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Cardiac Valve Disease 心脏瓣膜疾病

Cardiac valve disease normally occurs from valve vegetation or thickening (Ferri, 2018). Most valve damage occurs in the pulmonary valve followed by the aortic valve (Singhi & Kumar, 2015). Rheumatic heart disease is the most common cause of cardiac valve disease and is a major cause of heart failure in children and adults (Nkoke, et al., 2016). Rheumatic heart disease is caused by Group A streptococcal infections that are not treated or not completely treated (Nkoke, et al., 2016). Most valve disease seen in the adult population is rheumatic in etiology and could have been prevented if the underlying infection would have been treated (Moreas and Tarasoutchi, 2014). There is also a chance of congenital heart disease affecting the valves of the heart. Congenital heart disease occurs at a rate of 6-8 per 1,000 live births, with 15-20% of children having valvular involvement (Singhi & Kumar, 2015).

When cardiac valve disease is suspected it is important to look at the epidemiology, clinical profile and echocardiography to make a diagnosis (Moraes, & Tarasoutchi, 2014). It is important to assess a patient’s age, gender, underlying valve disease including the etiology of the valve disease, previous cardiac or valve treatments, medications are taken and any comorbidities. Moraeas and Tarasoutchi (2014) recommend asking about specific comorbidities like hypertension, angina, diabetes mellitus, coronary artery disease, peripheral artery disease, neurological disorders, atrial fibrillation, valve prosthesis, and any previous neurological disease.

The most common valves associated with valve stenosis are the aortic, pulmonary or mitral valve (Singi & Kumar, 2015). Each valve has its own signs and symptoms specific to the valve that is damaged. Based on the presenting symptoms a chest x-ray and echocardiogram should be performed so a correct diagnosis can be appropriately made, for some cardiac catheterization may be recommended. Differential diagnosis can include cardiac sclerosis, regurgitations, hypertrophic cardiomyopathies, atrial septal defects. Depending on the location of valvular involvement will determine what treatment will be necessary. Some only require surgery, while others may be treated with closed valvotomy.

Mitral valve is the rarest of the three and is both obstructive and regurgitant (Singi & Kumar, 2015). Someone with mitral valve disease is going to often present with dyspnea, fatigue, decreased cardiac output, pulmonary edema, hypertension, hemoptysis, atrial fibrillation, mitral facies, and a low pitch rumbling diastolic murmur (Ferri, 2018). On an ECG, thickening of the valve will be at 1.5 cm or less with leaflet thickness, and lesions with left atrial enlargement of the pulmonary arteries that indicate pulmonary hypertension seen on an x-ray (Singi, & Kumar, 2015). Treatment for mitral valve disease is a valvotomy which can be done open, closed, or with a balloon (Ferri, 2018). Depending on the other residual symptoms medication may need to be prescribed. Anticoagulants may need to be given if the atrial fibrillation is not controlled. Beta-blockers, calcium channel blockers, or digoxin may be needed if tachycardia persists. Mitral valve disease can lead to congestive heart failure if not diagnosed and treated promptly in which case loop diuretics may be needed (Ferri, 2018).

The aortic valvular disease consists of 60-75% of cases with the bicuspid aortic valve being the most common resulting in regurgitation or stenosis (Singhi, & Kumar, 2015). Aortic valvular damage presents with angina, syncope, a harsh midsystolic crescendo-decrescendo murmur and an absent or diminished intensity of S2 (Ferri, 2018). Dilation of the aorta with possible calcification as well as cardiomegaly may be seen on an x-ray with left ventricle hypertrophy and left arterial enlargement seen on an ECG (Singhi, & Kumar, 2015). Treatment for the aortic valvular disease is surgery once the patient becomes symptomatic, and most cases are not diagnosed until symptomatic (Ferri, 2018).

The best thing to do for patients is to teach them about preventing most valvular disease by educating them about the importance of only taking medication when needed, taking it as prescribed, and taking the complete dose prescribed. Luckily cases of valvular disease in the United States have decreased, but the valvular disease is still very prevalent in many other countries (Nkoke, et al., 2016).

References:

Ferri, F. (2018). Ferri’s clinical advisor. Elsevier: St. Louis, Mo.

Moraes, R., Katz, M., & Tarasoutchi, F. (2014). Clinical and epidemiological profile of patients with valvular heart disease admitted to the emergency department. Einstein, 12(2), 154-158.

Nkoke, C., Lekoubou, A., Dzudie, A., Jingi, A., kingue, S., Menanga, A., & Kengne, A. (2016). Echocardiographic pattern of rheumatic valvular disease in a contemporaroy sub-Saharan African pediatric population: an audit of a major cardiac ultrasound unit in Yaounde, Cameroon. BioMedical Central Pediatrics, 16(43).

Singhi, A., & Kumar, R. (2015). Evaluation of congenital valvular heart diseases by the pediatrician: When to follow, when to refer for an intervention? Indian Journal of Pediatrics, 82(11), 1021-1026

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