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Heart Valve Disease


What is heart valve disease?

Heart valve disease is any of a number of conditions that prevent one or more of the valves in the heart from working correctly in circulating blood to the rest of the body.

The heart has four valves:

  • aortic
  • mitral
  • pulmonary
  • tricuspid

Each of these valves have flaps of tissue called leaflets that open and close each time the heart beats. The flaps make sure that the blood flows in the right direction to the four chambers of the heart, then to the rest of the body. If the valves do not open or close properly, blood can flow back into the heart’s chambers, making the heart work harder and affecting its ability to pump blood.

There are basically three problems that can keep these valves from working properly:

  • regurgitation (also called backflow), during which blood flows back into a chamber rather than flowing through the heart or into an artery because a valve doesn’t close tightly
  • stenosis, which is when the flaps of a valve thicken, stiffen, or stick together and keep the valve from fully opening; this results in not enough blood flowing to the heart
  • atresia, which is a lack of an opening in the value for the blood to flow through

Heart valve disease can be caused by a number of issues, including birth defects, rheumatic fever, changes that occur as you age, or infections. Heart valve disease that develops before birth is called congenital heart disease, and usually results in aortic or pulmonary valves that don’t form properly. Heart valve disease that develops over time due to illness, infections, or aging is referred to as acquired heart disease, and typically affects the aortic and mitral valves.

Heart valve disease is a serious condition that requires medical attention. If it isn’t treated, it can affect your quality of life or become life-threatening. Heart valves can be repaired or replaced to restore normal function in providing blood flow to the heart.

What are the symptoms of heart valve disease?

As heart valves begin to fail, the heart begins to beat faster to make up for the reduced blood flow. This can result in symptoms appearing over time.

For many people, one of the first symptoms to appear is a heart murmur, which the doctor can detect with a stethoscope. A heart murmur is an extra or unusual sound heard during a heartbeat; it could also be the sound of blood moving through a leaky valve. Not everyone gets them, and not all heart murmurs are caused by heart valve disease. But for some, it can be the first indication.

For most people, the symptoms of heart valve disease don’t start appearing until middle age or older. These symptoms can vary, depending on which valve is being affected. They include:

  • fatigue (unusual tiredness)
  • shortness of breath
  • palpitations, which is feeling of your heart skipping a beat, thumping or fluttering in your chest, or beating too hard or fast (racing)
  • swelling in the feet, ankles, legs, abdomen, or veins in the neck
  • chest pain or discomfort
  • dizziness, weakness, or fainting
  • rapid weight gain

How is heart valve disease diagnosed?

The diagnosis of heart valve disease begins with a discussion with your doctor about your medical history, and about the symptoms you have been having and how long you’ve had them.

Next, your doctor will want to perform a physical exam. During the exam, the doctor will listen to your heart and lungs with a stethoscope for signs of a heart murmur, which could be caused by a heart valve problem. The doctor will also look for signs of an enlarged heart and examine your ankles, feet, legs, abdomen, or veins in your neck for swelling, which could be signs of fluid retention.

In addition, the doctor may want you to have certain tests to help with the diagnosis. These tests may include:

  • echocardiogram (ultrasound), which is the main test for diagnosing heart valve disease; the test uses sound waves to create a moving image of the heart, so that doctors can assess the size and shape of the heart valves and chambers, whether a valve is narrow or has backflow, and how well the heart is pumping blood
  • chest x-ray to see whether your heart is enlarged, which type of valve defect you have and its severity, and whether you have any other heart problems
  • electrocardiogram (EKG or ECG), which is a simple, painless test performed in the doctor’s office that shows how well your heart is working and to detect any problems
  • exercise stress test, during which you walk on a trend mill or ride a stationary bike to make your heart work hard and beat fast while heart tests are performed to see if you have signs of heart valve disease and its severity

Your doctor may also want you to have one or more medical procedures after the diagnosis to see how severe your condition is to help plan the appropriate treatment for you. These tests may include:

  • cardiac catherterization, during which a long, thin, flexible tube called a catheter is inserted into a blood vessel in the arm, upper thigh, neck, then threaded into the heart. There, it can assess how your heart valves, heart chambers, and arteries are working. The procedure is typically performed in a hospital while you’re awake and with minimal pain.
  • coronary angiography, which involves using an iodine dye and x-rays to show the inside of your coronary arteries so that the doctor can see the flow of blood through your heart valves, heart, and blood vessels. This procedure is often done with cardiac catheterization.
  • cardiac magnetic resonance imaging (MRI), which is a long tunnel-like machine with a sliding table you lay on; the machine uses magnets, radio waves, and a computer to captures images of your heart to confirm information about any valve defects and capture more detailed information.

While your doctor may detect signs of heart valve disease, a cardiologist—a doctor who specializes in the diagnosis and treatment of heart problems—will diagnose your condition.

How is heart valve disease treated?

Because heart valve disease can be caused by a number of conditions that can affect the different valves of the heart, the treatment of the disease can take many forms. These treatments may include:

  • addressing the symptoms of other related heart conditions
  • taking medications
  • protecting heart valves from further damage
  • repairing or replacing faulty heart valves

Addressing symptoms of other heart related conditions

Changes to your lifestyle can help to prevent, treat, or relieve symptoms you may be experiencing due to your heart valve disease. Some changes that your doctor may recommend include:

  • following a heart-healthy diet (such as foods that are low in fat, sodium, sugar, refined grains)
  • quitting smoking
  • limiting physical activities that make you short of breath or tired

If diagnostic testing shows that your condition is mild to moderate and you have no symptoms, your doctor may want to monitor you through regular check-ups to look for any changes in your condition.

Taking medications

Medications can play different roles in the treatment of heart valve disease. Though they cannot correct heart disease by themselves, they can help by lessening the heart’s workload, regulating heart rhythms, slowing or stopping the progression of the disease, or reducing the chances of further damage.
These medications include:

  • ACE inhibitors to widen blood vessels and lower blood pressure, improve blood flow, reduce the workload on the heart, and help lower the risk of heart failure
  • antiarrhythmics to treat and prevent irregular heartbeats
  • beta-blockers to slow down the heart rate and reduce blood pressure to reduce the heart’s demand for oxygen; they also reduce the risk of heart attacks and sudden death and may reduce signs and symptoms of heart failure, improve heart function, and help people live longer
  • blood thinners (aspirin, anti-coagulants) to lower the risk of blood clots in the heart or on heart valves
  • diuretics to help reduce fluid buildup in your lungs and swelling in the feet and ankles
  • statins to lower your cholesterol and help prevent further blockage in your blood vessels and heart attacks
  • vasodilators that relax blood vessels to reduce the workload of the heart and help blood flow in the right direction, rather than backward through a leaky valve

Protecting heart valves from further damage

People who have heart valve disease may be at greater risk for a serious condition called infective endocarditis (IE). It is an infection that can worsen heart valve disease, and in some cases, could be life-threatening. IE is generally caused by poor dental hygiene, and there is an increased risk if you have a gum infection or tooth decay.

The best way to avoid IE is to floss, brush your teeth, and see your dentist regularly. Before you have any procedure, tell your doctor and your dentist that you have heart valve disease—even if you have already had valve repair or replacement surgery. It may be important to take antibiotics before any procedure to avoid an IE infection.

Repairing or replacing faulty heart valves

The decision about whether to repair or replace a heart valve depends on a number of factors, including:

  • the severity of the damage (how advanced the disease is)
  • your age and general health or medical history
  • whether there is a need for other heart surgery that could be performed at the same time, such as bypass surgery or treating atrial fibrillation

Even if you have no symptoms, your doctor may suggest valve repair or replacement surgery to prevent further damage to your heart or sudden death.

Whenever possible, heart valve repair is preferred over heart valve replacement. Though repair surgery is more difficult to perform than replacement surgery, there are advantages to repairing vs. replacement. Repairing a heart valve:

  • can maintain the strength and function of the heart muscle
  • may reduce the risk of IE infection after the surgery
  • may eliminate the life-long need for taking of blood-thinning medications

However, not all valves can be repaired and need to be replaced. Surgeons and cardiologists usually know before surgery which procedure is required; other times, surgeons will make the decision once they’ve actually seen the valve.

Repair
There are both surgical and non-surgical ways to repair faulty heart valves, with surgery being the most effective. Repair is usually done without the use of artificial parts. Doctors use surgery to:

  • separate valve flaps (leaflets) that have fused together
  • remove or reshape tissue to allow the valve to close more tightly
  • add tissue to patch holes or tears or increase support at the base of the valve

Heart valves that have stenosis (they don’t fully open) can be repaired with a less invasive, non-surgical procedure called balloon valvuloplasty. This procedure involves inserting a long, thin, flexible tube called a catheter with a balloon on its tip into a blood vessel in the arm, upper thigh, or neck. The tube is then threaded to the faulty valve in the heart, where the balloon is inflated to widen the opening of the valve. Though you are awake during the procedure, it usually requires an overnight stay in the hospital.

The pros and cons of balloon valvuloplasty include:

  • it may relieve many symptoms of heart valve disease
  • it may have a shorter recovery time than surgery
  • it is sometimes preferred over surgery for patients with mitral valve stenosis
  • it may not work for patients with aortic valve stenosis
  • your condition may worsen over time, requiring medication or more surgery to repair or replace the valve

Replacement
In some cases, a heart valve cannot be repaired and must be replaced. This requires surgery to remove the old faulty valve and attach a new valve in its place.

Replacement valves are made from human, cow, or pig heart tissue (biological) or are man-made (mechanical). Sometimes the replacement has elements of both. Depending on the type of valve used, you may need to take medications to keep your body from rejecting it. Mechanical valves usually last a lifetime and don’t need to be replaced, while biological valves may need to be replaced after 10 to 15 years.

Advanced Cardiovascular Care at Jeanes Hospital

If you’re experiencing symptoms of heart valve disease, the highly-experienced cardiologists at the Temple Heart & Vascular Institute at Jeanes Hospital are ready to assist in the diagnosis and treatment of your condition. From patient consultation to a full range of diagnostic tests and surgical procedures, our Temple doctors are prepared to help you understand and manage all aspects of your heart valve disease.

The Temple cardiologists at Jeanes Hospital evaluate hundreds of patients every year, managing a wide range of serious cardiovascular conditions. After careful evaluation, they can develop and oversee a treatment plan tailored to meet your specific needs.

If surgery is required, there’s no need to travel to another institution to have it done. Since 2006, Temple cardiovascular surgeons have been performing cardiac surgery procedures at Jeanes Hospital.
Our surgeons are supported by a full-time team of cardiac anesthesiologists, surgical technicians, and critical care nurses. Dedicated nurse practitioners also collaborate with surgeons to manage patient care in Jeanes Hospital and in our outpatient settings.

Procedures performed here for the diagnosis and treatment of cardiomyopathy and its related conditions include:

  • Heart value repair and replacement
  • Complex coronary interventions
  • Surgical treatment of cardiac arrhythmia

This is the level and quality of care you would expect to find downtown or in another city. Yet, it’s available right here, in your own community.

To schedule an appointment with a cardiologist at the Temple Heart & Vascular Institute at Jeanes Hospital, click here or call 215-728-CARE (2273).

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