Heart Valve Disease
(Also known as: valvular stenosis, valvular insufficiency, valve prolapse)
When one or more of the heart’s valves do not work properly, the condition is called heart valve disease. The heart has four valves—one at the exit of each of the heart’s chambers. As the heartbeat pushes blood through the chambers, the valves close after the blood has entered to prevent it from leaking backward through the heart.
Sometimes, a valve may not open properly—a condition called valvular stenosis. Stenosis can occur because the valve opening is too small or because the parts of the valve that open (called the leaflets) become stiff or stuck together. With valvular stenosis, the heart has to work harder to push a normal volume of blood through the body.
In a condition called valvular insufficiency, the valve does not close completely. Sometimes, the valve bulges back into the previous chamber of the heart (called valve prolapse). When a valve does not close completely, blood leaks back into the previous chamber of the heart. Valvular insufficiency, like valvular stenosis, causes the heart to work harder; in this case, as it pushes against the backflow of blood.
If untreated, heart valve disease can sometimes lead to other heart problems, including arrhythmias, stroke, pulmonary hypertension, or heart failure.
Causes
Sometimes heart valve disease is congenital—that is, a person is born with the condition. Some cases of heart valve disease are caused by normal wear and tear on the heart valves, which open and close hundreds of thousands of times each day. Other heart diseases or disorders can contribute to heart valve disease by scarring or causing thickening of heart tissue, including:
Some infections can also cause heart valve disease by scarring and damaging the valve leaflets. Examples include rheumatic fever, which was common before the widespread use of antibiotics, and endocarditis, an infection of the lining of the heart. Once valves have been damaged by endocarditis, they are more vulnerable to repeat infection.
Symptoms
Sometimes heart valve disease does not cause any symptoms. The only indication may be a heart murmur that can be heard through a stethoscope. Symptoms of heart valve disease can include:
- Shortness of breath, especially during exercise or when lying down
- Dizziness or fainting
- Chest pain or pressure
- Heart palpitations (a racing heartbeat)
- Weakness or tiredness
- Swelling of the feet, ankles, or abdomen
Many of these symptoms can be confused with less serious conditions, as well as with the effects of aging or physical inactivity, or with other diseases affecting the heart or lungs.
The severity of symptoms does not always correlate with the severity of the heart valve disease. Some people with mild symptoms may need treatment immediately to prevent further heart damage.
Diagnosis
Tests commonly used to diagnose heart valve disease include:
- Echocardiogram: to assess anatomy, valve function, and blood flow through the heart
- Electrocardiogram: to identify problems with heart rhythm
- Chest X-rays: to look at the size and shape of the heart
- Coronary catheterization: to identify blocked or restricted blood vessels
- Exercise Stress Test: to measure how well the heart functions when challenged to work harder than normal
- Magnetic resonance imaging (MRI): to take detailed pictures of the heart’s chambers and blood vessels
Treatment/Management
In many cases, the symptoms of heart valve disease can be managed with drugs, but eventually the valves may need to be surgically repaired or replaced. There are many treatment options available for any one type of heart valve disease. Only a trained specialist can determine the appropriate method for any particular case.
Drug Therapies: Many drugs are available for reducing the symptoms of heart valve disease. These include drugs to:
- Lower blood pressure (ACE inhibitors or angiotensin receptor blockers)
- Slow the heartbeat (beta blockers)
- Keep the heart rhythm normal (anti-arrhythmic drugs)
- Dilate (open) the blood vessels
- Help prevent blood clots (anticoagulants and blood thinners)
- Remove excess fluid in the body (diuretics)
Surgery: Heart valve surgery may be needed to repair or replace a defective valve that might otherwise cause damage to the rest of the heart. If repair is possible, it is preferred over replacement, because a repaired valve is stronger than a replacement valve. Repairs can sometimes be done through a catheter—a small tube threaded through a blood vessel through the heart. Large repairs may require open-heart surgery.
Lifestyle Changes: People with any type of heart valve disease can benefit from reducing salt in the diet to help lower blood pressure, and reducing intake of fat and cholesterol. If a patient is overweight, losing weight can help relieve some of the symptoms of heart valve disease by reducing the burden on the heart. Patients with any type of heart disease should quit smoking. Smoking-cessation aids are available to patients who find it difficult to quit on their own.
Risk Factors and Prevention
Some risk factors for developing heart valve disease are the same as other heart conditions and can be reduced with lifestyle changes or with early detection and medication. To prevent heart disease in general, it is important to:
- Quit smoking
- Get your cholesterol checked and under control
- Eat a healthy diet
- Exercise regularly
- Lose weight if you are overweight
