Valvular Heart Disease

Definition

Valvular Heart Disease occurs when the heart valves do not work the way they should. The malfunctioning valve can be any of the four valves: the aortic valve, bicuspid valve, tricuspid valve, or the pulmonary valve.

The disease may be in the form of valvular insufficiency, which occurs when the valves do not close tightly and thus leak, or in the formation of valvular stenosis, which is when the valves do not fully open due to stiff or fused leaflets.

Signs and Symptoms

The symptoms which may indicate the disease include:

·         Shortness of breath while active or lying down flat 

·         Weakness or dizziness

    

     ·         Discomfort or pressure in chest’

     ·         Palpations (may feel like rapid, irregular, or skipped beats)

     ·         Swelling of: ankles, feet, or abdomen 

     ·         Rapid weight gain  (as much as 1.3kg/day)

However, the quantity of experienced symptoms does not always relate to the severity of the disease. A patient requiring immediate treatment might not experience any of the above symptoms, whereas one with a minor condition might experience noticeable symptoms.

Causes and Risk Factors

Patients might be born with valvular heart disease or otherwise acquire it during their lifetime.

Congenital valvular heart disease most often affects the aortic or pulmonic valve. The valves may be the wrong size, or have malformed leaflets, or have leaflets that are not attached correctly. Also, the aortic valve may have only two instead of three leaflets.

Valvular heart disease may also have been acquired due to a variety of other diseases such as rheumatic fever or endocarditis. These diseases are similar in that they change the structure of the valves.

Patients have an increased risk of acquiring the disease at an older age, or if they have a history rheumatic fever, heart attack, heart failure, drug use, smoking, or high blood pressure, etc.

Diagnosis

The cardiologist will diagnose the disease after talking to you about your symptoms and medical history, performing physical examinations, and diagnostic tests. These diagnostic tests include echocardiography, transesophageal echocardiography and cardiac catheterization. These tests may also be followed up with tests such as the exercise stress echocardiogram, radionuclide scans, and magnetic resonance imaging.

MRI SCANNING OF THE HEART 

By repeating these tests over time, the cardiologist can see the progress of the disease and advice
accordingly.

Treatment

Heart valve disease treatment depends on the type and severity of the disease. The three goals of treatment are as follows:
·         To protect the valve from further damage

·         To lessen the symptoms

·         To repair or replace valves

Patients with heart valve disease are vulnerable to developing endocarditis and therefore should take care of teeth and gums to prevent infections, and notify a doctor if such infections occur.

Medications may be prescribed to treat symptoms and to lessen the chance of further damage. Some of the drugs may be stopped after surgery has been done to correct the problem. Others may need to be taken for life.

Common heart disease drugs include:

Drugs	Function
Diuretics	Removes extra fluid from the tissues and bloodstream; lessens the symptoms of the disease
Anti-arrhythmic medications	Controls the heart’s rhythm
Vasodilators	Lessens the heart’s work and encourages blood to flow in a forward direction, rather than backwards through a leaky valve
ACE inhibitors	A type of vasodilator used to treat high blood pressure and heart failure
Beta blockers	Used to decrease palpitations in some patients
Anticoagulants	Prolongs the clotting time of the blood; lessens the chance of developing blood clots on the heart valve

Heart valves may be repaired or replaced with heart valve surgery. Also, other procedures such as percutaneous balloon valvotomy may be used.

Statistics

In industrialized countries, the prevalence of valvular heart disease is estimated at 2.5%. In developing countries, rheumatic heart disease remains the leading cause of valvular heart disease. Its prevalence is high, between 20 and 30 cases per 1000 subjects when using systematic echocardiographic screening.

References:

 http://www.webmd.com/heart-disease/guide/heart-valve-disease

http://my.clevelandclinic.org/services/heart/disorders/valve/diagnosevalve

http://www.nhlbi.nih.gov/health/health-topics/topics/hvd/atrisk

http://www.ncbi.nlm.nih.gov/pubmed/24986049