Talk:Valvular heart disease

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 18 November 2019 and 14 December 2019. Further details are available on the course page. Student editor(s): Segregg. Peer reviewers: Bdbwiki1990.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 12:14, 17 January 2022 (UTC)

Work Plan 2019

Hi folks, I'm a 4th year medical student and I'll be working on updates to this page as a part of an elective course at MUSC. I will be using the wikiproject medicine manual of style, and will be sure that my sources adhere to the WP:MEDRS. Specifically I think the page probably should be rearranged according to the content sections described in the WP:MEDMOS. I'm not sure if these sections should be sub-sectioned based on the valve involved or not, if anyone has any strong opinions, feel free to let me know. I think the table in the comparison was a good thought, but it seems a little difficult to read given the size.
I will prioritize updating the diagnosis, treatment, and epidemiology sections in particular. If available, I think chest X-rays and EKGs could be helpful multimedia to add in the diagnosis section.
I plan on updating treatment guidelines based on the 2017 updated Guideline for the Management of Patients with Valvular Heart Disease. I will use additional sources that include Harrison's Principles of Internal Medicine (20th ed) and the 2019 AATS/ACC/ASE/SCAI/STSExpert Consensus Systems of Care Document: A Proposal to Optimize Care for Patients With Valvular Heart Disease.
I will include information about the diseases that will be relevant to the general public (especially in causes, signs/symptoms subheadings), but will try not to restate what is already in the articles for the specific valvular disorders. I'll continue to link to other existing Wikipedia articles that are relevant. I'll also focus on using clear language and avoiding medical jargon, and will review some patient-directed resources that can help me rephrase if necessary.
Segregg (talk) 20:43, 18 November 2019 (UTC)

Sounds like a good plan! --Emilybrennan (talk) 13:57, 25 November 2019 (UTC)

Content removed

The following content was removed:

In March 29, 2007, pergolide, a dopamine agonist used in treatment of Parkinson's disease and also off label for Restless legs syndrome (RLS), was withdrawn from the US market due to implication in valvular heart disease [1]. The withdrawal was based on findings published in New England Journal of Medicine, confirming previous reports associating pergolide with increased risk of regurgitation of the mitral valve, tricuspid valve, and aortic valve of the heart. Cabergoline, a similar ergot-derived dopamine agonist, is still marketed in EU.

Ergot derivatives (ergotamines) have been implicated in fibrosis not only of the heart valves but also of the pleura and retroperitoneum [2] and possibly other locations.

This is a typical Wikipedia phenomenon - just because this discovery was made after 2001 it is mentioned with massive prominence in an article that is otherwise nothing more than a list. I am removing it temporarily per WP:WEIGHT considerations until the page is more mature. JFW | T@lk 11:52, 13 January 2008 (UTC)

European guidelines

... are a lot shorter - just 39 pages. doi:10.1093/eurhartj/ehl428 JFW | T@lk 12:37, 21 January 2008 (UTC)

Skumin syndrome

Skumin syndrome was added to the intro. Perhaps it ought to be mentioned somewhere, but not in the lead. JFW | T@lk 06:17, 24 October 2011 (UTC)

It seems PMID 7392405 is the relevant reference. On the whole, I don't think the eponym is in widespread use outside Russia. JFWUser_talk:Jfdwolff|T@lk 06:18, 24 October 2011 (UTC)

Pregnancy

A table of the 'Valvular heart lesions associated with high maternal and fetal risk during pregnancy' seems like a better format than the list.

I realize that the citations in the pregnancy section have increasing numbers but all point to the same source. — Preceding unsigned comment added by Triggity (talk • contribs) 16:53, 10 January 2013 (UTC)

AHA/ACC guideline 2014

Bigger than ever:

• doi:10.1161/CIR.0000000000000029 (executive summary)
• doi:10.1161/CIR.0000000000000031 (full report)

The DOIs will be switched on eventually... JFW | T@lk 06:18, 10 June 2014 (UTC)

Review of drug therapy

doi:10.1161/CIRCULATIONAHA.115.016006 JFW | T@lk 09:05, 21 September 2015 (UTC)

Updated American guideline

doi:10.1161/CIR.0000000000000503 JFW | T@lk 09:42, 21 June 2017 (UTC)

Peer Review for Segregg

Overall, this article is written well and in a way that reads simply. I did not feel that the content was biased at any point when reading and the sources provided are reliable. Additionally, one of the strengths of this article is the organization of the contents and succinct explanations of the different types of valvular heart diseases. The lead section is broad and to the point. I actually prefer that the written portion is brief and that this section ends with a very organized content table that leads the reader into a very clear outline of the main points made in the article.

You have done an excellent job adding many reputable sources to this page. I do think that there are large parts of discussion where no sources have been included (examples: “Types” lead introduction, “aortic and mitral valve disorders”). Some of this is due to a more definitional description of terms, like “stenosis”, but I do think there is room for improvement here. A few sections could still be expanded upon, such as “Dysplasia” and “Epidemiology”, but overall, the content of this article is very helpful.

You discussed in your talk page the comparison table is difficult to read and I agree with you. The content within it is helpful, but also very dense and it seems to be overwhelming and in ways takes away from the rest of the clean, concise aspects of this article.

Finally, I really liked reading the "treatment" section. The opening line is very succinct and easy to read, while each section that discusses the specific diseases is clear and to the point. Bdbwiki1990 (talk) 15:26, 9 December 2019 (UTC)

Comparison

I am planning on removing this section from the page and redistributing the information elsewhere in the page, but wanted to leave the section here in case anyone wanted to reference it or put it back in. -Segregg (talk) 16:53, 12 December 2019 (UTC)

The following table includes the main types of valvular stenosis and regurgitation. Major types of valvular heart disease not included in the table include mitral valve prolapse, rheumatic heart disease and endocarditis.

Valvular disease	Mitral stenosis	Aortic stenosis	Aortic regurgitation	Mitral regurgitation	Tricuspid regurgitation
Prevalence	Most common valvular heart disease in pregnancy	Approximately 2% of people over the age of 65, 3% of people over age 75, and 4% percent of people over age 85		2% of the population, equally in males and females.
Main causes and risk factors	Almost always caused by rheumatic heart disease	Calcification of tricuspid aortic valve with age (>50%) Calcification of bicuspid aortic valve (30-40%) Rheumatic fever (<10%) Hypertension, diabetes mellitus, hyperlipoproteinemia and uremia may speed up the process.	Acute Infective endocarditis Trauma Ascending Aorta dissection Chronic Primary valvular: rheumatic fever, bicuspid aortic valve, Marfan's syndrome, Ehlers–Danlos syndrome, ankylosing spondylitis, systemic lupus erythematosus Disease of the aortic root: syphilitic aortitis, osteogenesis imperfecta, aortic dissection, Behçet's disease, reactive arthritis, systemic hypertension	Acute Endocarditis, mainly S. aureus Papillary muscle rupture or dysfunction, including mitral valve prolapse Chronic Rheumatic fever Marfan's syndrome Cardiomyopathy	Usually secondary to right ventricular dilation left ventricular failure is, in turn, the most common cause Right ventricular infarction Inferior myocardial infarction Cor pulmonale Other causes: Tricuspid endocarditis, rheumatic fever, Ebstein's anomaly, carcinoid syndrome and myxomatous degeneration
Hemo dynamics / Patho- physiology	Progressive obstruction of the mitral ostium causes increased pressure in the left atrium and the pulmonary circulation. Congestion may cause thromboembolism, and atrial hypertension may cause atrial fibrillation.	Obstruction through the aortic ostium causes increased pressure in the left ventricle and impaired flow through the aorta	Insufficiency of the aortic valve causes backflow of blood into the left ventricle during diastole.	Insufficiency of the mitral valve causes backflow of blood into the left atrium during systole.	Insufficiency of the tricuspid valve causes backflow of blood into the right atrium during systole.
Symptoms	Heart failure symptoms, such as dyspnea on exertion, orthopnea and paroxysmal nocturnal dyspnea Palpitations Chest pain Hemoptysis Thromboembolism Ascites and edema (if right-sided heart failure develops) Symptoms increase with exercise and pregnancy	Heart failure symptoms, such as dyspnea on exertion (most frequent symptom), orthopnea and paroxysmal nocturnal dyspnea Angina pectoris Syncope, usually exertional	Heart failure symptoms, such as dyspnea on exertion, orthopnea and paroxysmal nocturnal dyspnea Palpitations Angina pectoris In acute cases: cyanosis and circulatory shock	Heart failure symptoms, such as dyspnea on exertion, orthopnea and paroxysmal nocturnal dyspnea Palpitations Pulmonary edema	Symptoms of right-sided heart failure, such as ascites, hepatomegaly, edema and jugular venous distension
Medical signs	Opening snap followed by a low-pitched diastolic rumble with presystolic accentuation. The opening snap follows closer to the S2 heart tone with worsening stenosis. The murmur is heard best with the bell of the stethoscope lying on the left side and its duration increases with worsening disease. Loud S1 - may be the most prominent sign Advanced disease may present with signs of right-sided heart failure such as parasternal heave, jugular venous distension, hepatomegaly, ascites and/or pulmonary hypertension (presenting with a loud P2. Signs increase with exercise and pregnancy	Systolic murmur of a harsh crescendo-decrescendo type, heard in 2nd right intercostal space, radiating to the carotid arteries Pulsus parvus et tardus, that is, diminished and delayed carotid pulse Fourth heart sound Decreased A2 sound Sustained apex beat Precordial thrill	Increased pulse pressure by increased systolic and decreased diastolic blood pressure, but may not be significant if acute Diastolic decrescendo murmur best heard at left sternal border Water hammer pulse Austin Flint murmur Apex beat displaced down and to the left Third heart sound may be present	Holosystolic murmur at the apex, radiating to the back or clavicular area Commonly atrial fibrillation Third heart sound Laterally displaced apex beat, often with heave Loud, palpable P2, heard best when lying on the left side In acute cases, the murmur and tachycardia may be only distinctive signs.	Pulsatile liver Prominent V waves and rapid y descents in jugular venous pressure Inspiratory third heart sound at left lower sternal border (LLSB) Blowing holosystolic murmur at LLSB, intensifying with inspiration, and decreasing with expiration and Valsalva maneuver Parasternal heave along LLSB Atrial fibrillation is usually present
Diagnosis	Chest X-ray showing left atrial enlargement Echocardiography is the most important test to confirm the diagnosis. It shows left atrial enlargement, thick and calcified mitral valve with narrow and "fish-mouth"-shaped orifice and signs of right ventricular failure in advanced disease	Chest X-ray showing calcific aortic valve, and in longstanding disease, enlarged left ventricle and atrium ECG showing left ventricular hypertrophy and left atrial abnormality Echocardiography is diagnostic in most cases, showing left ventricular hyperthrophy, thickened and immobile aortic valve and dilated aortic root, but may appear normal if acute Cardiac chamber catheterization provides a definitive diagnosis, indicating severe stenosis in valve area of <0.8 cm2 (normally 3 to 4 cm2). It is useful in symptomatic patients before surgery.	Chest X-ray showing left ventricular hypertrophy and dilated aorta ECG indicating left ventricular hypertrophy Echocardiogram showing dilated left aortic root and reversal of blood flow in the aorta. In longstanding disease there may be left ventricular dilatation. In acute aortic regurgitation, there may be early closure of the mitral valve. Cardiac chamber catetherization assists in assessing the severity of regurgitation and any left ventricular dysfunction	Chest X-ray showing dilated left ventricle Echocardiography to detect mitral reverse flow, dilated left atrium and ventricle and decreased left ventricular function	Echocardiography identifying tricuspid prolapse or flail ECG showing enlargement of right ventricle and atrium
Treatment	No therapy is required for asymptomatic patients. Diuretics for any pulmonary congestion or edema. If stenosis is severe, surgery is recommended. Any atrial fibrillation is treated accordingly. Medically, with diuretics, prophylaxis of infective endocarditis and chronic anticoagulant administration with warfarin (especially when there's atrial fibrillation) Surgically, by mitral valvuloplasty with a percutaneously inserted balloon, unless significant mitral regurgitation or too much calcification. Indicated in ostium area < 1-1.2 cm2. Other options include valvulotomy or mitral valve replacement by open surgery	No treatment in asymptomatic patients. If symptomatic, treated with aortic valve replacement surgery. Medical therapy and percutaneous balloon valvuloplasty have relatively poor effect. - Any angina is treated with short-acting nitrovasodilators, beta-blockers and/or calcium blockers - Any hypertension is treated aggressively, but caution must be taken in administering beta-blockers - Any heart failure is treated with digoxin, diuretics, nitrovasodilators and, if not contraindicated, cautious inpatient administration of ACE inhibitors	If stable and asymptomatic - conservative treatment such as low sodium diet, diuretics, vasodilators (e.g. (hydralazin or prazosin), digoxin, ACE inhibitors/angiotensin II receptor antagonists, calcium blockers and avoiding very strenuous activity Aortic valve replacement in symptomatic patients (NYHA II-IV) or progressive left ventricular dilation or systolic ventricular diameter >55 mm on echocardiography. Immediately if acute. Also, endocarditis prophylaxis is indicated before dental, gastrointestinal or genitourinary procedures.	Medically Afterload reduction with vasodilators Any hypertension is treated aggressively, e.g. by diuretics and low sodium diet digoxin Antiarrhythmics Chronic anticoagulation in concomitant mitral valve prolapse or atrial fibrillation In acute cases - IABP as temporary solution until surgery Surgery by either mitral valve repair or mitral valve replacement, indicated if very symptomatic (NYHA III), ventricular dilation or decreasing ejection fraction	Treatment of underlying cause Surgery Tricuspid valvular repair Valvuloplasty Valve replacement (rarely performed)
Follow-up		In moderate cases, echocardiography every 1–2 years, possibly complemented with cardiac stress test. Immediate revisit if new related symptoms appear. In severe cases, echocardiography every 3–6 months. Immediate revisit or inpatient care if new related symptoms appear.	In mild to moderate cases, echocardiography and cardiac stress test every 1–2 years In severe moderate/severe cases, echocardiography with cardiac stress test and/or isotope perfusion imaging every 3–6 months.	In mild to moderate cases, echocardiography and cardiac stress test every 1–3 years. In severe cases, echocardiography every 3–6 months.

Diagnostic classification of aortic stenosis

Hello: I think the classification is wrong. It's the other way around. --Ortisa (talk) 15:39, 23 June 2020 (UTC)