Valve stenosis and regurgitation
How heart valves keep blood moving one way, why a narrowed valve loads the heart with pressure and a leaking valve with volume, how the heart adapts and then fails, and how murmurs and symptoms follow from the mechanism.
By the end, you can
- Describe how the four valves open and close during the cardiac cycle.
- Distinguish stenosis (obstruction) from regurgitation (backflow) and the loads each places on the heart.
- Explain how aortic stenosis causes left ventricular hypertrophy, angina, fainting and breathlessness.
- Explain how chronic mitral regurgitation dilates the left heart and how acute regurgitation differs.
- Relate the timing of a murmur to the valve and lesion that cause it.
- Recognise the classic appearances, grading and tests of valve disease, and explain how valve procedures and the main drug classes act on its mechanism.
What it is
Valvular heart disease is dysfunction of one or more heart valves. A valve can be stenotic, failing to open fully so that it obstructs forward flow, or regurgitant (incompetent), failing to close fully so that blood leaks backwards. The commonest serious lesions in high-income countries are aortic stenosis and mitral regurgitation; rheumatic heart disease remains a major cause worldwide.
3 types to tell apart
- Aortic stenosis
- Usually age-related calcification of a normal or bicuspid valve; a pressure load on the left ventricle.
- Mitral regurgitation
- Degeneration and prolapse of the leaflets, a dilated ventricle stretching the ring, or damage to papillary muscles; a volume load.
- Mitral stenosis and aortic regurgitation
- Mitral stenosis is mostly rheumatic; aortic regurgitation follows valve or aortic root disease. Each follows the same pressure-or-volume logic.
Normal function
Valves keep blood moving one way
Four valves direct blood through the heart. Between atria and ventricles lie the tricuspid valve and the mitral valve, with its and . At the outflows lie the pulmonary valve and the aortic valve, with its three cusps, including the .
Valves open and close passively, driven by pressure. In systole, the left ventricle pushes the aortic valve open and the mitral valve shut; anchored to stop the mitral leaflets turning inside out. In diastole the aortic valve closes and the mitral valve opens to let the ventricle fill.
Valve closure makes the heart sounds: the first sound as the mitral and tricuspid valves close, the second as the aortic and pulmonary valves close. Normal valves let blood pass silently.
Underlying change · Step 1 of 4
Two ways a valve fails: narrowing or leaking
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Disrupted function · Step 2 of 4
Aortic stenosis: a pressure load
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Disrupted function · Step 3 of 4
Mitral regurgitation: a volume load
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Consequences · Step 4 of 4
Murmurs, symptoms and consequences
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Symptoms and signs
Symptoms, signs and findings
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Exam detail
Exam detail
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Treatment
How treatment works
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Recap
Recap
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Self-check
Check your understanding
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .