Valvular Heart Disease: Symptoms.

Valvular heart disease (VHD) occurs when one or more of the heart’s valves are damaged or impaired, disrupting normal blood flow and putting strain on the heart. This condition can be congenital (present at birth) or acquired later in life due to aging, infections, or other heart conditions. VHD includes a variety of lesions such as stenosis (narrowing of the valve), regurgitation (leakage), or combined lesions.

Given its potential to cause serious complications like heart failure, stroke, and sudden death, understanding the symptoms and diagnostic procedures is crucial for early intervention and optimal outcomes.

Overview of Valvular Heart Disease

The human heart contains four valves — mitral, tricuspid, aortic, and pulmonic — each ensuring one-way blood flow through the heart’s chambers and into the circulatory system. In VHD, these valves do not open or close properly, leading to inefficient circulation.

Valve Lesions can be classified as:

• Stenosis: Narrowing that restricts blood flow.
• Regurgitation (Insufficiency): Leakage of blood backward due to incomplete valve closure.
• Mixed Disease: Both stenotic and regurgitant features in the same valve.

Common causes include age-related degeneration (calcific aortic stenosis), rheumatic fever, infective endocarditis, congenital defects (bicuspid aortic valve), and autoimmune diseases. Risk is higher in individuals with a history of coronary artery disease, heart failure, high blood pressure, or prior valvular surgery.

Symptoms of Valvular Heart Disease

Early-Stage Symptoms

In the early stages, VHD may be silent or produce very subtle signs. This is because the heart compensates for reduced valve efficiency by increasing chamber pressure or contractility.

1. Mild Shortness of Breath (Dyspnea): Often occurs only during exertion.
   • May be perceived as getting "out of shape" rather than a heart issue.
   • More common in aortic stenosis and mitral regurgitation.
2. Fatigue: Reduced cardiac output decreases oxygen delivery to tissues, causing tiredness even after mild activity.
3. Palpitations: Sensation of irregular or rapid heartbeat due to associated atrial fibrillation in mitral valve disease.
4. Mild Swelling: Peripheral edema in ankles or feet, especially in tricuspid valve involvement.
5. Chest Discomfort: Rare in early stages; mild pressure may occur during heavy exertion with aortic stenosis.

Clinical Insight: Many patients ignore early signs, thinking they’re due to aging or inactivity. Routine checkups are critical in detection.

Advanced-Stage Symptoms

Once compensation mechanisms fail, symptoms become pronounced and may affect daily activities.

1. Severe Dyspnea:
   • Shortness of breath during mild exertion or even at rest.
   • Orthopnea (breathlessness when lying down) and paroxysmal nocturnal dyspnea (waking at night short of breath) are common in mitral stenosis.
2. Marked Fatigue and Exercise Intolerance: Even simple tasks become exhausting due to severely reduced cardiac output.
3. Angina: Chronic pressure overload in the left ventricle, common in severe aortic stenosis.
4. Syncope (Fainting): Particularly alarming in advanced aortic stenosis; linked to inability to maintain adequate brain perfusion.
5. Edema and Ascites: Right-sided heart valve disease (tricuspid or pulmonic) can cause systemic venous congestion.
6. Heart Failure Signs: Weight gain from fluid retention, distended neck veins, and severe swelling of extremities.

Risk Factors Influencing Symptom Severity

• High blood pressure
• Coronary artery disease
• Age >65
• Rheumatic heart history
• Endocarditis risk factors (IV drug use, prosthetic valves)

Long-Term Complications

• Chronic heart failure
• Pulmonary hypertension in mitral stenosis
• Stroke from emboli in atrial fibrillation
• Sudden cardiac death in untreated severe aortic stenosis