9. Valvular Heart Disease (VHD)
📄 Definition
Valvular heart disease refers to dysfunction of one or more heart valves, resulting in either stenosis (restricted opening) or regurgitation (incompetent closure). Commonly affected valves include the aortic and mitral valves.
🔁 Types and Common Causes
| Valve | Stenosis | Regurgitation |
|---|---|---|
| Aortic | Bicuspid valve, calcific degeneration, rheumatic fever | Aortic root dilation, bicuspid valve, endocarditis |
| Mitral | Rheumatic fever, calcification | Mitral valve prolapse, LV dilatation, endocarditis |
| Tricuspid | Rare – rheumatic | RV dilatation, pulmonary hypertension |
| Pulmonary | Congenital (e.g. Tetralogy of Fallot) | Pulmonary hypertension, congenital |
📋 Clinical Features – Mnemonic: SLOW HEART
Syncope
Left heart failure (dyspnoea, fatigue – mitral/aortic)
Oedema (right heart signs – tricuspid/pulmonary)
Weak pulse (esp. in aortic stenosis)
Heart murmurs
Exercise intolerance
Angina (esp. in AS)
Respiratory signs – crackles, orthopnoea
Thrill/heave (palpable murmur/ventricular hypertrophy)
🎧 Murmurs – Key Patterns
| Condition | Timing | Character | Radiation |
|---|---|---|---|
| Aortic stenosis | Ejection systolic | Harsh | → Carotids |
| Aortic regurgitation | Early diastolic | Blowing | → LLSB |
| Mitral stenosis | Mid-diastolic | Rumbling | → Apex |
| Mitral regurgitation | Pansystolic | Blowing | → Axilla |
| Tricuspid regurgitation | Pansystolic | Increases on inspiration | → LLSB |
Investigations
🥇 First-Line
Echocardiogram (TTE): structure, function, severity
ECG: LVH, AF (mitral), conduction blocks
🥈 Second-Line
TOE: if endocarditis or poor TTE window
CXR: cardiomegaly, pulmonary oedema
Bloods: BNP (if HF), FBC, U&Es
Cardiac MRI / CT: anatomical planning (e.g. TAVI)
Management – Mnemonic: SEVERE
Symptom control – loop diuretics for fluid overload
Echo surveillance – annual if moderate–severe
Valve replacement – mechanical or bioprosthetic
Endocarditis prophylaxis (not routinely given unless indicated)
Risk factor control – BP, cholesterol, smoking
Education – symptoms to report (e.g. exertional syncope)
⚠️ Complications
Heart failure
Arrhythmias (especially AF in mitral disease)
Infective endocarditis
Thromboembolism
Sudden cardiac death (especially aortic stenosis)
🔺 Last updated in line with NICE CG23 – Management of heart valve disease in adults
Published: March 2021 • Last updated: July 2023
Last reviewed: August 2025
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