An Overview of Heart Valve Disease

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In heart valve disease, one or more of the structures that allow for the proper movement of blood through the four chambers of the heart become blocked or damaged, preventing blood from entering the heart (stenosis) or allowing it to leak backward (regurgitation). Any type of heart valve disease can have serious cardiac complications, including heart failure.

Heart valve disease can be tricky to detect because it rarely causes symptoms until a fair amount of damage has occurred. Fortunately, during routine medical exams, a doctor can hear sounds through a stethoscope that indicate a potential heart valve problem. The cause and diagnosis can then be pinpointed. Treatment for heart valve disease is almost always surgery to repair or replace the affected structures.

Types of Heart Valve Disease

There is one valve for each of the four chambers of the heart, so it stands to reason there are four kinds of heart valve stenosis and four kinds of heart valve regurgitation. Sometimes a person will develop both problems.

Valvular Stenosis

When a heart valve becomes stenotic, the cardiac chamber that must push blood across the narrowed valve has to work substantially harder, eventually causing the heart muscle to become hypertrophic. Over time, this can lead the muscle to fail. There are several variations of valvular stenosis.

Mitral Stenosis

When the mitral valve becomes thickened, immobile, and unable to open fully, the left atrium cannot empty completely into the left ventricle, producing an increase in left atrial pressure. Over time, significant heart problems can result from mitral stenosis.

Pulmonary Stenosis

This condition most often is associated with congenital disorders, including tetralogy of Fallot, Noonan syndrome, and congenital rubella. Pulmonary stenosis is usually diagnosed at birth or during childhood. If severe, it can lead to failure of the right side of the heart.

Tricuspid Stenosis

The least common of the major valvular diseases, this is partial obstruction of the tricuspid valve. It's most often seen in people who've had rheumatic heart disease and is accompanied by disease in other cardiac valves. Those with significant tricuspid stenosis fatigue easily and aren't able to tolerate physical exertion. Symptoms caused by disease in one of the other valves usually occurs well before tricuspid stenosis begins to produce symptoms.

Aortic Stenosis

This partial blockage of the aortic valve makes it difficult for the left ventricle to eject blood out to the body’s tissues. Aortic stenosis leads to hypertrophy of the muscle of the left ventricle and eventually to heart failure. In addition, if the amount of blood the heart can pump is decreased substantially, syncope (fainting) or even sudden death can occur.

Syncope due to aortic stenosis should be treated as a medical emergency since it indicates that the aortic valve is critically narrowed.

Valvular Regurgitation

Heart valve disease can cause a valve to become incompetent, meaning it fails to close completely, allowing blood to flow backward. Regurgitation causes the affected ventricle to pump a greater volume of blood than normal, which can lead to dilation of the cardiac chambers, weakening of the heart muscle, and eventual heart failure.

Tricuspid Regurgitation

In tricuspid regurgitation, blood leaks from the right ventricle back into the right atrium. Tricuspid regurgitation most often is caused by dilation of the tricuspid annulus that occurs as the result of pulmonary artery hypertension, heart failure, or pulmonary embolus.

Pulmonary Regurgitation

Pulmonary regurgitation allows blood to leak across a closed pulmonary valve from the pulmonary artery into the right ventricle. The most common causes of pulmonary regurgitation are pulmonary artery hypertension, which can produce dilation of the pulmonary valvular annulus, and congenital heart defects. If severe, pulmonary regurgitation can cause the right side of the heart to become dilated, and heart failure can occur.

Mitral Regurgitation

The most common type of heart valve disease because it has so many causes, including mitral valve prolapse (MVP), mitral regurgitation produces a backflow of blood from the left ventricle to the left atrium. Mitral regurgitation can cause dangerous enlargement in both of these parts of the heart and, unless it is treated, can lead to irreversible heart failure.

Aortic Regurgitation

With aortic regurgitation, the aortic valve becomes so leaky that blood washes backward from the aorta into the left ventricle, forcing this chamber to work much harder than it should. If the regurgitation is significant, the ventricle eventually becomes greatly dilated, often leading to heart failure.

Symptoms

In most cases, it is only when actual damage is done to the heart that discernible symptoms appear. It follows, then, that once symptoms of heart valve disease develop, what a person is really experiencing are those of heart failure, including:

  • Dyspnea (shortness of breath)
  • Generalized weakness
  • Lightheadedness
  • Edema (swelling) of the ankles, feet, or abdomen

Heart valve disease also increases the risk of arrhythmias, particularly atrial fibrillation, bringing on additional symptoms such as heart palpitations and a low tolerance for physical exertion.

Causes

Heart valve disease can result from a number of different medical conditions. The most common include the following:

  • Valvular calcification: With age, calcium deposits can form on the heart valves for no apparent reason. Valvular calcification is particularly likely to affect the mitral valve and, to a lesser extent, the aortic valve. In many cases, valvular calcification never causes any significant change in the function of the valve, but it can produce either stenosis or regurgitation. Anyone with heart valve calcification should be monitored regularly.
  • Cardiac dilation: If a heart chamber becomes dilated, it can eventually cause the annulus of the associated cardiac valve to also become dilated, preventing the valve leaflets from closing completely and leading to regurgitation. Cardiac dilation can occur with many kinds of heart disease. Commonly, the dilation that can occur after a heart attack, or with dilated cardiomyopathy, is accompanied by dilation of the mitral valve or tricuspid valve, leading to mitral or tricuspid regurgitation.
  • Congenital heart disease: Many types of congenital heart disease are associated with valvular deformities that can produce stenosis or regurgitation. The most common types of valve problems seen with congenital heart conditions are pulmonary stenosis, bicuspid aortic valve disease (in which the aortic valve has two cusps instead of three, which can lead to aortic stenosis), and mitral valve prolapse (an excess of tissue on this particular heart valve).
  • Infectious endocarditis: An infection of the lining of the heart and especially of the heart valves, infectious endocarditis can lead to heart valve damage, usually regurgitation. This is one condition that may produce acute, and perhaps catastrophic, heart valve regurgitation.
  • Rheumatic heart disease: Rheumatic heart disease is a form of heart valve damage that can develop as a complication of rheumatic fever, a condition that can occur after an infection with the streptococcus bacteria. Although uncommon in the United States and other Western countries, it is still a major concern in many parts of the world.

Heart valve disease also can result from other medical conditions and circumstances, including:

Diagnosis

Early diagnosis of heart valve disease is important as early treatment is key to preventing extensive and irreversible damage that can lead to heart failure. Given that early-stage heart valve problems aren't likely to cause symptoms, this can be a tall order.

Fortunately, although early heart valve disease is an asymptomatic medical problem, it usually can be detected with a stethoscope (a very good reason to get yearly physical exams). Both valvular stenosis and valvular regurgitation create turbulence of the blood flow that creates a discernible sound (i.e., a heart murmur).

In order to definitively diagnose heart valve disease in a patient who has a heart murmur, a doctor will order an echocardiogram, a non-invasive ultrasound test that can distinguish between a heart valve problem and an innocent murmur.

If valvular disease is present, the echocardiogram also can measure the extent of the problem. Several specific measurements can be made of blood flow patterns and cardiac chamber size, and these measurements can be compared to those from subsequent echo tests in order to determine how quickly the valve problem is worsening (if at all).

Treatment

Heart valve disease is fundamentally a mechanical problem. As such, when treatment is required, surgery to repair or replace the damaged valve is usually the only effective option. Some types of valvular disease can be monitored, however, and only require surgery if they progress.

There also are medications that can be used to alleviate symptoms associated with heart valve disease.

Surgery

The circumstances under which surgery will be recommended depend on the type of heart valve disease involved and, in some cases, its severity.

  • Mitral valve stenosis: Treatment is surgical repair or replacement of the mitral valve. Once the need for surgery is established, the optimal type of mitral stenosis surgery needs to be determined for each individual.
  • Mitral valve regurgitation: The optimal timing of surgical treatment depends on the stage of the regurgitationSeveral surgical approaches are available for treating mitral regurgitation.
  • Aortic valve stenosis: Mild aortic stenosis needs to be observed closely over time. If the condition becomes advanced enough, surgery may be necessary.
  • Aortic valve regurgitation: Significant aortic regurgitation requires surgical replacement of the aortic valve.
  • Tricuspid valve stenosis: Surgical treatment of tricuspid stenosis (in which the valve is repaired rather than replaced) almost always happens as an “add-on” procedure when surgery is necessary to treat a more severely affected heart valve.
  • Tricuspid valve regurgitation: Often this condition is relatively mild. One exception: When caused by Ebstein anomaly (a form of congenital heart disease), tricuspid regurgitation often produces severe cardiac problems and requires surgical treatment.
  • Pulmonary valve stenosis: Mild pulmonary stenosis can be a benign condition that requires no therapy. If the condition is more serious, it can often be treated with balloon valvuloplasty, a minimally invasive catheterization procedure.

The typical treatment for pulmonary regurgitation is to take steps to reduce pulmonary artery pressure. Surgery is not often needed.

Medication

In some cases of heart valve disease—in particular, certain types of valvular regurgitation—medication can help stabilize the heart and slow progression of damage.

Aggressive medical treatment directed at treating underlying hypertension or dilated cardiomyopathy, preventing ventricular remodeling after a heart attack, or even controlling the heart rate in atrial fibrillation, for instance, also may lower the risk of significant mitral or tricuspid regurgitation.

You should talk to your doctor about whether you need to take antibiotic prophylaxis for endocarditis.

Living With Heart Valve Disease

If you have heart valve disease, managing your condition is vital to living a long and healthy life. Start by learning everything you can about the type of valvular disorder you have and the extent of your valve problem. If you are on medications to help your heart work more efficiently, take them regularly and report any trouble with them to your doctor.

Since valvular heart disease often progresses over time, it's vital to keep your regular appointments with your doctor whether you're experiencing problems or not.

Finally, since you have a heart condition, you should do everything you can to reduce your odds of developing other kinds of cardiovascular disease: Don’t smoke; follow a healthy diet and maintain a healthy weight; get plenty of exercise; and, if you have hypertension or diabetes, make sure you have these conditions under control.

A Word From Verywell

Valvular heart disease can be a very serious problem. But with early detection, regular medical follow-up, and the availability of modern medical and surgical care, today most people with heart valve disease can expect to live long and healthy lives.

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Article Sources

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