Valvopathy

Symptoms of Valvulopathies

The main symptom of a valve disease is dyspnea, caused by increased cavity filling pressures secondary to volume or pressure overload. The graduation of dyspnea follows the guidance of the New York Heart Association and can be summarized below:

Class I: No limitation on physical activity

Class II: Slight limitation on physical activity

Class III: Marked limitation on physical activity. Asymptomatic at rest.

Class IV: Symptoms at rest or minimal physical activity.

Other symptoms can be found with some frequency in the valvulopathies in general.

Palpitation

Palpitation is the sensation of beat expressed by an individual. Patients with valvular heart disease may present dilation of cavities, as well as decompensation of physiological compensatory mechanisms leading to the appearance of myocyte apoptosis and interstitial fibrosis. Both situations can evolve with the appearance of arrhythmias, from the simplest, such as supraventricular ectopics, to the most complex, such as malignant ventricular tachyarrhythmias.

Chest pain

Chest pain can occur for several reasons in patients with heart valve disease. From the concomitance with common coronary artery disease in cases of senile calcific aortic stenosis, as well as in cases of intense elevation in cavity filling pressures, such as pulmonary hypertension, we can find the complaint of chest pain or discomfort.

Patients with aortic stenosis alone, with no coronary disease, may experience chest pain that is typically anginal due to a decoupling between coronary flow and myocardial O2 demand.

Fatigue

The complaint of fatigue or tiredness is not as frequent as dyspnea, but it can be found, especially in the involvement of the valves on the right side of the heart, such as the tricuspid. Advanced pictures of tricuspid regurgitation can lead to systolic dysfunction of the right ventricle and systemic venous congestion upstream. In this scenario, due to an elevated preload in a dysfunctional ventricle, the systolic output may fall short of what is necessary, resulting in this symptom of fatigue.

Syncope

Some valvular heart diseases may develop with syncope and the severity of the condition is directly related to the origin of the syncope. Patients with advanced cavity dilations, or disproportionate hypertrophies, may have dysfunction of intracavitary baroreceptors that emit inadequate signals to the peripheral vasculature resulting in vaso-vagal pictures.

Patients who evolve with severe arrhythmias may present syncope preceded by palpitations, which, in general, denotes more severe conditions, with risk of sudden death.

Individuals with heart failure with a drop in ejection fraction and concomitant valve disease may present with borderline blood pressure and small falls from it can cause syncopes that are usually associated with typical hypotension prodromes.

Suggested literature:

1 – Braunwald, Eugene. Tratado de medicina cardiovascular. 10ª ed. São Paulo: roca, 2017. v.1 e v.2.

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