Definition of Valvular Heart Disease

The collective term for the malformations and disorders that can affect the valves of the heart. Valvular heart disease may affect any of the heart’s four valves: mitral, pulmonary, aortic, and tricuspid.

The most common forms of valvular heart disease are

  • Stenosis, in which the valve does not open completely
  • Regurgitation, also called incompetence or insufficiency, in which the valve does not close completely
  • Prolapse, affecting primarily the mitral valve, in which the valve leaflets are irregularly shaped such that they bulge when they close

Causes of Valvular Heart Disease

POSSIBLE CAUSES OF VALVULAR HEART DISEASE
ankylosing spondylitisatrial septal defect (ASD)
bicuspid aortic valvecalcification
congenital anomalycoronary artery disease (cad)
endocarditisgraves’s disease
heart attackhypertrophic cardiomyopathy
marfan syndromemuscular dystrophy
pulmonary hypertensionrheumatic heart disease
rheumatoid arthritissickle cell disease
systemic lupus erythematosus (sle)ventricular septal defect (VSD)

Until the 1950s, valvular heart disease was the leading cardiovascular cause of death, and rheumatic heart disease, a complication of streptococcal infection such as strep throat, was the most frequent cause of valvular heart disease.

As antibiotic medications became the standard of treatment for strep throat and other infections, rheumatic heart disease and correspondingly valvular heart disease declined dramatically.

Though rheumatic heart disease still accounts for about half of valvular heart disease, other causes include congenital malformations and degenerative effects that accompany aging.

Symptoms and Diagnostic Path

Many people who have valvular heart disease do not have symptoms until damage to the heart becomes significant, progressing to heart failurecardiomyopathy, and arrhythmia. When symptoms are present, they may include

  • Tiredness or fatigue
  • Shortness of breath, especially with exertion
  • Periods of lightheadedness
  • Chest tightness or discomfort
  • Palpitations

Often, the underlying valve malformation (congenital or acquired) exists for years to decades before affecting the valve’s function to the extent of causing symptoms. Sometimes the doctor detects valvular heart disease before symptoms are present, commonly by hearing a heart murmur during a routine medical examination.

Though many heart murmurs are occasional and innocent (not indicating any disease), certain valve disorders produce distinctive murmurs. Other procedures likely along the diagnostic path include electrocardiogram (ecg)echocardiogram, and computed tomography (ct) scan or magnetic resonance imaging (mri).

Depending on the person’s general cardiovascular status, the cardiologist may also recommend cardiac catheterization.

Treatment Options and Outlook

Medications can control much valvular heart disease. Those commonly prescribed include anticoagulants to reduce the risk for blood clots and beta blockers or calcium channel blockers to lower blood pressure and slow the heart rate.

When heart failure or cardiomyopathy is also present, the cardiologist may prescribe digoxin to strengthen the heart’s contractions and diuretic medications to reduce or prevent excessive fluid accumulation in the body tissues.

Lifestyle efforts, such as nutritious eating habits and daily physical exercise, are important to improve overall cardiovascular status. Smoking cessation and weight loss, if appropriate, are essential to reduce the risk for further cardiovascular disease (cvd).

Surgery becomes a treatment option when medical efforts are unsuccessful or valve damage is significant. Surgical options include repair (valvuloplasty) or replacement (prosthetic valve).

Valvuloplasty

Balloon valvuloplasty is a procedure to treat stenosis in which the cardiologist uses cardiac catheterization to thread a catheter with a tiny balloon on the tip through a blood vessel and into the heart. When the catheter tip is in position in the valve’s opening, the cardiologist inflates the balloon to gently expand the opening.

Operative valvuloplasty involves open heart surgery to gain access to the diseased valve. The surgeon may use various methods to repair the valve, depending on the valve and the nature of the damage.

Valve replacement

The surgeon may replace a damaged valve that is beyond repair. Prosthetic heart valves fall into two general categories, tissue and mechanical. Tissue valves come from human cadaver donors or animal tissues. Animal valves are typically porcine (pig) or bovine (cow) and are sterilized and processed before use.

The advantage to tissue valves is that they function in the same manner as the native valve. The disadvantage is that they wear out. Mechanical valves are made of materials such as stainless steel and high-tech plastics.

Their main advantage is that they are completely inert and last a very long time. After receiving a prosthetic heart valve the person must take anticoagulation therapy for life and take prophylactic antibiotics before invasive dental, surgical, or diagnostic procedures.

Prosthetic valves, whether tissue or mechanical, are prone to collecting blood clots. A valve replacement operation is also open heart surgery.

Risk Factors and Preventive Measures

Adults who are over the age of 40 may have had rheumatic fever or rheumatic heart disease as children and may be vulnerable to valvular heart disease as a result. Most people under the age of 40 receive antibiotic medications as the standard course of treatment for strep throat, which has greatly reduced the spread of the infection to the heart.

Despite these advances, however, nearly 20,000 Americans a year die from valvular heart disease. It remains essential to receive prompt and appropriate treatment for strep infections as well as for early indications of valvular heart disease.

People who know or believe they had rheumatic fever in childhood should make sure their doctors are aware of this when having routine medical examinations or receiving treatment for other cardiovascular conditions.

See also CARDIOPULMONARY BYPASS; CARDIOVASCULAR DISEASE PREVENTION; CONGENITAL HEART DISEASELIVING WITH CARDIOVASCULAR DISEASE; OBESITY AND CARDIOVASCULAR DISEASE; WEIGHT LOSS AND WEIGHT MANAGEMENT.

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