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Heart Chamber Valves

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Why This Matters

The four heart valves are your key to understanding how the cardiovascular system maintains unidirectional blood flow—a principle you'll see tested repeatedly in this course. These valves don't just open and close; they represent the heart's solution to a fundamental engineering problem: how do you move fluid through a pump without it flowing backward? When you understand valve structure and position, you unlock questions about cardiac cycle timing, heart sounds, and the pathophysiology of murmurs.

You're being tested on more than valve names and locations. Exam questions will ask you to connect valve function to ventricular pressure changes, the sequence of systole and diastole, and clinical presentations of valve disease. Don't just memorize which valve has two cusps versus three—know why the left side valves are built to handle higher pressures and what happens physiologically when valves fail. Each valve illustrates broader concepts about pressure gradients, structural adaptation, and the consequences of disrupted flow.


Atrioventricular (AV) Valves: Guarding the Atrial-Ventricular Junction

The AV valves prevent backflow from the ventricles into the atria during ventricular contraction (systole). These valves are anchored by chordae tendineae and papillary muscles, which prevent valve prolapse when ventricular pressure spikes.

Tricuspid Valve

  • Three cusps (leaflets) positioned between the right atrium and right ventricle—the "tri" in tricuspid helps you remember it's on the right side (both have an "r" sound)
  • Chordae tendineae attachment prevents the leaflets from everting into the atrium when the right ventricle contracts
  • Lower pressure environment compared to the left side, which is why tricuspid regurgitation may be tolerated longer before symptoms appear

Mitral Valve (Bicuspid Valve)

  • Two cusps located between the left atrium and left ventricle—the only valve with just two leaflets, making it structurally unique
  • Thicker, stronger leaflets than the tricuspid valve because the left ventricle generates pressures around 120 mmHg during systole
  • Most commonly affected valve in rheumatic heart disease; mitral stenosis and prolapse are high-yield clinical correlations

Compare: Tricuspid vs. Mitral—both are AV valves anchored by chordae tendineae, but the mitral has only two cusps and withstands significantly higher pressures. If asked why the mitral valve is more prone to clinically significant disease, think about the mechanical stress of systemic pressure.


Semilunar Valves: Guarding the Ventricular Outflow Tracts

The semilunar valves prevent backflow from the great arteries back into the ventricles during ventricular relaxation (diastole). Their crescent-shaped cusps fill with blood when arterial pressure exceeds ventricular pressure, snapping shut without any muscular attachments.

Pulmonary Valve

  • Three semilunar cusps positioned between the right ventricle and pulmonary trunk—controls flow into the pulmonary circuit for gas exchange
  • No chordae tendineae; closure depends entirely on the pressure gradient when the right ventricle relaxes
  • Lower pressure system (pulmonary arterial pressure ~25/10 mmHg), so this valve experiences less mechanical stress than the aortic valve

Aortic Valve

  • Three semilunar cusps between the left ventricle and aorta—the final checkpoint before blood enters systemic circulation
  • Withstands the highest pressures in the heart; aortic pressure reaches ~120 mmHg during systole
  • Coronary artery ostia are located just above two of the cusps (in the aortic sinuses), so valve disease can affect coronary perfusion

Compare: Pulmonary vs. Aortic—both are semilunar valves with three cusps and no chordae tendineae, but the aortic valve operates under ~5x higher pressure. This explains why aortic stenosis causes more dramatic symptoms (syncope, angina) than pulmonary valve disease.


Functional Pairing: Right Side vs. Left Side

Understanding valves as functional pairs helps you predict clinical consequences and answer comparison questions efficiently.

Right Heart Valves (Tricuspid + Pulmonary)

  • Low-pressure circuit serving pulmonary circulation—right ventricular pressure peaks at only ~25 mmHg
  • Dysfunction consequences include systemic venous congestion (jugular venous distension, peripheral edema, hepatomegaly)
  • Often affected by IV drug use (tricuspid endocarditis) and congenital defects

Left Heart Valves (Mitral + Aortic)

  • High-pressure circuit serving systemic circulation—left ventricular pressure reaches ~120 mmHg
  • Dysfunction consequences include pulmonary congestion (dyspnea, pulmonary edema) because blood backs up into the lungs
  • More clinically significant when diseased due to the higher pressures involved; these are the valves most commonly replaced surgically

Compare: Right-sided vs. Left-sided valve failure—right-sided failure causes systemic backup (edema, JVD), while left-sided failure causes pulmonary backup (shortness of breath, crackles on auscultation). This distinction is essential for clinical reasoning questions.


Quick Reference Table

ConceptBest Examples
AV valves (atria → ventricles)Tricuspid, Mitral
Semilunar valves (ventricles → arteries)Pulmonary, Aortic
Anchored by chordae tendineaeTricuspid, Mitral
No chordae tendineae (pressure-dependent closure)Pulmonary, Aortic
Two cuspsMitral (only one)
Three cuspsTricuspid, Pulmonary, Aortic
High-pressure environmentMitral, Aortic
Low-pressure environmentTricuspid, Pulmonary

Self-Check Questions

  1. Which two valves share the structural feature of semilunar cusps, and what functional property does this shape provide?

  2. Compare and contrast the tricuspid and mitral valves in terms of cusp number, pressure environment, and clinical significance of disease.

  3. A patient presents with pulmonary edema and dyspnea. Which side of the heart (and which valves) would you suspect is dysfunctional, and why?

  4. Why do the AV valves require chordae tendineae and papillary muscles while the semilunar valves do not?

  5. If an exam question asks you to identify the valve most likely affected by IV drug use-related endocarditis, which valve would you choose and what is the anatomical reasoning?