Valvular Heart Disease

The authors aim to provide a concise and straightforward guide to the recognition and management of valvular heart disease, complemented by current guidelines and abundant high quality images. This book will be a valuable reference for all involved in the care of patients with valvular heart disease, including cardiologists in practice and training, young hospital doctors, general physicians, cardiac nurse specialists, and medical students. The study of valvular heart disease has progressed rapidly over the past two decades. The under - standing of etiology and natural history, the precision of noninvasive assessment, and the surgical and interventional management of valve disease have all improved dramatically. Coupled with an appreciation of physiologic principles, thoughtful interviews and physical exam, current technology allows clinicians to characterize valve lesions fully. In addition, evolving techniques in interventional cardiology and cardiac surgery, guided by quantitative outcome analysis, have reduced the morbidity and mortality of these procedures. Throughout this handbook, we have endeavored to incorporate these developments. Since the clinician’s work generally begins with a patient’s complaint, we have devoted most of the first chapter to the evaluation of symptoms commonly voiced by those with valvular heart disease. The second chapter focuses on the evaluation of murmurs, an important topic, since their recognition is critical to diagnosing asymptomatic valvular heart disease before irreversible myocardial damage occurs. The middle chapters provide a structured summary of the current understanding of the etiology, pathophysiology, natural history, clinical presentation, laboratory features, and medical and surgical treatment of valve disease. Single valve lesions are followed by mixed valve disease and an additional chapter on multiple valve disease. The final chapters address special topics in valvular heart disease which are not covered in a valve-by-valve approach. These include infective endocarditis, drugrelated valvulopathy, pregnancy, special concerns in the elderly, valve prostheses, and improvement efforts in valvular heart disease. In the interest of evidence-based medical practice and consistent, rational application of limited resources, we have extensively cited clinical guidelines and recommendations from specialty societies on both sides of the Atlantic. We expect the succinct and structured text, complemented by current guidelines and abundant images, will be a valuable reference for all involved in the care of patients with valvular heart disease including medical students, house officers/registrars, cardiac nurse specialists, generalist physicians, and cardiologists. Bruce W. Andrus John C. Baldwin Contents Preface Glossary 1. Approach to the patient, 2. Cardiac murmurs 3. Prevention of valvular heart disease, 4. Aortic stenosis, 5. Chronic aortic Regurgitation 6. Acute aortic regurgitation, 7. Mitral stenosis, 8. Mitral valve prolapse, 9. Chronic mitral regurgitation, 10. Acute mitral regurgitation, 11. Pulmonic stenosis, 12. Pulmonic regurgitation, 13. Tricuspid stenosis, 14. Tricuspid regurgitation, 15. Mixed single valve disease, 16. Multiple valve disease, 17. Infective endocarditis, 18. Drug induced valvular heart disease, 19. Prosthetic heart valves, 20. Pregnancy and valvular heart disease, 21. Valvular heart disease in the elderly, 22. Quality improvement in valvular heart disease. Index