Heart Valve Disease

What Is Valvular Heart Disease?

Heart valve disease occurs when your heart's valves do not work the way they should.

What Causes Valvular Heart Disease?

Valve disease can develop before birth (congenital) or can be acquired sometime during one's lifetime. Sometimes the cause of valve disease is unknown. Congenital valve disease: Most often affects the aortic or pulmonic valve. Valves may be the wrong size, have malformed leaflets, or have leaflets that are not attached to the annulus correctly.

Bicuspid aortic valve disease:is a congenital valve disease that affects the aortic valve. Instead of the normal three leaflets or cusps, the bicuspid aortic valve has only two. Without the third leaflet, the valve may be stiff (unable to open or close properly) or leaky (not able close tightly).

Acquired valve disease: This includes problems that develop with valves that were once normal. These may involve changes in the structure or your valve due to a variety of diseases or infections, including rheumatic fever or endocarditis.

  • Rheumatic fever is caused by an untreated bacterial infection (usually strep. throat). Introduction of antibiotics to treat this infection has dramatically reduced the numbers of this infection. The initial infection usually occurs in children, but the heart problems associated with the infection may not be seen until 20-40 years later. At that time, the heart valves become inflamed, the leaflets stick together and become scarred, rigid, thickened and shortened. This leads to mitral regurgitation.
  • Endocarditis occurs when germs, especially bacteria, enter the bloodstream and attack the heart valves, causing growths and holes in the valves and scarring. This can lead to leaky valves. The germs that cause endocarditis enter the blood during dental procedures, surgery, IV drug use, or with severe infections. People with valve disease (except mitral valve prolapse without thickening or regurgitation/leaking) are at increased risk for developing this life-threatening infection.

Mitral valve prolapse (MVP) MVP causes the leaflets of the mitral valve to flop back into the left atrium during the heart's contraction. MVP also causes the tissues of the valve to become abnormal and stretchy, causing the valve to leak. The condition rarely causes symptoms and usually doesn't require treatment.

Other causes of valve disease include: coronary artery disease, heart attack, cardiomyopathy (heart muscle disease), syphilis (a sexually transmitted disease), hypertension, aortic aneurysms, and connective tissue diseases. Less common causes of valve disease include tumors, some types of drugs and radiation.

How Are Valve Diseases Diagnosed?

Symptoms

  • Shortness of breath and/or difficulty catching your breath.
  • Weakness or dizziness.
  • Discomfort in your chest.
  • Palpitations.
  • Swelling of your ankles, feet or abdomen.
  • Rapid weight gain.

After the physical exam, the doctor may order diagnostic tests. These may include:

  • Echocardiography
  • Transesophageal echocardiography
  • Cardiac catheterization (also called an angiogram)

How Is Heart Valve Disease Treated?

There are three goals of treatment for heart valve disease: protecting your valve from further damage; lessening symptoms; and repairing or replacing valves.

Protecting your valve from further damage.

If you have valve disease, you are at risk for developing endocarditis, a serious condition. People who have mitral valve prolapse without thickening or regurgitation/leaking are not at risk of developing endocarditis.

You are still at risk for endocarditis, even if your valve is repaired or replaced through surgery. To protect yourself:

  • Tell your doctors and dentist you have valve disease.
  • Call your doctor if you have symptoms of an infection (sore throat, general body aches, fever).
  • Take good care of your teeth and gums to prevent infections. See your dentist for regular visits.
  • Take antibiotics before you undergo any procedure that may cause bleeding, such as any dental work (even a basic teeth cleaning), invasive tests (any test that may involve blood or bleeding), and most major or minor surgery.
  • Medications. You may be prescribed medications to treat your symptoms and to lessen the chance of further valve damage. Some medications may be stopped after you have had valve surgery to correct your problem. Other medications may need to be taken all your life. Medications may include:

Surgical options include heart valve repair or replacement.

Valve replacement:

  • Natural valve damaged beyond repair
  • Valve excised; prosthesis placed.

Valve repair: Various techniques.

  • Less applicable in Indian situation as less value in rheumatic pathology.
  • Annuloplasty rings used to support.
  • Avoid anticoagulation.

Valve substitutes:

  • Mechanical valves
  • Biological or tissue valves. Choosing a valve:
  • Mechanical valve: < 60 years
    Tissue Valve: > 65 years
    Life expectancy <10 years
    atients with problems likely to cause life threatening bleeding.

Living With Valve Disease

When you have valve disease, it is important to protect yourself from future heart problems, even if your valve has been repaired or replaced with surgery. Here are some tips to stay healthy:

  • Know the type and extent of your valve disease.
  • Tell all your doctors and dentist you have valve disease.
  • Call your doctor if you have symptoms of an infection.
  • Take good care of your teeth and gums.
  • Take antibiotics before you undergo any procedure that may cause bleeding.
  • Take your medications. Your medications are used to control your symptoms and help your heart pump blood more efficiently. Follow your doctor's instructions when you take your medications.
  • See your heart doctor for regular visits, even if you have no symptoms. Your appointments may be spaced once a year or more often, if your doctor feels you need to be followed more closely.


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