MEDICAL MONDAYS NEWS NOTES
Evans Kemp, MD, cardiologist
Todd Shuman, MD, CT surgeon
ST THOMAS HEART
TOPIC: Valvular Disease
Monday, September 15, 2008
Heart Disease: Heart Valve Disease
According to the American Heart Association, about 5 million Americans are diagnosed with valvular heart disease each year.
What Is Valvular Heart Disease?
Heart valve disease occurs when the heart 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:
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.
There are many changes that can occur to the valves of the heart. The chordae tendinae or papillary muscles can stretch or tear; the annulus of the valve can dilate (become wide); or the valve leaflets can become fibrotic (stiff) and calcified.
Mitral valve prolapse (MVP) is a very common condition, affecting 1 to 2 percent of the population. 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.
What Are the Symptoms of Valve Disease?
Symptoms do not always relate to the seriousness of your valve disease. You may have no symptoms at all and have severe valve disease, requiring prompt treatment. Or, as with mitral valve prolapse, you may have severe symptoms, yet tests may show your valve leak is not significant.
How Are Valve Diseases Diagnosed?
Your heart doctor can tell if you have valve disease by talking to you about your symptoms, performing a physical exam, and giving you other tests.
During a physical exam, your doctor will listen to your heart to hear the sounds the heart makes as the valves open and close. A murmur is a swishing sound made by blood flowing through a stenotic or leaky valve. Your doctor can also tell if your heart is enlarged or if your heart rhythm is irregular.
The doctor will listen to your lungs to hear if you are retaining fluid in your lungs, which shows your heart is not able to pump as well as it should.
By examining your body, the doctor can find clues about your circulation and the functioning of your other organs.
After the physical exam, the doctor may order diagnostic tests. These may include:
By looking at the results, repeated over time, your doctor can also see the progress of your valve disease. This will help him or her make decisions about your treatment.
How Is Heart Valve Disease Treated?
Treatment for heart valve disease depends on the type and severity of valve disease. 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:
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:
Common types of medications
What they do
Diuretics ("water pills")
Remove extra fluid from the tissues and bloodstream; lessen the symptoms of heart failure
Control the heart's rhythm
Lessen the heart's work. Also encourages blood to flow in a forward direction, rather than backwards through a leaky valve.
A type of vasodilator used to treat high blood pressure and heart failure.
Treat high blood pressure and lessen the heart's work by helping the heart beat slower and less forcefully. Used to decrease palpitations in some patients
Anticoagulants ("blood thinners")
Prolong the clotting time of your blood, if you are at risk for developing blood clots on your heart valve.
Follow your doctor's orders when taking medications. Know the names of your medications, what they are for, and how often to take them.
Surgery and Other Procedures. The diagnostic tests your heart doctor orders help to identify the location, type, and extent of your valve disease. The results of these tests, the structure of your heart, your age, and your lifestyle will help your cardiologist (heart doctor), surgeon, and you decide what type of procedure will be best for you.
Surgical options include heart valve repair or replacement. Valves can be repaired or replaced with traditional heart valve surgery or a minimally invasive heart valve surgical procedure. Heart valves may also be repaired by other procedures such as percutaneous balloon valvotomy.