Symptoms pointing to specific valvular lesions

Symptoms pointing to specific valvular lesions

Symptoms pointing to specific valvular lesions – certain symptoms could point to certain specific valvular lesions more than the others:

Paroxysmal nocturnal dyspnea (PND) is more likely a feature of severe mitral stenosis. PND is often an early feature and may disappear later as protective mechanisms develop in the pulmonary vasculature. It could be a late feature in other left sided valvular lesions.

Exertional palpitation is more likely to be due to regurgitant valvular lesions like mitral and aortic regurgitation. This is because of the hyperdynamic motion of the volume overloaded left ventricle being felt.

Episodic palpitation at rest can occur due arrhythmia, more often atrial fibrillation, in mitral stenosis. Onset of atrial fibrillation is an important cause of precipitation of heart failure in those with valvular lesions. Atrial fibrillation also enhances the risk of cardioembolic stroke.

Effort angina is a feature of aortic stenosis. In severe aortic stenosis, left ventricular hypertrophy causes a mismatch between the coronary arterial blood flow and oxygen demand of the left ventricle, leading to effort angina. Median survival in aortic stenosis with angina is considered to be five years without definitive treatment.

Syncope is an important symptom of severe aortic stenosis. In severe aortic stenosis, the cardiac output cannot increase much during exercise. This leads to fall in blood pressure when there is peripheral vasodilation with exercise, leading to syncope. Syncope can also occur, though less commonly with other obstructive valvular lesions and severe pulmonary hypertension, which act in a similar way by restricting cardiac output.