ABSTRACT
Preface 7 Glossary of Abbreviations 8
Chapter 1 Approach to the Patient 9 General principles 9 History 9
Past medical history 9 Family history 9 Social history 9 Chief complaint and present illness 10
Dyspnea 10 Palpitations 10 Angina 10 Syncope 11 Weight gain, edema, and abdominal
discomfort 11 Constitutional symptoms 11 Embolic phenomena 11
Physical exam 12 General appearance 12 Vital signs 12 Skin and mucosa 12 Central venous pulsations 12 Arterial pulse 12 Precordial palpation 12 Cardiac auscultation 12 Chest exam 13
Laboratory investigations 13 Electrocardiography 13 Chest radiography 13 Echocardiography 14 Cardiac catheterization and contrast
radiography 15 Magnetic resonance imaging/
computed tomography 15 Nuclear cardiology 16 Positron emission tomography 16
References 16
Chapter 2 Cardiac Murmurs 17 Introduction 17 Classification 17
Systolic murmurs 18 Early systolic murmurs 18 Midsystolic murmurs 19 Late systolic murmurs 20 Holosystolic murmurs 20
Diastolic murmurs 21 Early diastolic murmurs 21 Mid-diastolic murmurs 21 Late diastolic (presystolic) murmurs 22
Continuous murmurs 22 Further evaluation of a murmur 24 References 25
Chapter 3 Prevention of Valvular Heart Disease 27 Introduction 27 Bacterial infective endocarditis 27 Rheumatic fever prophylaxis 30 Metabolic disorders 32 Valvulopathic agents 32 References 32
Chapter 4 Aortic Stenosis 33 Definition 33 Etiology 34 Pathophysiology 36 Clinical presentation 36
Symptoms 36 Signs 37 Laboratory findings 38
Electrocardiography 38 Chest radiography 38 Echocardiography 39 Cardiac catheterization 40 Cardiac magnetic resonance 40
Treatment 41 Medical management 41 Percutaneous intervention 42 Surgical intervention 42
Case study 46 Comments 46
References 47
48 Definition 48 Etiology 48 Pathophysiology 48 Clinical presentation 48
Symptoms 48 Signs 49 Laboratory findings 50
Natural history 52 Medical management 53
Medical therapy 53 Physical activity 53 Patient follow-up 55
Surgical intervention 55 Repair versus replacement 55 Asymptomatic patients 55 Symptomatic patients with normal left
ventricular function 57 Symptomatic patients with left
ventricular dysfunction 57 Case study 58
Comments 58 References 59
Chapter 6 Acute Aortic Regurgitation 60 Definition 60 Etiology 60 Pathophysiology 61 Clinical presentation 62
Symptoms 62 Signs 62 Laboratory findings 62
Natural history 62 Medical management 62 Surgical intervention 63 Case study 63
Comments 63 References 64
Chapter 7 Mitral Stenosis 65 Definition 65 Etiology 65 Pathophysiology 66 Clinical presentation 66
Symptoms 66 Signs 67 Laboratory findings 67
Electrocardiography 67 Chest radiography 67 Echocardiography 68 Cardiac magnetic resonance 68
Natural history 68 Medical management and follow-up 68 Percutaneous intervention 70 Surgical intervention 73
Surgical commissurotomy 73 Mitral valve repair and replacement 73
Case study 74 Comments 74
References 75
Definition 76 Etiology 76 Clinical presentation 77 Natural history 79 Medical management 79 Surgical intervention 79 Case study 79
Comments 80 References 80
Chapter 9 Chronic Mitral Regurgitation 81 Definition 81 Etiology 81 Pathophysiology and natural history 82 Clinical presentation 82
Symptoms 82 Signs 83 Laboratory findings 83
Electrocardiography 83 Chest radiography 84 Echocardiography 84 Cardiac catheterization 84
Medical management and follow-up 86 Surgical intervention 87 Case study 88
Comments 89 References 90
Chapter 10 Acute Mitral Regurgitation 91 Definition 91 Etiology 91 Pathophysiology 92 Clinical presentation 92
Symptoms 92 Signs 94 Laboratory findings 94
Medical management 94 Surgical intervention 94
Case study 94 Comments 95 References 95
Chapter 11 Pulmonic Stenosis 96 Definition 96 Etiology 96 Pathophysiology 97 Clinical presentation 98
Symptoms 98 Signs 98 Laboratory findings 98
Electrocardiography 98 Chest radiography 98 Echocardiography 98 Cardiac catheterization 99
Medical management 99 Percutaneous and surgical intervention 99 Case study 100
Comments 100 References 100
101 Definition 101 Etiology 101 Pathophysiology 102 Clinical presentation 102
Symptoms 102 Signs 102 Laboratory findings 102
Electrocardiography 102 Chest radiography 102 Echocardiography 102 Cardiac catheterization 104
Medical, surgical, and percutaneous intervention 104
Case study 104 Comments 105
References 106
Chapter 13 Tricuspid Stenosis 107 Definition 107 Etiology 107 Pathophysiology 108 Clinical presentation 108
Symptoms 108 Signs 108 Laboratory findings 108
Electrocardiography 108 Chest radiography 108 Echocardiography 110 Cardiac catheterization 110
Medical management 110 Percutaneous and surgical intervention 110 Case study 111
Comments 112 References 112
Chapter 14 Tricuspid Regurgitation 113 Definition 113 Etiology 113 Pathophysiology 114 Clinical presentation 115
Symptoms 115 Signs 115 Laboratory findings 115
Electrocardiography 115 Chest radiography 115 Echocardiography 116 Cardiac catheterization 116
Natural history 116 Medical management 117 Surgical intervention 117 Case study 118
Comments 118 References 119
Aortic stenosis and aortic regurgitation 120
Pathophysiology 120 Clinical presentation 120 Management 122
Mitral stenosis and mitral regurgitation 122 Etiology 122 Pathophysiology 122 Clinical presentation 122 Management 122
References 122
Chapter 16 Multiple Valve Disease 123 Mitral stenosis/aortic stenosis 123 Mitral stenosis/aortic regurgitation 123 Mitral regurgitation/aortic stenosis 123 Mitral regurgitation/aortic regurgitation 126 Prosthetic valves in multiple valve disease 126 References 126
Chapter 17 Infective Endocarditis 127 Definition 127 Etiology 127 Pathophysiology 128 Clinical presentation 129 Medical management 130 Surgical intervention 131 Case study 133
Comments 134 References 135
Chapter 18 Drug-Induced Valvular Heart Disease 136 Anorectic medication 136
Background 136 Initial reports of valvulopathy 136 Subsequent epidemiologic studies 139 Pathogenesis 139 Recommendations 139
Methysergide 140 Ergotamine 140 Pergolide 141 References 142
Chapter 19 Prosthetic Heart Valves 143 Types of prosthetic valves 143 Selection of valve prosthesis 144 References 148
Heart Disease 149 Pregnancy in women without
valvular heart disease 149 Physiology 149 Physical exam 149 Echocardiography 150
Maternal and fetal outcomes in valvular heart disease 150
Management guidelines for specific lesions 152 Mitral stenosis 152 Mitral regurgitation 152 Aortic stenosis 153 Aortic regurgitation 153 Pulmonic stenosis 153 Tricuspid valve disease 153
Endocarditis prophylaxis 153 Cardiac valve surgery 154 Anticoagulation 154
Warfarin 154 Heparin 155
References 156
Chapter 21 Valvular Heart Disease in the Elderly 157 General considerations 157
Epidemiology 157 Effect of normal aging 157 Prevalence of comorbidities 157
Impact of aging on presentation and evaluation 157 Aortic valve disease 157
Aortic sclerosis 157 Aortic stenosis 157 Aortic regurgitation 158
Mitral valve 158 Mitral annular calcification 158 Mitral stenosis 158 Mitral regurgitation 158
Tricuspid and pulmonic valve disease 158 Infective endocarditis 159
Special considerations in valve surgery in the elderly 160 Weighing risks and benefits 160 Preoperative investigations 160 Choice of prosthesis 160 Results 161
References 162
Valvular Heart Disease 163 Introduction 163 Outcome measures 163 Examining variation 163 Approaches to improving results 164 Conclusion 164 References 164
Chapter 23 Recent and Future Developments in Valvular Heart Disease 166 Introduction 166 Biology and prevention 166 Diagnosis and imaging techniques 167 Pharmacologic management 167 Electrophysiologic techniques 168 Percutaneous and surgical techniques 168 References 169
Appendix A – Seminal Randomized Clinical Trials in Valvular Heart Disease 171
Appendix B – International Websites Relevant to Valvular Heart Disease 173
