- so you're probably aware that we have four valves in the heart, and if you're not, that's completely okay. and you can see in thishandy little drawing that i've placed on theleft side of the screen that you can actually seeall four valves at once in this picture, and that'skind of a unique view, and it gives you a way to visualize where the valves are inrelation to each other.
so let me help you orientyourself real quick. so the way i like to think about this is as if i'm on top of a building, there's me, a little stick guy, and i'm about to dropthis big water balloon on someone down here, who's just kind of minding their own businessand reading a newspaper. and if you're wondering, i definitely would havedropped the balloon.
but you can see that this guydown here is facing this way, and i'm up here looking down basically at the back of his head. and so, if i could look through his skull and down into his chest, i may come across a crosssection of the heart that actually looks likewhat i've drawn here. and i can tell you thatthis is the pulmonic valve, and i'll abbreviate that pv.
this is the aortic valve, av. this is the mitral valve, andthis is the tricuspid valve. so let's talk about murmurs for a second. so if you've been in the hospital, or you're familiar with cardiology, or maybe your grandmaor grandpa has a murmur, maybe you've heard ofsome of the common ones, like, let's say, mitral regurgitation or maybe aortic stenosis.
well, a lot of people get caught up with the regurgitation part or the stenosis and may forget what's actually causing or caused these problems. and so, let's take a lookat some of the things that actually causevalvular heart disease. so some valves canactually become calcified, and even though i'm drawingthese little calcium ions as if they're ions and in solution,
that's not really the case. and these calcium ionskind of go together with fat and cholesterol, andthe last time you heard all those words together, unless you were talking abouta big mac and a glass of milk, it was probably in referenceto atherosclerosis. and so, the process of valve calcification has actually been found tobe very close to the process that causes atherosclerosis,
and atherosclerosis is just the buildup of fatty and, over time, calcific plaques in the arteries of the body. so another cause of valvulardisease is valve degeneration, and a lot of the times the degeneration is associated withconnective tissue disorders, and all that really meansis that you have problems with proteins that normally make up some of the structuralcomponents of the body,
and there are these structuralcomponents in valves and some of the heart structures. and so, that's why these valvescan become dysfunctional. and so, a classicconnective tissue disorder would be something like marfan syndrome, and the way i like to remember that is with a picture of good ole abe lincoln. now this is not to say that abelincoln had marfan syndrome, but he did have some of the very typical
outward features of marfan, such as being really tall and skinny, having long fingersand a really long face. so what else can do it? well, bugs can do it. and when i say bugs, idon't mean an ant or a fly but rather a pathogenor a bacteria or virus. and so, these bugs canactually get into the blood, and since all the bloodgoes through the heart,
then these bugs will actually see the surface of the valves in the heart, and they can either stick toit or cause an immune response or a combination of thetwo, and as a result, you could get problems withthe normal working of a valve. and so, if you'll notice where i've placed all of these causes, they're actually all on theleft side of this diagram. and so, if you bear with me for a second,
i'm going to kind of splitthe heart into left and right. and so, here i've separatedthe left side of the heart and the right side of the heart, in terms of the valves, and the reason i've done this and listed all the causes on the left side is because as a general rule, left-sided valvular heart conditions are much more common thanright-sided valvular conditions,
and the reason for this ispretty easy to understand. i like to think aboutit with a pair of shoes. so i have this pair of shoes that i love and wear all the time, and those get really worn out quickly. and then i have this other pairof shoes that i kind of baby and i wear on the weekendsor on special occasions, and those never get worn out. they last for a really long time.
and so, the left-sided valves are like that pair of shoes thati wear all the time. and so, because the left side of the heart is the workforce that pumps blood out to the rest of the body, and it's pumping at really high pressures, every time the heart beatsand goes through a cycle, blood is smacked up againstthese valves on the left side. in the right side, bloodsplashes up against these valves
because it's at much lower pressure and is performing much less work. and so, to illustrate thelast two major causes, i'm going to come over tothe right side of the screen. and so, let me explainwhat this diagram is. we're actually lookingat the left atrium here, the aorta here, and this wholething is the left ventricle. and so, for these two causes, the same left-to-right rule,
meaning left more commonthan right, still applies. and so, the first thingi want to talk about is annular dilation. so the annulus is reallyjust this fibrous ring that supports the valves. and so, you can see i'mcircling those in right here for the two valves in this diagram. and so, in a conditionsuch as an aortic aneurysm, which is really just a ballooning out
of the walls of an artery, you would have something thatlooks a little more like this, and as a result, it's goingto pull the annulus this way. and so, if we actually come over to the other diagram for a second and get rid of this line down the middle, so we can see the aortic annulus, i can actually show youwhat that would look like in this view of the heart.
and so, instead of theannulus that i'm erasing now, as a result of this aortic aneurysm, now it's been dilated,and instead of the cusps coming together nicely, now maybe you have a situation like this, meaning that the valvedoes not close fully. and that circle that i'mdrawing is the open area from the valve not being able to close. now, how could you get annular dilation
in the other valve inthis diagram on the right? well, what if the actual heartmuscle dilates or expands? well now the annulus of thisvalve is being pulled this way. and so, in a similar fashion it's going to pull the valve apart. and over here on the left diagram, this would now look something... like this. and so, now you can see thatthis space in the middle,
where my cursor is, is all open. and so, you can imagine howthat could cause problems with blood flow in the proper direction. and so, the last major causei want to talk to you about are ventricular attachment points. and so, you'll notice in this diagram that we have these blue things right here, and these are called papillary muscles, and this is actually part ofthe left ventricular muscle,
but they have a specific function, and that function is to holdthese white strings here, which are called chordae tendineae. and i'm not really aprofessional at language, but to me that would seemto mean tendinous cords, and these tendinous cordsare attached to the valve. and so, the papillary muscles serve as a ventricular attachment to the valves via the chordae tendineae.
and so, you can imaginethat if we have a rupture or break in a papillarymuscle, or the same thing, a rupture or a breakin a chordae tendineae, then this valve over here is kind of free to float wherever it wants. and so, that can be problematic. and so, these are most of the major causes of valvular heart disease.
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