Valvular Heart Disease - Causes Signs Symptoms Management Notes With MCQs Practice

Cardiovascular Disorders

VALVULAR HEART DISEASE

Complete Nursing Notes + High-Yield Revision + MCQ Practice

BSc Nursing NORCET AIIMS Nursing RRB / ESIC

Understand the valves, recognize the murmurs, and master the clinical scenarios.

Learning Objectives

Define valvular heart disease and differentiate stenosis from regurgitation.
Identify the major features of mitral and aortic valve disorders.
Understand causes, manifestations, investigations, and treatment.
Recognize important murmurs and common examination clues.
Apply nursing management and patient education principles.

📚 Table of Contents

1. Introduction and Definition

Valvular heart disease (VHD) refers to a disorder involving one or more of the heart valves that interferes with normal blood flow through the heart.

The heart has four valves that open and close in a coordinated manner to maintain forward blood flow and prevent backward flow.

Definition: Valvular heart disease is a structural or functional abnormality of a heart valve that causes stenosis, regurgitation, or a combination of both.

Why are heart valves important?

Maintain one-way blood flow.
Prevent backward flow of blood.
Support effective cardiac output.
Help maintain appropriate pressure in cardiac chambers and pulmonary circulation.

2. Heart Valves and Normal Blood Flow

Valve	Location	Main function
Tricuspid valve	Right atrium to right ventricle	Prevents backflow into the right atrium during ventricular systole.
Pulmonary valve	Right ventricle to pulmonary artery	Prevents backflow into the right ventricle during diastole.
Mitral valve	Left atrium to left ventricle	Prevents backflow into the left atrium during ventricular systole.
Aortic valve	Left ventricle to aorta	Prevents backflow into the left ventricle during diastole.

BODY
↓
Superior and Inferior Vena Cava
↓
RIGHT ATRIUM
↓ Tricuspid valve
RIGHT VENTRICLE
↓ Pulmonary valve
PULMONARY ARTERY → LUNGS
↓ Pulmonary veins
LEFT ATRIUM
↓ Mitral valve
LEFT VENTRICLE
↓ Aortic valve
AORTA → BODY

Exam point: The mitral and aortic valves are on the left side of the heart. Disorders of these valves commonly produce pulmonary congestion or reduced systemic cardiac output.

3. Classification of Valvular Disorders

A. Stenosis

Stenosis means narrowing of the valve opening. The affected valve does not open adequately, obstructing forward blood flow.

Example: Mitral stenosis increases resistance to blood flow from the left atrium to the left ventricle.

B. Regurgitation (Insufficiency)

Regurgitation means incomplete valve closure, allowing blood to flow backward.

Example: Mitral regurgitation allows blood to flow from the left ventricle back into the left atrium during systole.

C. Prolapse

Prolapse occurs when valve leaflets bulge backward into the preceding chamber during valve closure. Mitral valve prolapse may occur with or without significant regurgitation.

Feature	Stenosis	Regurgitation
Basic problem	Valve fails to open adequately.	Valve fails to close adequately.
Blood flow	Forward flow is obstructed.	Backward flow occurs.
Pressure effect	Pressure rises behind the narrowed valve.	Volume overload develops in affected chambers.
Common example	Mitral stenosis	Mitral regurgitation

4. Causes and Risk Factors

Common causes include:

Rheumatic heart disease: Chronic valve damage following acute rheumatic fever, often affecting the mitral valve.
Age-related degeneration and calcification: An important cause of aortic stenosis in older adults.
Congenital abnormalities: For example, a bicuspid aortic valve.
Infective endocarditis: Infection can damage valve leaflets and supporting structures.
Ischemic heart disease: Myocardial infarction can cause papillary muscle dysfunction or rupture, leading to acute mitral regurgitation.
Connective tissue disorders: Certain disorders can affect valve structure and supporting tissues.
Annular dilation or ventricular remodeling: Can prevent normal valve closure and cause regurgitation.
Degenerative valve disease: Changes in valve leaflets or supporting structures may cause prolapse or regurgitation.

Clinical warning: Sudden severe breathlessness, hypotension, chest pain, syncope, or signs of acute heart failure in a person with known or suspected valve disease require urgent assessment.

5. Pathophysiology

VALVE STRUCTURAL OR FUNCTIONAL ABNORMALITY
↓
STENOSIS: Obstruction to forward flow
OR
REGURGITATION: Backward flow and volume overload
↓
Changes in cardiac pressure and workload
↓
Chamber hypertrophy and/or dilation
↓
Reduced effective cardiac output or raised filling pressures
↓
Dyspnea, fatigue, congestion, arrhythmias
↓
Possible heart failure and other complications

Effects of stenosis

The affected chamber must generate higher pressure to move blood through the narrowed opening.
Pressure may increase in chambers and vessels behind the valve.
Chronic pressure overload may lead to hypertrophy.

Effects of regurgitation

Some blood flows backward instead of moving forward effectively.
The receiving chamber may experience volume overload.
Chamber dilation and eventual ventricular dysfunction can occur.

6. Mitral Stenosis (MS)

Definition

Mitral stenosis is narrowing of the mitral valve opening, which obstructs blood flow from the left atrium to the left ventricle during diastole.

Major cause

Rheumatic heart disease is a major cause of mitral stenosis worldwide. Degenerative calcification can also cause mitral stenosis, particularly in older adults.

Pathophysiology

NARROWED MITRAL VALVE
↓
Obstructed flow into left ventricle
↓
Increased left atrial pressure
↓
Pulmonary venous congestion
↓
Dyspnea and possible pulmonary hypertension
↓
Right ventricular strain and right-sided heart failure in advanced disease

Clinical manifestations

Exertional dyspnea.
Orthopnea and paroxysmal nocturnal dyspnea in advanced disease.
Fatigue and reduced exercise tolerance.
Palpitations, particularly with atrial fibrillation.
Hemoptysis may occur due to pulmonary venous hypertension.
Signs of pulmonary hypertension or right-sided heart failure in advanced disease.

Characteristic auscultation findings

Loud S1: May be present when the valve remains mobile.
Opening snap: May occur after S2 in pliable rheumatic mitral stenosis.
Low-pitched, rumbling mid-diastolic murmur: Best heard at the apex with the patient in the left lateral position, using the bell of the stethoscope.
Presystolic accentuation: May occur in sinus rhythm; it is absent when effective atrial contraction is lost, as in atrial fibrillation.

Memory trick: MS = Mitral Stenosis

Mid-diastolic murmur.
Shortness of breath from pulmonary congestion.
Atrial fibrillation may develop.

Investigations

Echocardiography with Doppler: assesses valve anatomy, valve area, gradients, pulmonary pressure, and associated lesions.
ECG: may reveal atrial fibrillation or left atrial enlargement.
Chest X-ray: may show left atrial enlargement or pulmonary congestion.

Management

Diuretics may relieve pulmonary congestion.
Rate control may be needed in selected patients with tachycardia or atrial fibrillation.
Anticoagulation is indicated in selected patients, particularly those with mitral stenosis and atrial fibrillation, according to clinical guidelines and thromboembolic risk.
Percutaneous mitral balloon commissurotomy may be appropriate for selected patients with favorable valve anatomy and without contraindications such as left atrial thrombus or more than mild mitral regurgitation.
Surgical intervention may be needed when balloon treatment is unsuitable or when other cardiac conditions require surgery.

7. Mitral Regurgitation (MR)

Definition

Mitral regurgitation occurs when the mitral valve fails to close properly, allowing blood to flow from the left ventricle back into the left atrium during systole.

Causes

Mitral valve prolapse.
Rheumatic valve damage.
Infective endocarditis.
Ischemic papillary muscle dysfunction or rupture.
Chordae tendineae rupture.
Left ventricular dilation causing functional mitral regurgitation.

Pathophysiology

MITRAL VALVE DOES NOT CLOSE COMPLETELY
↓
Blood flows backward into left atrium during systole
↓
Left atrial and left ventricular volume overload
↓
Pulmonary congestion and reduced forward output
↓
Dyspnea, fatigue, and possible heart failure

Clinical manifestations

Exertional dyspnea and fatigue.
Orthopnea or pulmonary edema in severe disease.
Palpitations due to atrial fibrillation.
Displaced apical impulse may occur with chronic left ventricular enlargement.
Acute severe regurgitation may cause sudden pulmonary edema and hemodynamic instability.

Characteristic murmur

High-pitched, blowing holosystolic (pansystolic) murmur, usually best heard at the apex and often radiating toward the left axilla.

Exam pearl: A holosystolic murmur at the apex radiating to the axilla strongly suggests mitral regurgitation.

Management

Treat the underlying cause and manage congestion when present.
Use guideline-directed heart failure therapy when indicated, especially in secondary mitral regurgitation with left ventricular dysfunction.
Valve repair is preferred when feasible in appropriate patients with severe primary mitral regurgitation.
Valve replacement may be necessary when repair is unsuitable.
Selected high-risk patients may be considered for transcatheter edge-to-edge repair after specialist assessment.

8. Mitral Valve Prolapse (MVP)

Definition

Mitral valve prolapse occurs when one or both mitral valve leaflets bulge backward into the left atrium during ventricular systole.

Clinical features

Many patients are asymptomatic.
Some report palpitations, atypical chest discomfort, or anxiety-like symptoms.
A midsystolic click may be heard.
A late systolic murmur may occur if mitral regurgitation is present.

Diagnosis

Echocardiography confirms valve morphology and evaluates the severity of any associated regurgitation.

Management

Asymptomatic patients with no significant regurgitation may require observation and periodic clinical follow-up.
Manage palpitations or arrhythmias according to clinical findings.
Significant mitral regurgitation requires specialist assessment and appropriate follow-up.

Exam pearl: Midsystolic click is a classic auscultatory clue for mitral valve prolapse.

9. Aortic Stenosis (AS)

Definition

Aortic stenosis is narrowing of the aortic valve opening, obstructing blood flow from the left ventricle into the aorta during systole.

Causes

Age-related calcific degeneration.
Congenital bicuspid aortic valve.
Rheumatic heart disease.

Pathophysiology

NARROWED AORTIC VALVE
↓
Increased resistance to ventricular ejection
↓
Left ventricular pressure overload
↓
Concentric left ventricular hypertrophy
↓
Reduced ability to increase cardiac output
↓
Angina, syncope, and dyspnea

Classic clinical triad

Remember: SAD

Syncope, particularly during exertion.
Angina.
Dyspnea due to heart failure.

These are classic symptoms of severe aortic stenosis. Their presence warrants prompt specialist evaluation.

Characteristic murmur

Harsh crescendo-decrescendo systolic ejection murmur.
Best heard at the right upper sternal border.
Often radiates to the carotid arteries.
A delayed carotid upstroke may occur in severe disease.

Investigations

Echocardiography with Doppler is the primary test to assess severity and ventricular function.
ECG may show left ventricular hypertrophy.
Additional imaging or cardiac catheterization may be needed in selected cases.

Management

Monitor symptoms and severity through clinical assessment and echocardiography.
Severe symptomatic aortic stenosis generally requires valve replacement unless intervention is inappropriate.
Options include surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR), selected according to age, anatomy, operative risk, comorbidities, and patient preferences.
Medical treatment may address associated conditions but does not remove the fixed obstruction.

NORCET pearl: Exertional syncope, angina, and dyspnea in an older adult with a systolic murmur radiating to the neck should raise suspicion for aortic stenosis.

10. Aortic Regurgitation (AR)

Definition

Aortic regurgitation occurs when the aortic valve does not close completely, allowing blood to flow backward from the aorta into the left ventricle during diastole.

Causes

Congenital bicuspid aortic valve.
Rheumatic valve disease.
Infective endocarditis.
Aortic root dilation.
Connective tissue disorders affecting the aorta.
Acute aortic dissection involving the aortic root.

Pathophysiology

AORTIC VALVE FAILS TO CLOSE
↓
Blood returns to left ventricle during diastole
↓
Left ventricular volume overload
↓
Ventricular dilation and increased stroke volume
↓
Possible wide pulse pressure and heart failure

Clinical manifestations

Exertional dyspnea and fatigue.
Palpitations or awareness of forceful heartbeats.
Bounding peripheral pulses may occur in significant chronic AR.
Wide pulse pressure may be present in significant chronic AR.
Acute severe AR can cause pulmonary edema, hypotension, and shock.

Characteristic murmur

High-pitched, blowing, early diastolic decrescendo murmur, best heard along the left sternal border with the patient sitting forward and breathing out, when clinically appropriate.

Management

Monitor symptoms, left ventricular size, and ventricular function.
Manage hypertension when present.
Valve surgery is indicated in selected patients with severe AR based on symptoms, ventricular function, ventricular dimensions, and other cardiac surgical indications.
Acute severe AR is a medical emergency and often requires urgent surgical assessment.

Exam pearl: Early diastolic decrescendo murmur with bounding pulses and a wide pulse pressure suggests significant aortic regurgitation.

11. Tricuspid Valve Disorders

A. Tricuspid Regurgitation (TR)

Tricuspid regurgitation allows blood to flow backward from the right ventricle into the right atrium during systole.

Causes:

Right ventricular dilation, often associated with pulmonary hypertension.
Infective endocarditis, particularly in selected high-risk groups.
Congenital valve abnormalities.
Rheumatic heart disease.
Pacemaker or defibrillator leads interfering with valve function.

Clinical features:

Raised jugular venous pressure.
Peripheral edema.
Hepatomegaly or hepatic congestion.
Ascites in advanced disease.
A holosystolic murmur at the lower left sternal border that typically becomes louder during inspiration.

B. Tricuspid Stenosis (TS)

Tricuspid stenosis obstructs blood flow from the right atrium to the right ventricle during diastole.

Possible features:

Raised jugular venous pressure.
Peripheral edema and hepatic congestion.
Fatigue and reduced cardiac output.
A diastolic murmur near the lower left sternal border.

Exam pearl: Right-sided murmurs generally become louder during inspiration. This is known as the Carvallo sign, classically associated with tricuspid regurgitation.

12. Pulmonary Valve Disorders

A. Pulmonary Stenosis

Pulmonary stenosis obstructs blood flow from the right ventricle into the pulmonary artery. It is commonly congenital.

Possible findings:

Systolic ejection murmur at the left upper sternal border.
Right ventricular hypertrophy in significant disease.
Exercise intolerance, dyspnea, or cyanosis in severe cases, depending on associated abnormalities.

B. Pulmonary Regurgitation

Pulmonary regurgitation allows blood to flow backward from the pulmonary artery into the right ventricle during diastole.

Possible causes include pulmonary hypertension, congenital abnormalities, and previous procedures involving the pulmonary valve.

Significant pulmonary regurgitation may cause right ventricular dilation and eventually right-sided heart failure.

13. General Clinical Manifestations

Manifestation	Possible explanation
Dyspnea	Pulmonary congestion, pulmonary hypertension, or heart failure.
Orthopnea	Breathlessness when lying flat, often associated with pulmonary congestion.
Fatigue	Reduced effective cardiac output.
Palpitations	Arrhythmias such as atrial fibrillation.
Syncope	May occur with severe aortic stenosis or other causes of reduced cerebral perfusion.
Chest pain	May occur with aortic stenosis, coronary disease, or other cardiac conditions.
Peripheral edema	Systemic venous congestion, often associated with right-sided heart failure.
Hemoptysis	May occur with pulmonary venous hypertension, including advanced mitral stenosis.

14. Diagnostic Investigations

1. Echocardiography with Doppler

Primary investigation for most valvular disorders. It evaluates:

Valve anatomy and leaflet movement.
Severity of stenosis or regurgitation.
Transvalvular gradients and valve area where applicable.
Chamber size and ventricular function.
Pulmonary artery pressure estimates.

2. Electrocardiography (ECG)

Detects atrial fibrillation and other arrhythmias.
May show chamber enlargement or hypertrophy.
Assesses rhythm and electrical abnormalities.

3. Chest X-ray

May show cardiac enlargement.
May reveal pulmonary vascular congestion or edema.
Can help assess alternative causes of respiratory symptoms.

4. Transesophageal echocardiography (TEE)

Provides detailed images of selected valves and cardiac structures. It may be used when transthoracic images are inadequate or when detailed assessment is needed, such as suspected endocarditis or valve thrombosis.

5. Exercise testing

In selected patients, supervised exercise testing may help clarify symptoms or functional capacity. It is not appropriate in every patient, particularly when severe symptomatic disease makes testing unsafe.

6. Cardiac CT, MRI, or catheterization

These tests may be used when further anatomical, functional, coronary, or hemodynamic information is required.

Exam focus: Echocardiography is the key investigation for defining valve structure and grading most forms of valvular heart disease.

15. Medical and Surgical Management

A. Medical management

Diuretics: May relieve fluid overload and pulmonary congestion.
Rate-control medicines: May be used for selected patients with tachyarrhythmias.
Anticoagulants: Used when indicated, such as with certain valve-related thromboembolic risks or atrial fibrillation.
Heart failure treatment: Selected according to the type of valve disorder and associated ventricular dysfunction.
Blood pressure management: Important in appropriate patients, particularly with associated hypertension and some regurgitant lesions.
Antibiotics: Used to treat proven or suspected bacterial infection when clinically indicated, not as routine treatment for all valve disorders.

B. Percutaneous procedures

Percutaneous mitral balloon commissurotomy for selected patients with suitable mitral stenosis.
Transcatheter aortic valve replacement for appropriately selected patients with aortic stenosis.
Selected transcatheter mitral or tricuspid interventions for appropriate patients after specialist assessment.

C. Surgical management

Procedure	Description
Valve repair	Restores valve function while preserving the native valve when feasible.
Valve replacement	Replaces the diseased valve with a prosthetic valve.
Commissurotomy	Separates fused valve commissures in selected stenotic valves.

Mechanical vs bioprosthetic valves

Feature	Mechanical valve	Bioprosthetic valve
Material	Manufactured durable materials.	Tissue-based valve, commonly from animal tissue.
Durability	Generally highly durable.	May deteriorate over time.
Anticoagulation	Requires lifelong vitamin K antagonist anticoagulation, usually warfarin, with INR targets based on valve and patient factors.	Long-term anticoagulation requirements differ and depend on valve position, patient factors, and clinical indications.
Important consideration	Bleeding risk, monitoring, and thromboembolic prevention.	Potential structural deterioration and future reintervention.

Critical safety point: Direct oral anticoagulants should not be used as substitutes for warfarin in patients with mechanical heart valves. Anticoagulation decisions must follow specialist guidance.

16. Nursing Management

A. Assessment

Assess respiratory rate, oxygen saturation, pulse, blood pressure, temperature, and level of consciousness.
Assess dyspnea, orthopnea, fatigue, chest discomfort, palpitations, dizziness, and syncope.
Auscultate heart sounds and document the location, timing, and characteristics of murmurs when trained and appropriate.
Assess peripheral edema, jugular venous pressure, skin perfusion, and urine output.
Review echocardiography findings, ECG results, medication history, and relevant laboratory tests.
Assess for signs of bleeding in patients receiving anticoagulants.

B. Nursing diagnoses

Decreased cardiac output related to impaired cardiac function.
Activity intolerance related to reduced cardiac reserve.
Excess fluid volume related to cardiac dysfunction.
Impaired gas exchange related to pulmonary congestion, when present.
Anxiety related to illness and planned procedures.
Deficient knowledge regarding medication, follow-up, and symptom monitoring.

C. Nursing interventions

1. Monitor cardiovascular status

Monitor vital signs and cardiac rhythm as indicated.
Observe for new or worsening dyspnea, chest pain, syncope, hypotension, or confusion.
Report sudden deterioration immediately.

2. Maintain respiratory comfort

Position the patient upright or in semi-Fowler's position when breathlessness is present, if tolerated.
Monitor oxygen saturation and respiratory effort.
Administer oxygen when clinically indicated and prescribed or according to emergency protocols.
Escalate care for suspected pulmonary edema or acute respiratory distress.

3. Manage fluid balance

Monitor intake and output when indicated.
Measure daily weight under consistent conditions in patients with fluid overload or heart failure.
Assess edema and respiratory changes.
Administer prescribed diuretics and monitor response, renal function, electrolytes, and blood pressure as appropriate.

4. Promote activity and rest

Balance activity with rest periods.
Increase activity gradually according to symptoms and the care plan.
Assist with activities of daily living when fatigue or breathlessness limits independence.
Stop activity and assess immediately if chest pain, severe dyspnea, dizziness, or syncope develops.

5. Medication safety

Administer prescribed medicines and monitor therapeutic effects.
Monitor for hypotension, electrolyte abnormalities, and other adverse effects as relevant.
For warfarin, reinforce INR monitoring, adherence, bleeding precautions, and checking with the care team before starting or stopping medicines or supplements.
Teach patients not to discontinue prescribed anticoagulants without specialist advice.

6. Preoperative and postoperative care

Verify the planned procedure, consent process, investigations, and preoperative preparation according to institutional policy.
Monitor airway, breathing, circulation, cardiac rhythm, bleeding, wound status, and urine output after the procedure.
Observe for complications such as stroke, infection, arrhythmias, acute kidney injury, or prosthetic valve dysfunction.
Provide education regarding mobility, wound care, medication, and follow-up.

D. Evaluation

Patient maintains appropriate oxygenation and hemodynamic stability.
Dyspnea and congestion improve where present.
Activity is tolerated within the prescribed limits.
Patient demonstrates understanding of medication, warning signs, and follow-up.

17. Complications

Heart failure: Due to pressure or volume overload and eventual ventricular dysfunction.
Atrial fibrillation: Particularly associated with left atrial enlargement, such as in mitral stenosis.
Thromboembolism and stroke: Risk depends on the underlying valve condition, rhythm, and other patient factors.
Pulmonary hypertension: May develop in certain left-sided valve disorders.
Infective endocarditis: Infection of the valve or endocardial surface.
Syncope: May occur in severe aortic stenosis and other conditions that impair cerebral perfusion.
Arrhythmias: May impair cardiac output and increase clinical risk.
Acute pulmonary edema: Can occur in acute severe regurgitation or decompensated heart failure.
Prosthetic valve thrombosis or dysfunction: A potentially serious complication after valve replacement.

Emergency warning signs: Severe or sudden breathlessness, chest pain, fainting, new weakness or facial droop, confusion, cyanosis, or hypotension require urgent medical assessment.

18. Prevention and Patient Education

Promptly assess and appropriately treat suspected streptococcal throat infection according to clinical guidelines to help prevent acute rheumatic fever.
For patients with a history of rheumatic fever or rheumatic heart disease, prescribed secondary antibiotic prophylaxis may reduce recurrence risk.
Maintain regular clinical review and echocardiographic follow-up as recommended.
Practice good oral hygiene and receive regular dental care.
Antibiotic prophylaxis before certain dental procedures is recommended for specific high-risk cardiac conditions, not for every patient with valve disease. Follow current guidelines and clinician advice.
Take prescribed medication consistently.
Follow individualized advice on physical activity, salt intake, fluid intake, and weight monitoring.
Patients with mechanical valves should follow their anticoagulation plan and INR monitoring schedule.
Seek urgent assessment for symptoms suggesting heart failure, stroke, infection, or valve dysfunction.

19. Mnemonics and Exam Pearls

Mnemonic 1: Aortic Stenosis = SAD

S — Syncope
A — Angina
D — Dyspnea

Mnemonic 2: Mitral Stenosis

MS = Mid-diastolic murmur + Shortness of breath
Remember pulmonary venous congestion and possible atrial fibrillation.

Mnemonic 3: Murmur timing

MS / TS: Usually diastolic murmurs.
AS / PS: Systolic ejection murmurs.
MR / TR: Usually holosystolic murmurs.
AR / PR: Usually diastolic murmurs.
MVP: Midsystolic click, sometimes followed by a late systolic murmur.

Mnemonic 4: Remember valve location

APE To Man is a commonly used memory aid for valve auscultation areas:

Aortic — 2nd right intercostal space, right sternal border.
Pulmonic — 2nd left intercostal space, left sternal border.
Erb's point — 3rd left intercostal space.
Tricuspid — lower left sternal border.
Mitral — apex, typically 5th left intercostal space near the midclavicular line.

These are standard approximate listening areas; actual cardiac anatomy and examination findings vary.

Mnemonic 5: Nursing assessment — HEART

H — Hemodynamics and heart rate
E — Edema and exercise tolerance
A — Airway, breathing, oxygenation
R — Rhythm and respiratory symptoms
T — Treatment, tests, and teaching

High-yield clinical pearls

Mitral stenosis: opening snap and low-pitched mid-diastolic murmur may be present.
Mitral regurgitation: holosystolic murmur at the apex, often radiating to the axilla.
Aortic stenosis: systolic ejection murmur often radiating to the carotids.
Aortic regurgitation: early diastolic decrescendo murmur.
Mitral valve prolapse: midsystolic click.
Tricuspid regurgitation: holosystolic murmur that usually increases with inspiration.
Echocardiography with Doppler is central to evaluating most valve disorders.
Mechanical heart valves generally require lifelong warfarin anticoagulation.

20. Last-Minute Revision Table

Disorder	Basic problem	Classic clue	Common assessment finding
Mitral stenosis	Obstructed flow LA → LV	Opening snap	Low-pitched mid-diastolic murmur
Mitral regurgitation	Backflow LV → LA	Murmur radiating to axilla	Holosystolic murmur at apex
Mitral valve prolapse	Leaflets bulge into LA	Midsystolic click	Possible late systolic murmur
Aortic stenosis	Obstructed flow LV → aorta	SAD triad	Systolic ejection murmur to carotids
Aortic regurgitation	Backflow aorta → LV	Wide pulse pressure may occur	Early diastolic decrescendo murmur
Tricuspid regurgitation	Backflow RV → RA	Carvallo sign	Holosystolic murmur louder on inspiration
Pulmonary stenosis	Obstructed flow RV → pulmonary artery	Congenital cause is common	Systolic ejection murmur at left upper sternal border

Before the test, remember:

Stenosis = failure to open adequately.
Regurgitation = failure to close adequately.
Mitral stenosis is commonly associated with rheumatic heart disease.
Severe symptomatic aortic stenosis usually requires valve intervention.
Valve disease severity is assessed primarily with echocardiography.
New severe symptoms should never be ignored.

21. Practice Test: 25 MCQs

Instructions: Select one answer for each question. You have 30 minutes. Navigate using Previous and Next. Press Submit Test to see your score and explanations.

Question 1 of 25 30:00 Answered: 0/25

End of Valvular Heart Disease Notes

Revise the murmur patterns, pathophysiology, diagnostic investigations, and nursing interventions before attempting the test again.

Next recommended topic: Infective Endocarditis — Detailed Notes with Interactive MCQs Test.