Heart Valves and Valve Disease

Degenerative changes

This is one of the most common causes of leaky heart valves. The structures supporting the heart valves weaken and stretch over time and this prevents the valves from closing properly.

Rheumatic heart disease

Rheumatic heart disease is a general term which means any heart problem which develops after having an episode of rheumatic fever.

Other causes of valve disease include:

• Deposits of calcium (calcification) in parts of the valve. This is the most common cause of aortic stenosis in older people.
• Dilated cardiomyopathy.
• Hypertrophic cardiomyopathy.
• Some heart problems present from birth (congenital). It is then usually part of a complex heart deformity.
• Infection of the valve (infective endocarditis).
• A leaky heart valve may occasionally occur following heart valve surgery.
• A complication of various uncommon diseases.

• Shortness of breath. This tends to occur on exercise at first but occurs at rest if the stenosis becomes worse. This symptom is due to the congestion of blood and fluid in the lungs.
• Fainting, dizziness or tiredness. If the amount of blood getting through to the ventricle is reduced, the output of blood from the left ventricle to the body is then reduced.
• Chest pains (angina pectoris). This may develop if there is a reduced blood flow to the arteries that take blood to the heart muscle (the coronary arteries).
• Fast or irregular heartbeat which you may feel as the sensation of a ‘thumping heart’ (palpitations).
• Chest infections may happen more often.
• Coughing up bloodstained sputum. This may occur due to the congestion of blood and fluid in the lungs.
• Ascitesis the abnormal buildup of fluid in the abdomen. Symptoms may include increased abdominal size, increased weight, abdominal discomfort, and shortness of breath.

A doctor may hear a heart murmur or other abnormal noises when listening with a stethoscope. Murmurs and noises are due to blood passing through abnormal valves, or to abnormal movement of valves. There are typical murmurs and noises which occur with each heart valve problem.

• Initial tests usually include a chest X-ray and a heart tracing (an electrocardiogram, or ECG).
• An ultrasound scan of the heart (an echocardiogram, or ‘echo’) can confirm the diagnosis.
• Other heart tests, including computerised tomography (CT) scans and magnetic resonance imaging (MRI) scans can help to assess the severity of the condition.
• Cardiac catheterisation may be done to assess the severity of the heart valve problem. In this test a thin tube called a catheter is inserted into either the main blood vessel in the top of the leg (femoral artery) or an artery in the wrist (radial artery). It is passed up to the heart. A small device on the tip of the catheter can measure the pressure on either side of the heart valve.

Any treatment will depend on which valve is affected and the severity of the heart valve problem.

Medication

Mild cases may not require any regular medication. Some medicines may be prescribed to help ease symptoms, or to help prevent complications. For example:

• Angiotensin-converting enzyme (ACE) inhibitors are medicines which help to reduce the amount of work the heart does. One may be prescribed to ease symptoms of heart failure.
• ‘Water’ tablets (diuretics) usually help if you are breathless. They make the kidneys produce more urine. This gets rid of excess blood and fluid which may build up in the lungs or other parts of the body with the back pressure from the heart.
• If you develop atrial fibrillation, several medicines can be used to slow the heart rate down. They include beta-blockers, calcium-channel blockers and digoxin. Shocking the heart with an electrical current (a procedure called cardioversion) is also an option in some people who develop atrial fibrillation as a complication.
• Anticoagulation medication is usually advised if you develop atrial fibrillation. This helps to prevent blood clots from forming.

Surgery

Surgery to stretch, repair or replace the valve may be needed in some cases. Surgical treatment has greatly improved the outlook for many cases of severe valve disease. Surgery has a very good success rate.