Acquired Heart Valve Disease – Summary 

Acquired Heart Valve disease refers to damage or dysfunction of the heart valves that develops after birth. It may result in stenosis (narrowing) or regurgitation (leakage) of one or more valves, affecting normal blood flow. 

Summary of Major Acquired Heart Valve Diseases 

Valve Disease: Mitral Stenosis (MS) 
Common Causes: Rheumatic fever, calcific degeneration 
Pathophysiology: Thickened/fused leaflets → obstructed LA → LV flow 
Characteristic Murmur: Diastolic rumbling murmur at apex with opening snap
Key Clinical Features: Dyspnoea, orthopnea, haemoptysis, AF, malar flush 
Echo Findings: LA enlargement, reduced valve area (<2 cm²), pressure gradient 
Main Treatment: Diuretics, rate control, balloon valvotomy, surgery 

Valve Disease: Mitral Regurgitation (MR) 
 Common Causes: prolapse, papillary muscle dysfunction, annular dilatation, endocarditis, Rheumatic,  
Pathophysiology: Incomplete closure → LV blood regurgitates into LA during systole 
Characteristic Murmur: Holosystolic murmur at apex radiating to axilla 
Key Clinical Features: Fatigue, dyspnoea, palpitations 
Echo Findings: LA/LV dilation, regurgitant jet on Doppler 
Main Treatment: Vasodilators, diuretics, valve repair or replacement 

Valve Disease: Aortic Stenosis (AS) 
Common Causes: Degenerative calcification, bicuspid valve, rheumatic 
Pathophysiology: Narrowed aortic orifice → LV pressure overload 
Characteristic Murmur: Harsh ejection systolic murmur radiating to carotids 
Key Clinical Features: Angina, syncope, dyspnea (AS triad) 
Echo Findings: LV hypertrophy, high gradient across valve 
Main Treatment: Aortic valve replacement (AVR) or TAVI 
(BAV as bridging procedure) 

Valve Disease: Aortic Regurgitation (AR) 
Common Causes: endocarditis, aortic root dilation,  
Rheumatic, 
Pathophysiology: Backflow from aorta → LV during diastole 
Characteristic Murmur: Early diastolic decrescendo murmur (left sternal border) 
Key Clinical Features: Bounding pulse, wide pulse pressure, head bobbing (in extremis) 
Echo Findings: LV dilation, regurgitant jet 
Main Treatment: Vasodilators (ACEI), AVR  

Valve Disease: Tricuspid Stenosis (TS) 
Common Causes: Rheumatic, carcinoid syndrome 
Pathophysiology: Obstructed flow RA → RV 
Characteristic Murmur: Diastolic murmur at left lower sternal border, ↑ with inspiration 
Key Clinical Features: Fatigue, hepatomegaly, ascites, oedema 
Echo Findings: RA enlargement, low gradient 
Main Treatment: Diuretics, surgical repair/replacement 

Valve Disease: Tricuspid Regurgitation (TR) 
Common Causes: RV dilation (pulmonary HTN, LV failure), endocarditis  
Characteristic Murmur: Pathophysiology: Backflow from RV → RA 
Characteristic Murmur:Holosystolic murmur ↑ with inspiration 
Key Clinical Features: Raised JVP, oedema, ascites, pulsatile liver (in extremis) 
Echo Findings: RA/RV dilation, regurgitant flow 
Main Treatment: Treat cause, diuretics, valve repair 

Valve Disease: Pulmonary Stenosis (PS) 
Common Causes: Post-inflammatory, carcinoid, congenital 
Pathophysiology: Obstruction RV → PA 
Characteristic Murmur: Ejection systolic murmur at upper left sternal border 
Key Clinical Features: Fatigue, cyanosis (if severe/ associated with R to L shunt) 
Echo Findings: RV hypertrophy, pressure gradient 
Main Treatment: Balloon valvotomy, percutaneous valve implantation, or surgery 

Valve Disease: Pulmonary Regurgitation (PR) 
Common Causes: Pulmonary HTN, endocarditis, congenital 
Pathophysiology: Backflow from PA → RV 
Characteristic Murmur: Early diastolic murmur ↑ with inspiration 
Key Clinical Features: Dyspnoea, right heart failure 
Echo Findings: RV dilation, regurgitant jet 
Main Treatment: Treat cause, surgery if severe 

General Management Principles 
• Control symptoms (e.g., diuretics for congestion) 
• Manage arrhythmias (especially atrial fibrillation) 
• Prevent complications (e.g., anticoagulation, endocarditis prophylaxis) 
• Timely surgical/interventional correction before irreversible ventricular damage