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Rheumatic heart disease is the leading cause of mitral stenosis in developed countries. Its incidence has declined sharply wherever standards of living have improved and where penicillin is routinely used during episodes of pharyngitis due to group A streptococcus. Occasional small epidemics still occur in the US.
The major manifestations of VHD include both valvular heart disease, murmurs, aortic stenosis, mitral stenosis, mitral regurgitation, mitral prolapse, mitral valve prolapse left and right heart failure, left and right ventricular hypertrophy, atrial and ventricular arrhythmias, syncope, angina. pulmonary and systemic emboli, and endocarditis. With the exception of infectious etiologies, there are no known medical therapies that arrest the natural progression of the primary valvular stenotic or regurgitant lesions, and severe lesions ultimately require surgical therapy. Afterload reduction for chronic valvular heart disease, murmurs, aortic stenosis, mitral stenosis, mitral regurgitation, mitral prolapse, mitral valve prolapse aortic regurgitation can postpone the need for surgery, without compromising long-term outcome.
Recognition of VHD
Many patients with milder forms of VHD will be asymptomatic, with only a click or a murmur evident on exam. Most healthy adults do not have "benign" flow murmurs (except during pregnancy and certain systemic illnesses), and a murmur therefore usually represents some degree of valvular pathology. Correct identification of the origin of murmurs is essential, since quality of life and life span are limited in most severe forms of VHD. Murmurs due to organic VHD must be distinguished from functional murmurs caused by LV or RV dilation, hypertrophic cardiomyopathy, ischemic heart disease, or from murmurs due to intracardiac shunts and aortic coarctation. Congenital and myxomatous VHD must be identified because of the important risk of endocarditis.
Causes of Valvular Heart Disease
Rheumatic heart disease
Endocarditis
Infective
Non-infective. thrombotic
Congenital
Myxomatous valve degeneration
Marfan's Syndrome
Ehlers-Danlos Syndrome
Osteogenesis imperfecta
Mucopolysaccharidoses
Degenerative, calcific disease
Ischemic heart disease
Miscellaneous
Carcinoid syndrome
Systemic lupus erythematosus
Rheumatoid arthritis
Ankylosing spondylitis Reiter's syndrome
Endomyocardial fibrosis
Trauma
Aortic disease
dissection of aneurysm syphilis
Hypertrophic cardiomyopathy