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Johns Hopkins Symptoms and Remedies

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Valvular Heart Disease

When the heart's ventricles contract, the pulmonary valve and aortic valve (which is out of view in the illustration) open to allow blood to be pumped out to the lungs and the rest of the body, respectively. As the ventricles relax, the two valves close, while the mitral and tricuspid valves open, allowing the ventricles to fill with blood again..

What is it?

Valvular heart disease is characterized by damage to or a defect in one of the four heart valves: the mitral, aortic, tricuspid, or pulmonary. The mitral and tricuspid valves control the flow of blood between the atria and the ventricles (the upper and lower chambers of the heart). The pulmonary valve controls the flow of blood from the heart to the lungs, and the aortic valve governs blood flow between the heart and the aorta, and thereby the blood vessels to the rest of the body. The mitral and aortic valves are the ones most frequently affected by valvular heart disease. Normally functioning valves ensure that blood flows with proper force in the proper direction at the proper time. In valvular heart disease, the valves become too narrow and hardened (stenotic) to open fully, or are unable to close completely (incompetent). A stenotic valve forces blood to back up in the adjacent heart chamber, while an incompetent valve allows blood to leak back into the chamber it previously exited. To compensate for poor pumping action, the heart muscle enlarges and thickens, thereby losing elasticity and efficiency. In addition, in some cases blood pooling in the chambers of the heart has a greater tendency to clot, increasing the risk of stroke or pulmonary embolism (see Stroke and Pulmonary Embolism for more information). The severity of valvular heart disease varies. In mild cases there may be no symptoms, while in advanced cases, valvular heart disease may lead to congestive heart failure (see Congestive Heart Failure) and other complications. Treatment depends upon the extent of the disease.

What Causes It?

  • Rheumatic fever may cause valvular heart disease.
  • Bacterial endocarditis, an infection of the inner lining of the heart muscle and heart valves (endocardium), is a cause of valvular heart disease.
  • High blood pressure and atherosclerosis may damage the aortic valve.
  • A heart attack may damage the muscles that control the heart valves.
  • Congenital abnormalities of the heart valves may be present.
  • Heart valve tissue may degenerate with age.
  • Other disorders such as carcinoid tumors, rheumatoid arthritis, systemic lupus erythematosus, or syphilis may damage one or more heart valves (see these specific disorders for more information).
  • Methysergide, a medication used to treat migraine headaches, and some diet drugs may promote valvular heart disease.
  • Radiation therapy (used to treat cancer) may be associated with valvular heart disease.

Prevention

  • A heart-healthy lifestyle is advised to reduce the risks of high blood pressure, atherosclerosis, and heart attack.

Diagnosis

  • Patient history and physical examination. The doctor listens for distinctive heart sounds, known as heart murmurs, that indicate valvular heart disease.
  • An electrocardiogram (ECG), to measure the electrical activity of the heart, regularity of heartbeats, thickening of heart muscle (hypertrophy), and heartmuscle damage from coronary artery disease.
  • Stress testing (measurement of blood pressure, heart rate, ECG changes, and breathing rates while the patient walks on a treadmill).
  • Chest x-rays.
  • Echocardiogram (use of ultrasound waves to create a moving image of the valves as the heart beats).
  • Cardiac catheterization: the threading of a catheter into the heart chambers to measure pressure irregularities across the valves (to detect stenosis) or to observe backflow of an injected dye on an x-ray (to detect incompetence).

How to Treat It

  • Don't smoke; follow prevention tips for a hearthealthy lifestyle. Avoid excessive alcohol consumption, excessive salt intake, and diet pills—all of which may raise blood pressure.
  • Your doctor may adopt a "watch and wait" policy for mild or asymptomatic cases.
  • A course of antibiotics is prescribed prior to surgery or dental work for those with valvular heart disease, to prevent bacterial endocarditis.
  • Long-term antibiotic therapy is recommended to prevent a recurrence of streptococcal infection in those who have had rheumatic fever.
  • Antithrombotic (clot-preventing) medications such as aspirin or ticlopidine may be prescribed for those with valvular heart disease who have experienced unexplained transient ischemic attacks, also known as TIAs (see this disorder for more information).
  • More potent anticoagulants such as warfarin may be prescribed for those who have atrial fibrillation (a common complication of mitral valve disease) or who continue to experience TIAs despite initial treatment. Long-term administration of anticoagulants may be necessary following valve replacement surgery, because prosthetic valves are associated with a higher risk of blood clots.
  • Balloon dilatation (a surgical technique involving insertion into a blood vessel of a small balloon that is led via catheter to the narrowed site and then inflated) may be done to widen a stenotic valve.
  • Surgery to repair or replace a damaged valve may be necessary. Replacement valves may be artificial (prosthetic valves) or made from animal tissue (bioprosthetic valves). The type of replacement valve selected depends on the patient's age, condition, and the specific valve affected.

When to Call a Doctor

  • Call a doctor if you develop persistent shortness of breath, palpitations, or dizziness.
  • EMERGENCY Call an ambulance if you experience severe chest pain.