Valvular Heart Disease

Physicians who treat this condition

Valvular heart disease is characterized by damage to or a defect in one of the four heart valves:
the mitral, aortic, tricuspid or pulmonary.
The mitral and tricuspid valves control the flow of blood between the atria and the ventricles
(the upper and lower chambers of the heart). The pulmonary valve controls the flow of blood
from the heart to the lungs, and the aortic valve governs blood flow between the heart and the
aorta, and thereby the blood vessels to the rest of the body. The mitral and aortic valves are the
ones most frequently affected by valvular heart disease.
Normally functioning valves ensure that blood flows with proper force in the proper direction at
the proper time. In valvular heart disease, the valves become too narrow and hardened (stenotic)
to open fully, or are unable to close completely (incompetent).
A stenotic valve forces blood to back up in the adjacent heart chamber, while an incompetent
valve allows blood to leak back into the chamber it previously exited. To compensate for poor
pumping action, the heart muscle enlarges and thickens, thereby losing elasticity and efficiency.
In addition, in some cases, blood pooling in the chambers of the heart has a greater tendency to
clot, increasing the risk of stroke or pulmonary embolism.
The severity of valvular heart disease varies. In mild cases there may be no symptoms, while in
advanced cases, valvular heart disease may lead to congestive heart failure and other
complications. Treatment depends upon the extent of the disease.
Symptoms
Valve disease symptoms can occur suddenly, depending upon how quickly the disease develops.
If it advances slowly, then your heart may adjust and you may not notice the onset of any
symptoms easily. Additionally, the severity of the symptoms does not necessarily correlate to the
severity of the valve disease. That is, you could have no symptoms at all, but have severe valve
disease. Conversely, severe symptoms could arise from even a small valve leak.
Many of the symptoms are similar to those associated with congestive heart failure, such as
shortness of breath and wheezing after limited physical exertion and swelling of the feet, ankles,
hands or abdomen (edema). Other symptoms include:

Palpitations, chest pain (may be mild).

Fatigue.

Dizziness or fainting (with aortic stenosis).

Fever (with bacterial endocarditis).

Rapid weight gain.

Causes
There are many different types of valve disease; some types can be present at birth (congenital),
while others may be acquired later in life.

Heart valve tissue may degenerate with age.

Rheumatic fever may cause valvular heart disease.

Bacterial endocarditis, an infection of the inner lining of the heart muscle and heart
valves (endocardium), is a cause of valvular heart disease.

High blood pressure and atherosclerosis may damage the aortic valve.

A heart attack may damage the muscles that control the heart valves.

Other disorders such as carcinoid tumors, rheumatoid arthritis, systemic lupus

erythematosus, or syphilis may damage one or more heart valves.

Methysergide, a medication used to treat migraine headaches, and some diet drugs may
promote valvular heart disease.

Radiation therapy (used to treat cancer) may be associated with valvular heart disease.

Prevention
Get prompt treatment for a sore throat that lasts longer than 48 hours, especially if accompanied
by a fever. Timely administration of antibiotics may prevent the development of rheumatic fever
which can cause valvular heart disease.
A heart-healthy lifestyle is also advised to reduce the risks of high blood pressure, atherosclerosis
and heart attack.

Dont smoke.

Consume no more than two alcoholic beverages a day.

Eat a healthy, balanced diet low in salt and fat, exercise regularly and lose weight if you
are overweight.

Adhere to a prescribed treatment program for other forms of heart disease.

If you are diabetic, maintain careful control of your blood sugar.

Diagnosis
During your examination, the doctor listens for distinctive heart sounds, known as heart
murmurs, which indicate valvular heart disease. As part of your diagnosis, you may undergo one
or more of the following tests:

An electrocardiogram, also called an ECG or EKG, to measure the electrical activity of

the heart, regularity of heartbeats, thickening of heart muscle (hypertrophy) and heartmuscle damage from coronary artery disease.

Stress testing, also known as treadmill tests, to measure blood pressure, heart rate, ECG
changes and breathing rates during exercise. During this test, the hearts electrical activity
is monitored through small metal sensors applied to your skin while you exercise on a
treadmill.

Chest X-rays.

Echocardiogram to evaluate heart function. During this test, sound waves bounced off
the heart are recorded and translated into images. The pictures can reveal abnormal heart
size, shape and movement. Echocardiography also can be used to calculate the ejection
fraction, or volume of blood pumped out to the body when the heart contracts.

Cardiac catheterization, which is the threading of a catheter into the heart chambers to
measure pressure irregularities across the valves (to detect stenosis) or to observe
backflow of an injected dye on an X-ray (to detect incompetence).

Treatment
The following provides an overview of the treatment options for valvular heart disease:

Dont smoke; follow prevention tips for a heart-healthy lifestyle. Avoid excessive
alcohol consumption, excessive salt intake and diet pillsall of which may raise blood
pressure.

Your doctor may adopt a watch and wait policy for mild or asymptomatic cases.

A course of antibiotics is prescribed prior to surgery or dental work for those with
valvular heart disease, to prevent bacterial endocarditis.

Long-term antibiotic therapy is recommended to prevent a recurrence of streptococcal

infection in those who have had rheumatic fever.

Antithrombotic (clot-preventing) medications such as aspirin or ticlopidine may be

prescribed for those with valvular heart disease who have experienced unexplained
transient ischemic attacks, also known as TIAs (see this disorder for more information).

More potent anticoagulants, such as warfarin, may be prescribed for those who have
atrial fibrillation (a common complication of mitral valve disease) or who continue to
experience TIAs despite initial treatment. Long-term administration of anticoagulants
may be necessary following valve replacement surgery, because prosthetic valves are
associated with a higher risk of blood clots.

Balloon dilatation (a surgical technique involving insertion into a blood vessel of a small
balloon that is led via catheter to the narrowed site and then inflated) may be done to
widen a stenotic valve.

Valve Surgery to repair or replace a damaged valve may be necessary. Replacement

valves may be artificial (prosthetic valves) or made from animal tissue (bioprosthetic
valves). The type of replacement valve selected depends on the patients age, condition,
and the specific valve affected.

What Is Valvular Heart Disease?

Heart valve disease occurs when your heart's valves do not work the way they should.
How Do Heart Valves Work?

Your heart valves lie at the exit of each of your four heart chambers and maintain one-way blood
flow through your heart. The four heart valves make sure that blood always flows freely in a
forward direction and that there is no backward leakage.
Blood flows from your right and left atria into your ventricles through the open mitral and
tricuspid valves.

When the ventricles are full, the mitral and tricuspid valves shut. This prevents blood from
flowing backward into the atria while the ventricles contract (squeeze).
As the ventricles begin to contract, the pulmonic and aortic valves are forced open and blood is
pumped out of the ventricles through the open valves into the pulmonary artery toward the lungs,
the aorta, and the body.
When the ventricles finish contracting and begin to relax, the aortic and pulmonic valves snap
shut. These valves prevent blood from flowing back into the ventricles.
This pattern is repeated over and over, causing blood to flow continuously to the heart, lungs and
body.
What Are the Types of Valve Disease?

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. The narrowed opening may make the heart work
very hard to pump blood through it. This can lead to heart failure and other
symptoms (see below). 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", this 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 make up for the leaky valve, and less blood
may flow to the rest of the body. Depending on which valve is affected, the

conditioned is called tricuspid regurgitation, pulmonary regurgitation, mitral

regurgitation or aortic regurgitation.

Heart Failure Overview

Heart failure is a condition in which the heart is no longer able to pump out enough oxygen-rich
blood. This causes symptoms to occur throughout the body.
Causes

Heart failure is often a long-term (chronic) condition, but it may come on suddenly. It can be
caused by many different heart problems.
The condition may affect only the right side or only the left side of the heart. More often, both
sides of the heart are involved.
Heart failure is present when:

Your heart muscle cannot pump (eject) the blood out of the heart very well.
This is called systolic heart failure.

Your heart muscles are stiff and do not fill up with blood easily. This is called
diastolic heart failure.

As the heart's pumping becomes less effective, blood may back up in other areas of the body.
Fluid may build up in the lungs, liver, gastrointestinal tract, and the arms and legs. This is called
congestive heart failure.

The most common causes of heart failure are:

Coronary artery disease (CAD), a narrowing of the small blood vessels that
supply blood and oxygen to the heart. This can weaken the heart muscle over
time or suddenly.

High blood pressure that is not well controlled, leading to problems with
stiffness, or eventually leading to muscle weakening.

Other heart problems that may cause heart failure are:

Congenital heart disease

Heart attack

Heart valves that are leaky or narrowed)

Infection that weakens the heart muscle

Some types of abnormal heart rhythms (arrhythmias)

Other diseases that can cause or contribute to heart failure:

Amyloidosis

Emphysema

Overactive thyroid

Sarcoidosis

Severe anemia

Too much iron in the body

Underactive thyroid

Symptoms

Symptoms of heart failure often begin slowly. At first, they may only occur when you are very
active. Over time, you may notice breathing problems and other symptoms even when you are
resting. Symptoms may also appear suddenly after the heart is damaged from a heart attack or
other problem.
Common symptoms are:

Cough

Fatigue, weakness, faintness

Loss of appetite

Need to urinate at night

Pulse that feels fast or irregular, or a sensation of feeling the heart beat
(palpitations)

Shortness of breath when you are active or after you lie down

Swollen (enlarged) liver or abdomen

Swollen feet and ankles

Waking up from sleep after a couple of hours due to shortness of breath

Weight gain

Exams and Tests

Your health care provider will examine you for signs of heart failure:

Fast or difficult breathing

Leg swelling (edema)

Neck veins that stick out (are distended)

Sounds ("crackles") from fluid buildup in your lungs, heard through a

stethoscope

Swelling of the liver or abdomen

Uneven or fast heartbeat and abnormal heart sounds

Many tests are used to diagnose and monitor heart failure.

An echocardiogram (echo) is often the best test for heart failure. Your doctor will use it to guide
your treatment.
Other imaging tests can look at how well your heart is able to pump blood, and how much the
heart muscle is damaged.
Many blood tests may also be used to:

Help diagnose and monitor heart failure

Identify risks for heart disease

Look for possible causes of heart failure, or problems that may make your
heart failure worse

Monitor for side effects of medicines you may be taking

Treatment

MONITORING AND SELF CARE

If you have heart failure, your doctor will monitor you closely. You will have follow-up
appointments at least every 3 to 6 months, but sometimes much more often. You will also have
tests to check your heart function.
Knowing your body and the symptoms that your heart failure is getting worse will help you stay
healthier and out of the hospital. At home, watch for changes in your heart rate, pulse, blood
pressure, and weight.
Weight gain, especially over a day or two, can be a sign that your body is holding onto extra fluid
and your heart failure is getting worse. Talk to your doctor about what you should do if your
weight goes up or you develop more symptoms.
Limit how much salt you eat. Your doctor may also ask you to limit how much fluid you drink
during the day.
Other important changes to make in your lifestyle:

Ask your doctor how much alcohol you may drink.

Do not smoke.

Stay active. Walk or ride a stationary bicycle. Your doctor can provide a safe
and effective exercise plan for you. Do not exercise on days when your weight
has gone up from fluid or you are not feeling well.

Lose weight if you are overweight.

Lower your cholesterol by changing your lifestyle.

Get enough rest, including after exercise, eating, or other activities. This
allows your heart to rest too.

MEDICATIONS, SURGERY, AND DEVICES

Your doctor will ask you to take medicines to treat your heart failure. Medicines treat the
symptoms, prevent your heart failure from getting worse, and help you live longer. It is very
important that you take your medicine as your health care team directed.
These medicines:

Help the heart muscle pump better

Keep your blood from clotting

Lower your cholesterol levels

Open up blood vessels or slow your heart rate so your heart doesn't have to
work as hard

Reduce damage to the heart

Reduce the risk of abnormal heart rhythms

Replace potassium

Rid your body of excess fluid and salt (sodium)

It is very important that you take your medicine as your doctor and nurse directed. Do not take
any other drugs or herbs without first asking your doctor or nurse about them. Drugs that may
make your heart failure worse include:

Ibuprofen (Advil, Motrin)

Naproxen (Aleve, Naprosyn)

The following surgeries and devices for certain patients with heart failure may be recommended:

Coronary bypass surgery (CABG) or angioplasty with or without stenting may

help improve blood flow to the damaged or weakened heart muscle.

Heart valve surgery may be done if changes in a heart valve are causing your
heart failure.

A pacemaker can help treat slow heart rates or help both sides of your heart
contract at the same time.

A defibrillator sends an electrical pulse to stop life-threatening abnormal

heart rhythms.

END-STAGE HEART FAILURE

Severe heart failure occurs when treatments no longer work. Certain treatments may be used
when a person is waiting for a heart transplant:

Intra-aortic balloon pump (IABP)

Left ventricular assist device (LVAD)

At a certain point, the health care provider will decide whether it is best to keep treating heart
failure aggressively. The patient, along with his or her family and doctors, may want to discuss
palliative or comfort care at this time.
Outlook (Prognosis)

Often, you can control heart failure by taking medicine, changing your lifestyle, and treating the
condition that caused it.
Heart failure can suddenly get worse due to:

Angina (lack of blood flow to the heart muscle)

Eating high-salt foods

Heart attack

Infections or other illnesses

Not taking medicines correctly

New, abnormal heart rhythms

Most of the time, heart failure is a chronic illness that gets worse over time. Some people
develop severe heart failure. Medicines, other treatments, and surgery no longer help at this
stage.
People with heart failure may be at risk for dangerous heart rhythms. These people often receive
an implanted defibrillator.
When to Contact a Medical Professional

Call your health care provider if you develop:

Increased cough or phlegm

Sudden weight gain or swelling

Weakness

Other new or unexplained symptoms

Go to the emergency room or call the local emergency number (such as 911) if you experience:

Fainting

Fast and irregular heartbeat (especially if you also have other symptoms)

Severe crushing chest pain

Prevention

Most cases of heart failure can be prevented by living a healthy lifestyle and reducing your risk
for heart disease