Interplay Between Valvular Heart Disease and Psychiatric Disorders: Mechanisms, Manifestations, and Management

Valvular heart disease (VHD) and psychiatric disorders are each highly prevalent, yet their co-occurrence is underappreciated in clinical practice. Patients carrying both diagnoses present particular management challenges because the pathologic relationship between the two conditions is bidirectional and mechanistically diverse. This narrative review examines the mechanistic, clinical, and therapeutic interplay between VHD and psychiatric illness, with the aim of providing cardiologists and psychiatrists with an integrated framework for recognition and management. We conducted a systematic search of PubMed, MEDLINE, and EMBASE for publications through April 2025, supplemented by a review of the reference lists of retrieved articles. Three mechanistic directions are identified. First, VHD precipitates psychiatric symptoms through hemodynamic burden, neurohormonal activation, cerebral microembolism, and the psychological impact of serious illness. Second, psychiatric disorders and their treatments contribute to VHD through catecholamine-mediated valve stress, chronic inflammation, serotonergic drug-induced valvulopathy, and behavioral risk factors. Third, both conditions share common upstream pathways, including systemic inflammation, oxidative stress, genetic pleiotropy, and adverse social determinants of health. The interplay between VHD and psychiatric disorders calls for structured multidisciplinary care, with psychiatric screening warranted in selected valve populations and echocardiographic vigilance warranted in selected psychiatric cohorts. Adequately powered clinical trials are needed to validate these approaches.