Valvular Heart Disease

Authors: Katherine Henderson / Editors: Jason M Kendall, Thomas MacMahon / Reviewer: Thomas MacMahon, Josh Davison / Code: A1 / Published: 19/11/2021

Description:

This session deals with the important presentations of valvular heart disease in adults and the early management in the emergency department.

After completing this session you will be able to:

• Recognise which heart murmurs in adults may be significant in the context of a presentation to the emergency department
• Describe the pathophysiology of common forms of valvular heart disease
• Explain how to manage the common presentations of heart valve problems in the emergency department
• List the acute problems associated with prosthetic heart valves
• Identify the clinical features that would make you suspect a diagnosis of infective endocarditis

References:

1. Passik CS, Ackermann DM, Pluth JR, Edwards WD. Temporal changes in the causes of aortic stenosis: a surgical pathologic study of 646 cases. Mayo Clin Proc. 1987 Feb;62(2):119-23.
2. Stewart BF, Siscovick D, Lind BK, Gardin JM, Gottdiener JS, Smith VE, Kitzman DW, Otto CM. Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study. J Am Coll Cardiol. 1997 Mar 1;29(3):630-4.
3. Baumgartner H. Aortic stenosis: medical and surgical management. Heart. 2005 Nov;91(11):1483-8.
4. Mullany CJ, Elveback LR, Frye RL, Pluth JR, Edwards WD, Orszulak TA, Nassef LA Jr, Riner RE, Danielson GK. Coronary artery disease and its management: influence on survival in patients undergoing aortic valve replacement. J Am Coll Cardiol. 1987 Jul;10(1):66-72.
5. Otto CM, Mickel MC, Kennedy JW, Alderman EL, et al. Three-year outcome after balloon aortic valvuloplasty. Insights into prognosis of valvular aortic stenosis. Circulation. 1994 Feb;89(2):642-50.
6. Gardin JM, Schumacher D, Constantine G, Davis KD, Leung C, Reid CL. Valvular abnormalities and cardiovascular status following exposure to dexfenfluramine or phentermine/fenfluramine. JAMA. 2000 Apr 5;283(13):1703-9.
7. Chaliki HP, Mohty D, Avierinos JF, Scott CG, et al. Outcomes after aortic valve replacement in patients with severe aortic regurgitation and markedly reduced left ventricular function. Circulation. 2002 Nov 19;106(21):2687-93.
8. OLESEN KH. The natural history of 271 patients with mitral stenosis under medical treatment. Br Heart J. 1962 May;24(3):349-57.
9. Tcheng JE, Jackman JD Jr, Nelson CL, Gardner LH, et al. Outcome of patients sustaining acute ischemic mitral regurgitation during myocardial infarction. Ann Intern Med. 1992 Jul 1;117(1):18-24.
10. Freed LA, Benjamin EJ, Levy D, Larson MG, et al. Mitral valve prolapse in the general population: the benign nature of echocardiographic features in the Framingham Heart Study. J Am Coll Cardiol. 2002 Oct 2;40(7):1298-304.

Useful Guidelines

• Vahanian A, Baumgartner H, Bax J, Butchart E, Dion R, Filippatos G, Flachskampf F, Hall R, Iung B, Kasprzak J, Nataf P, Tornos P, Torracca L, Wenink A; Task Force on the Management of Valvular Hearth Disease of the European Society of Cardiology; ESC Committee for Practice Guidelines. Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J. 2007 Jan;28(2):230-68.
• Habib G, Hoen B, Tornos P, Thuny F, et al. Guidelines. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer. Eur Heart J. 2009 Oct;30(19):2369-413.