Valvular Heart Disease

Valve disease usually advances slowly, giving the body time to adjust. You may not notice the onset of any symptoms early on.   Additionally, the severity of the symptoms does not necessarily correlate to the severity of the valve disease. That is, you could have no symptoms at all, but have severe valve disease.

When symptoms do occur, they are similar to those associated with congestive heart failure:

• Shortness of breath
• Chest pain
• Fatigue or decreased ability to exercise
• Swelling in the legs
• Dizziness or fainting (with aortic stenosis).
• Rapid weight gain.

There are many different types of valve disease; some types can be present at birth (congenital), while others may be acquired later in life.

• Heart valve tissue may degenerate with age.
• Rheumatic fever may cause valvular heart disease.
• Bacterial endocarditis, an infection of the heart valves.
• High blood pressure and atherosclerosis may damage the aortic valve.
• A heart attack may damage the muscles that control the heart valves.
• Other disorders such as carcinoid tumors, rheumatoid arthritis, systemic lupus erythematosus, or syphilis may damage one or more heart valves.
• 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, if the cancer (and therefore the radiation beam) was located near the heart.

During your examination, the doctor listens for distinctive heart sounds, known as heart murmurs, which indicate valvular heart disease. As part of your evaluation, you may undergo one or more of the following tests:

• An electrocardiogram, also called an ECG or EKG, to measure the electrical activity of the heart, regularity of heartbeats, thickening of heart muscle (hypertrophy) and heart-muscle damage from coronary artery disease.
• Stress testing, also known as treadmill tests, to measure blood pressure, heart rate, ECG changes and breathing rates during exercise. During this test, the heart’s electrical activity is monitored through small metal sensors applied to your skin while you exercise on a treadmill.
• Chest X-rays.
• Echocardiogram to evaluate heart function. During this test, sound waves bounced off the heart and translated into images. The pictures can reveal abnormal heart size, shape and function, and allow the cardiologist to look at the heart valves.
• Cardiac catheterization, which is 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).

The following provides an overview of the treatment options for valvular heart disease:

• Don’t smoke; follow prevention tips for a heart-healthy 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.
• Antibiotic therapy may be needed if an infection was found.
• 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 tight valve.
• Valve Surgery to repair or replace a damaged valve may be necessary. Replacement valves may be artificial (mechanical 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.
• Less invasive procedure such as TAVR (for the aortic valve) and MitraClip (for the mitral valve) are being used much more frequently now.