What is heart valve disease?
Heart valve disease is an umbrella term that describes any disease or disorder that involves one or more of the heart’s valves. It is sometimes called valvular heart disease.
The human heart has four functional valves, namely the mitral valve, the tricuspid valve, the aortic valve, and the pulmonary valve. Any or all of these may be abnormal in some way, causing malfunction and health problems.
Heart valve disorders can be serious and symptomatic, or they can be benign and not cause problems.
What goes wrong in people with valve disease?
Heart valve disorders can be acquired or they can be congenital.
When congenital, birth defects are present. One or more valves do not open or close properly, restricting blood flow (stenosis) or allowing blood to leak back into the heart’s chambers (regurgitation). This can alter blood pumping function and affect the body’s organs, causing symptoms and complications.
The same occurs with the valves when valvular disease is acquired. However, the problem develops due to bodily changes that come naturally with age. Infection, the use of certain drugs and medications, and underlying medical conditions may also cause heart valve diseases.
What causes heart valve disorders?
Congenital heart valve disease is hereditary and develops before birth. It usually affects the aortic and pulmonary valves, which may not form properly. They may be the wrong shape, size, or structure.
Acquired valve disease develops after birth. It occurs due to age-related degeneration (valve deposits), atherosclerosis, hypertension, cardiomyopathy, heart attacks and heart failure, infective endocarditis, connective tissue problems like marfan syndrome, and infections such as rheumatic fever.
Carcinoid tumors, syphilis, autoimmune disorders like lupus, and metabolic disorders like fabry disease are other causes of heart valve disease. Radiation therapy of the chest and certain diet medications, especially phentermine and fenfluramine, can also damage the valves.
What types of valvular heart disease are there?
The two main heart valve problems are stenosis and regurgitation. Both can affect any of the valves.
When a valve does not open completely due to narrowing, thickening, stiffening, blockage, or fusion, this is called stenosis. When it does not close tightly and blood leaks backwards due to abnormal structure or prolapse, this is known as regurgitation, incompetence, or insufficiency.
Valve abnormalities aren’t always significant. Sometimes, damage or defects can be so slight that they do not cause improper closure, opening, symptoms, or complications.
Types of heart valve disease include mitral valve prolapse, mitral insufficiency, mitral stenosis, aortic insufficiency, aortic stenosis, tricuspid insufficiency, tricuspid stenosis, pulmonary valve insufficiency, pulmonary valve stenosis, endocarditis, and bicuspid aortic valve disease.
Who is at highest risk of developing problems with the valves?
The risk of developing heart valve disease increases with age. The heart’s valves tend to deteriorate over time. This can cause problems later on in life. Because the average life expectancy is longer now due to advances in medicine, people are more prone to developing heart valve problems.
A history of heart attacks, heart failure, rheumatic fever, or infective endocarditis significantly increases the risk of developing heart valve related disorders. Underlying problems such as high blood pressure, high blood cholesterol, diabetes, and insulin resistance can also lead to damage of the valves.
Other risk factors include obesity, a sedentary lifestyle, cigarette smoking, drug use/abuse (especially drugs taken through the veins), and a family history of heart disease.
What are the symptoms and signs of heart valve disease?
While heart valve problems can cause symptoms that are specific to the affected individual, people with valvular disorders often experience a lot of the same symptoms.
The most common symptoms are angina, shortness of breath (especially during exertion and when lying down), and unexplained fatigue. Dizziness, fainting, and heart palpitations (a racing heartbeat, skipped beats, etc.) are also fairly common. Some people may experience an uncomfortable sensation of pressure in the chest, especially with exertion and when the weather is cold.
Other symptoms include edema (swelling of the abdomen, legs, ankles, feet, and neck veins due to fluid buildup), rapid weight gain, and fever (as commonly featured in endocarditis). Although a heart murmur is normally a sign of valve disease, healthy people can also have murmurs.
How is valvular heart disease diagnosed?
Heart valve disease can be detected once a doctor performs a physical examination using a stethoscope and carefully evaluates the patient’s symptoms and medical history.
However, most physicians will perform additional tests, to confirm the diagnosis, establish the location and severity of the problem, and determine the most suitable treatment.
Testing typically involves having one or more of the following done: blood work, an echocardiogram, an electrocardiogram (EKG), chest x-rays, cardiac catheterization, and/or a magnetic resonance imaging (MRI) scan. A stress test and computed tomography (CT) scan may also be required.
Diagnostic tests provide a detailed look at the anatomy and function of the heart and its structures.
How are heart valve disorders treated?
The two main treatment options are surgery and medication.
With surgery, the aim is to repair or replace the problematic valve/s and correct any physical problems in nearby structures, restoring normal function. This may involve annuloplasty, leaflet repair, valvuloplasty, valvulotomy, replacing real valves with prosthetic or bioprosthetic valves, and other procedures.
Surgery can be invasive or minimally invasive.
Medication is given to promote proper blood flow and function, prevent infection and complications, and ease symptoms. Heart valve disease medications include beta blockers, anticoagulants, antithrombotics, vasodilators, cardiac glycosides, diuretics, prophylaxis antibiotics, and benzodiazepines, among others.
Healthy eating and regular exercise are also usually recommended in the treatment of valvular heart disease, and some supplements may prove helpful.
How are heart valve problems prevented?
Several things can be done to prevent valvular heart disease.
Firstly, a sore throat that persists for two or more days should be treated promptly, particularly if a fever is present. Prescribed antibiotics should be taken exactly as directed and should always be completed. This can prevent rheumatic fever, which is known to damage heart valves.
Good dental hygiene (regular flossing, brushing, and dentist visits) and treating and avoiding dental infections with antibiotics and is equally important, to prevent endocarditis. Patients who have had the infection before and those with prosthetic valves may need prophylaxis before dental work.
Leading a healthy lifestyle (staying active, eating a balanced diet, drinking alcohol in moderation, not smoking cigarettes, etc.) can also help to prevent heart valve disease.
What is the prognosis for patients with heart valve disease?
The prognosis depends on the severity of the condition and how it is treated and managed. Those who exercise and eat healthy generally have a better outlook. This is not always the case, though.
Some people with heart valve problems do not experience symptoms or complications and do not need treatment. However, heart valve disease tends to progress with age, and most patients will eventually need some form of treatment. Advanced heart valve disorders can be life threatening.
Researching your condition and being disciplined and vigilant is important when you have heart valve disease. Seeing a doctor regularly (at least once yearly) is necessary.