asymptomatic at first, but due to the progressive and degenerative nature of the disease, may eventually become severe and lead to heart failure and death if left untreated. In general, VHD is related to aging. Prevalence is increasing as the U.S. population ages and lives longer. Aortic stenosis is the most common valve disease in the United States, followed by mitral regurgitation, aortic regurgitation, and mitral stenosis.
Symptoms of VHD in decreasing frequency include shortness of breath or dyspnea, chest pain and palpitations, and syncope or near syncope. Because nearly all patients with severe disease will present with one of these symptoms, VHD can usually be evaluated using the algorithms for these symptom categories described in Figure 12-1.
Two simple principles govern the management of VHD and the probability that a patient is disabled from it: the presence of symptoms and the severity of the lesion. Table 12-1 presents the categories of disease severity for each valve lesion. In general, but with rare exceptions, only severe disease is capable of causing symptoms and disability. VHD should be diagnosed based on clinical evaluation of the patient and assessment by