Options and Outlook

Medications can control much valvular heart dis-

ease. Those commonly prescribed include antico-

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