Heart Valve Disease
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What is Heart Valve Disease?
     Symptoms of Heart Valve Disease
     Types of Heart Valve Disease
     Diagnosis of Heart Valve Disease
     Treatment of Heart Valve Disease

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What is Heart Valve Disease?

About 5 million Americans are diagnosed with heart valve disease each year. Heart valve disease may be present without symptoms. In fact, some people live their entire lives with a heart valve problem and never know it. And if symptoms are present, they may not correlate to the severity of your condition. You may have severe symptoms but have a minor valve problem or you may have no symptoms and need prompt intervention.


Symptoms

It is important to see a doctor if you experience any of the following symptoms:
  •  Shortness of breath This may be during exercise, your daily routine or even while lying in bed.
  •  Dizziness or lightheadedness.
     
  •  Fainting or passing out.
     
  •  Chest pain This may occur with exertion or exposure to the cold.
     
  •  Heart palpitations This may fel like a rapid or irregular heartbeat, or like your heart is flip flopping.
     
  •  Swelling in the ankles, feet, or stomach Your doctor may refer to this as edema.
     
  •  Sudden weight gain This may present as an increase of 2 to 3 pounds in a day.
     
  •  Fatigue.
     
  •  Abdominal pain and decreased appetite due to an enlarged liver and congestion.

Talk to your doctor if you have any of these symptoms. Be sure to download and print Questions to Ask Your Doctor about Heart Valve Disease as a reminder of what you want to ask and take notes during your visit.


Types of Heart Valve Disease

Valve diseases may be conditions that you were born with or develop over time as a result of your family history, a history of illness, or of aging. They usually affect the aortic or mitral valves. It may lead to bleeding, blood clots, stroke, an increased susceptibility to infections in the heart, or heart failure, as well as clinical depression trying to cope with the condition and periods of recovery after treatment.

There are several types of valve heart disease:

  • Aortic Valve Disease The aortic valve sits between the lower left chamber of your heart (the left ventricle) and the major blood vessel (the aorta). The aorta is a canal that acts like a gatekeeper, releasing oxygen-rich blood from the heart to nourish the body. The aortic valve opens to release blood from the left ventricle and closes to keep any of the blood from washing backward. Problems with the aortic valve can include:

    • Aortic Valve Regurgitation The valve’s tissue flaps that control the flow and direction of the blood don't fully close or the edges don't fully meet. This causes blood to leak back into the heart and the narrowed opening may cause the heart work very hard to pump blood through it, which can lead to heart failure. A congenital defect, calcium deposits, Rheumatic fever or other infection may have damaged the valves.
       
    • Aortic Valve Stenosis The leaflets can't open fully to allow enough blood to flow through. It's a leaky valve that can lead to heart failure. A congenital defect, calcium deposits or Rheumatic fever may have caused it.

    Think of a door. A door opens one way and closes very firmly in the other. That’s how a healthy valve works, too. But when a valve doesn’t close firmly, blood can leak through (regurgitation). And, if the valves get stuck, like hinges in a door can over time, the blood has trouble getting through (stenosis).
     
     

  • Mitral Valve Disease The mitral valve is one of four valves that regulate blood flow through the heart, controlling the flow from the left upper chamber of your heart (the left atrium) to the left lower chamber (the left ventricle). In a healthy heart, once the blood flows to the left ventricle, the mitral valve seals shut so that when the left ventricle contracts, the blood is pumped out only through the aortic valve out to the body, as it should be, and cannot flow back into the left atrium. Problems with the mitral valve include: 
     
    • Mitral Valve Regurgitation — The flaps of the mitral valve no longer seal properly in between heartbeats and allow blood to leak ‘backwards’ to the left atrium.
       
    • Mitral Valve Stenosis — The mitral valve narrows, limiting blood flow to the left lower chamber of the heart.


Diagnosis of Heart Valve Disease

Diagnosis generally begins with routine examination by your family doctor, who may notice an abnormal sound while listening to your heart with a stethoscope. You may be referred to a cardiologist who specializes in heart conditions, who may order certain tests to confirm a diagnosis and to evaluate the severity of your condition.

  • Chest x-ray to reveal an enlargement of the heart or your aorta that may need additional tests.
     
  • Electrocardiogram begins with special adhesive pads on your skin, attached to wires that measure the electrical activity of your heart to check for any abnormalities.
     
  • Echocardiogram uses sound waves to create a video of your heart function. A device shaped like a wand is moved on the outside of your chest, creating images of the heart chambers and function of the valves.
     
    Another form of echocardiogram called a transesophageal echocardiogram inserts a small wand into your esophagus to get a closer look at the aortic valve from inside your chest.
     
  • CT Scan produces a series of x-rays that give a detailed look at the structures of the heart and heart valves, which may show signs of an enlarged heart or valve abnormalities.
     
  • Cardiac MRI uses magnetic fields to create images of the heart, especially effective in revealing changes in soft tissues like the aorta or valves.
  • Exercise tests may identify undiagnosed symptoms like heart rate or rhythm abnormalities, as well as measure the severity of your condition.
     
  • Cardiac catherization threads a very thin tube called a catheter into a blood vessel near your wrist or groin to reach a blood vessel near your heart and releases a dye through the catheter to show structures, evaluate heart function, and measure the pressure inside the heart chambers. This test is usually used if other tests aren’t definitive.


Treatment

Heart valve disease treatment depends on how severe your condition is, if you're experiencing signs and symptoms, and if your condition is getting worse. If you have heart valve disease, consider being evaluated and treated at a medical center with a multidisciplinary team of doctors and medical staff trained and experienced in evaluating and treating heart valve disease. Your doctor may suggest monitoring your condition with regular follow-up appointments, recommending healthy lifestyle changes, or taking medications to treat symptoms.

You may eventually need heart valve surgery to repair or replace the diseased heart valve. If you need surgery for another heart condition, your doctor may repair or replace the diseased valve at the same time. Doctors may also use less invasive procedures to repair certain valves using long, thin tubes (catheters) in some people. In some cases, valves can be replaced during a catheter procedure. Doctors continue to study catheter procedures to repair or replace heart valves.

Surgery options include:

  • Heart valve repair is performed whenever possible to preserve the valve and heart function. To repair a valve, surgeons may separate valve flaps (leaflets or cusps) that have fused, replace the cords that support the valve, remove excess valve tissue so that the leaflets or cusps can close tightly or patch holes in a valve. Repairs require a minimal surgery procedure, but may need more extensive surgery. Repair is most often possible for mitral valve regurgitation and tricuspid valve regurgitation.
     
  • Heart valve replacement is performed when the valve can't be repaired, replacing the valve with a mechanical or other valve. Mechanical valves require blood-thinning meds and biological valves degenerate over time and must be replaced. It may include TAVR (or TAVI) or other minimally invasive procedure. A TAVR procedure may be comparable to a balloon treatment or even an angiogram in terms of down time and recovery, and a shorter hospital stay.

Treatment for heart valve disease depends on the type and severity of the valve disease. There are three goals of treatment: protecting the valve from further damage; lessening symptoms; and repairing or replacing valves. Having valve disease may put you at risk for developing endocarditis, an infection of the endocardium (and infection of the inner lining of the heart chambers and valves). People who have mitral valve prolapse without thickening or regurgitation/leaking are not at risk of developing endocarditis. But you are still at risk for endocarditis, even if your valve is repaired or replaced through surgery.


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