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Heart Valve Disease (more information)

Overview

Heart valve disease occurs when your heart's valves don't work as they should. You have valves at the exit of each chamber of your heart. Each of these valves makes sure that blood flows freely in a forward direction and that there is no backward leakage.
Heart valves regulate the flow of blood through the heart's four chambers--two small upper chambers (atria) and two large lower chambers (ventricles). Each ventricle has a one-way inlet valve and a one-way outlet valve. The tricuspid valve opens from the right atrium into the right ventricle, and the pulmonary valve opens from the right ventricle into the pulmonary arteries. The mitral valve opens from the left atrium into the left ventricle, and the aortic valves opens from the left ventricle into the aorta.

The heart valves can malfunction either by leaking (valve regurgitation) or by failing to open enough (valve stenosis). Either problem can seriously interfere with the heart's ability to pump blood. Sometimes a valve has both problems.

See heart anatomy www.my.webmd.com/content/pages/9/1675_57850.htm

There are several types of valve disease:

  • Valvular stenosis: This occurs when a valve opening is smaller than normal due to stiff or fused leaflets. Valvular stenosis can lead to heart failure because the narrowed opening may make the heart work harder to pump blood through it. All four valves can be stenotic (hardened, restricting blood flow); the conditions are called tricuspid stenosis, pulmonic stenosis, mitral stenosis or aortic stenosis.
  • Valvular insufficiency: Also called regurgitation, incompetence or "leaky valve", occurs when a valve does not close tightly. If the valves do not seal, some blood will leak backwards across the valve. As the leak worsens, the heart has to work harder to compensate for the leaky valve, and less blood may flow to the rest of the body. Depending on which valve is affected, the condition is called tricuspid regurgitation, pulmonary regurgitation, mitral regurgitation or aortic regurgitation.
  • Mitral valve prolapse: This occurs when the mitral valve leaflets are abnormally stretchy so that as the heart beats, the mitral valve bows or flops back into the left atrium. The condition rarely causes symptoms and usually doesn't need treatment.

(From WebMD)

For an in-depth review of heart valve diseases see www.merck.com/mrkshared/mmanual_html/sec3/19.jsp

Risk factors

Sometimes the cause of valve disease is unknown. It can develop before birth (congenital) or can be acquired sometime during one's life. Acquired valve disease involves changes in the structure of the valve due to a variety of disease or infections, including rheumatic fever or endocarditis.

Risk factors for valve disease include: coronary artery disease, heart attack, heart muscle disease (cardiomyopathy), hypertension, aortic aneurysms, and connective tissue diseases and less commonly, some types of drugs and radiation. Syphilis, a sexually transmitted disease, is also a risk factor for heart valve disease. If you have any of the above conditions, you have an increased risk of developing heart valve disease and should see your doctor.

Prevention and Planning Ahead

As mentioned, heart valve disease can be caused by coronary artery disease, heart attack, and hypertension. To reduce your chance of developing valve disease, try to control the risk factors associated with those diseases. See your doctor regularly and ask questions if you experience any of the symptoms for valve disease. Remain abstinent or use protection when having sex. The sexually transmitted disease syphilis has been shown to contribute to the development of heart valve disease.

If you have valvular disease, follow your doctor's orders. Be sure to tell your doctor and dentist that you have valve disease and take antibiotics before any medical procedure that may cause you to bleed. This includes body piercing and tattoos. Call your doctor immediately if you experience any cold symptoms, fatigue, or just don't feel well. You want to make sure that your illness is not related to your heart disease.

Warning Signs & Symptoms

The symptoms of heart valve disease are not directly related to the severity of your heart valve disease. You many have no symptoms at all and have severe valve disease, or you may have severe symptoms and tests show that your valve leak is not significant (ex. mitral valve prolapse).

Common symptoms of heart valve disease are:

  • Shortness of breath and/or difficulty catching your breath. This may occur while you are doing your normal activities or while you are lying down. You may need to sleep propped up on a few pillows to breath.
  • Weakness or dizziness. You may feel too weak to carry out your normal daily activities. Dizziness and passing out may be symptoms.
  • Discomfort in your chest. You may feel a pain, pressure or weight in your chest with activity or when going out in cold air.
  • Heart palpitations. You may feel rapid heart rhythm, irregular heartbeat, skipped beats or a flip-flop feeling in your chest.
  • Swelling (edema) in your ankles, feet or abdomen. Swelling may occur in your belly, which may cause you to feel bloated.
  • Rapid weight gain. A weight gain of two or three pounds in one day is possible.

Diagnosis

To diagnosis heart disease your doctor will ask you about your symptoms, perform a physical exam, and may order diagnostic tests. The doctor will listen to your heart to hear the sounds your heart makes as the valves open and close. The doctor may also listen to your lungs to see if you are retaining fluid. After the physical exam, the doctor might order the following tests:

  • Echocardiogram
  • Transesophageal echocardiogram
  • Cardiac catherization
  • Radionuclide scans
  • Magnetic resonance imaging (MRI)

By examining your results, repeated over time, your doctor can see the progress of your heart valve disease and prescribe treatment.

Complications

If you have valve disease, you are at risk for getting endocarditis, a life-threatening infection. You are still at risk even if your valve is repaired or replaced through surgery. You should:

  • Tell doctors and dentist you have valve disease. It may be a good idea to carry a card with this information. Call you doctor if you have symptoms of an infection (sore throat, general body aches, fever, etc.). Colds and flues do not cause endocarditis, but infections do.
  • Take good care of your teeth and gums to prevent infections. See your dentist regularly.
  • Take antibiotics before you undergo any procedure that may cause bleeding, such as any dental work (even basic cleanings), tests that may involve blood or bleeding, and most major and minor surgery. Consult your doctor before getting any tattoos or piercing.

Intervention/Treatment

According to WebMD, there are three treatment goals for heart valve disease: protecting your valve from further damage, lessening symptoms, and repairing or replacing valves. www.my.webmd.com/pages/9/1675_57850 Heart Valve Disease).

To treat symptoms and to lessen the chance of further valve damage medication may be given. An ACE inhibitor may be prescribed to widen the blood vessels and lower blood pressure. Anticoagulants or blood thinners are use to prevent blood clots. Diuretics (water pill) decrease the amount of fluid in the body.

The diagnostic tests your doctor orders help to identify the location, type and extent of your valve disease. The result of these tests, the structure of your hearts, your age and your lifestyle will help your cardiologist (heart doctor), surgeon, and you decide what type of procedure will be best for you.

In terms of surgery, you may have your heart valve repaired or replaced. Valves can be repaired or replaced with one of three procedures: percutaneous balloon valvuloplasty, valvulotomy or a minimally invasive heart valve surgical procedure. (www.my.webmd.com/content/article/ 51/40663.htm)

Interactive tutorial on heart valve replacement: www.nlm.nih.gov/medlineplus/tutorials/heartvalve replacement.html

Alternative Medicine

You may find the following website helpful as your search for alternative solutions to treating and preventing heart valve disease:

Frequently Asked Questions

Q: What do heart valves do?

A: Heart valves regulate the flow of blood through the heart's four chambers--two small upper chambers (atria) and two large lower chambers (ventricles).They make sure that blood flows freely in a forward direction and that there is no backward leakage.

Q: What is valvular heart disease?

A: Valvular heart disease or heart valve disease occurs when your heart's valves don't work as they should. Your valves can malfunction either by leaking (valve regurgitation) or by failing to open enough (valve stenosis). Either problem can seriously interfere with the heart's ability to pump blood. Sometimes a valve has both problems.

Q: Is heart valve disease always life-threatening?

A: No. In particular, mitral valve prolapse does not often cause symptoms and does not need treatment. However, it is important to see your doctor if you have the risk factors for valvular disease so you can be properly diagnosed and, if necessary, treated.

Q: Can a sexually transmitted disease (STD) affect my heart?

A: Yes. Studies have shown that syphilis can contribute to the development of heart valve disease. The best way to prevent contracting syphilis is to remain abstinent. However, if you are going to have sex, use protection.

Q: At night I have trouble breathing. I normally have to sleep propped up on a few pillows. Is this related to my heart?

A: Yes, it could be. Shortness of breath and/or difficulty catching your breath is a symptom of heart valve disease. This may occur while you are doing your normal activities or while you are lying down. You may need to sleep propped up on a few pillows to breath. See your doctor immediately if you are experiencing problems breathing.

Q: I feel a flip-flop and/or fluttering feeling in my chest. What is this?

A: You may be experiencing heart palpitations. You may feel rapid heart rhythm, irregular heartbeat, skipped beats or this flip-flop feeling. This occurs in patients with heart valve disease because the heart is being overworked. Discuss your symptoms with your doctor and get an official diagnosis from him or her.

Q: My feet are swelling and I gained 5 pounds this week. What is going on?

A: Swelling (edema) in your ankles, feet or abdomen is a symptom of heart valve disease. Because the heart's valves are not pumping blood as they should, fluid begins to back-up in the ankles, felt or abdomen. Rapid weight gain is also a symptom of heart valve disease. See your doctor so that he/she can determine if you have heart valve disease.

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