Valvular Heart Disease

How serious is Valvular Heart Disease? Let us understand

Valvular heart disease is a cardiovascular disease that occurs when one or more of the heart’s four valves do not open or close properly. When more than one valve is affected, it is termed multiple valvular heart disease. This disease typically occurs due to aging and can be treated by using medications and valve repair surgery. 

Valvular Heart Disease Types

  • Regurgitation results from leakage of the valve. There is a backward flow of the blood due to leaky valves that do not close properly. It generally results in reduced forward blood flow and results in volume overload in the heart. It is subdivided into four types depending on the valve affected :
    • Tricuspid valve regurgitation
    • Pulmonary valve regurgitation
    • Mitral valve regurgitation
    • Aortic valve regurgitation
  • Valvular stenosis ( narrowing of the valve ) – Narrowing the valve opening due to stiffening of the valve muscle limits blood flow out of the atria or ventricles. It is further classified as :
    • Tricuspid valve stenosis
    • Pulmonary valve stenosis
    • Mitral valve stenosis
    • Aortic valve stenosis 
  • Valvular prolapse – This condition occurs when the valve slips out of place or if the valve flaps do not close properly and disrupt the unidirectional flow of blood. The most common valvular prolapse is mitral valve prolapse.

What Causes Valvular Heart Disease?

  • This disease can occur due to congenital abnormalities or acquired causes that cause damage to the heart valves. 
  • Change in the heart valve structures due to aging is one of the main etiological factors of valvular heart diseases, but this is not the sole contributing factor.  
  • The other common causes of this disease are congenital valvular heart disease, bicuspid aortic valve disease, and Marfan syndrome.
  • Following are the health conditions that can also cause valvular heart disease:

What are the Risk factors?

  • Age – Older age people are more prone to getting this disease due to the “wear and tear” of advanced age and the enhanced calcium deposition in the valves. It, in turn, leads to stiffening or thickening of the heart valves.
  • Congenital abnormalities – Congenital birth defects affecting the size and structure of the heart valve increase the rate of valvular heart disease. Heart valve dysplasia, tetralogy of Fallot, and Ebstein’s anomaly are common predisposing factors. Do you know how serious is Congenital Heart Disease?
  • Metabolic disorders – Individuals with metabolic disorders such as high blood cholesterol and diabetes show a higher incidence of valvular heart disease than others.
  • Inflammatory disorders – Generalized inflammation of the heart due to bacterial infections can often lead to regurgitation through the valves. People with valvular endocarditis and rheumatic heart disease are at a higher risk.
  • Radiation therapy – Exposure to high–dose radiation that results in calcium deposits in the valve is also a risk factor.
  • Other diseases – Bacterial infections of the heart that can cause scarring of the heart valve and autoimmune diseases such as lupus also increase the risk of this disease.
  • Certain medications – Ergotamine derivatives such as cabergoline and pergolide used in treating Parkinson’s disease increase the risk of developing valvular heart disease.

Valvular Heart Disease

Signs and symptoms:

  • Chest pain, discomfort, or tightness
  • Heart palpitations
  • Fatigue
  • Dizziness
  • Shortness of breath
  • Swelling in the extremities
  • Abdominal pain
  • Rapid weight gain
  • Fever

Complications

Other life-threatening complications that are more likely to occur due to valvular heart diseases include:

Diagnosis

  • The physician looks for abnormal heart sounds such as a characteristic heart murmur to diagnose this disease. Further diagnostic tests are then performed to identify the type of valve disease.
  • Diagnostic tests – The commonly recommended diagnostic tests are :
    • Electrocardiogram (ECG) – Abnormal heart rhythms and heart muscle damage are identified via this test.
    • Echocardiogram (Echo) – It is typically used to evaluate the heart valve function.
    • Transesophageal echocardiogram – This test is used to create images of the valves and chamber of the heart for diagnostic purposes.
    • Chest x-ray
    • Cardiac catheterization – This procedure is done to determine the type and extent of the heart valve disorder.
    • Magnetic resonance imaging (MRI)

Treatment of Valvular Heart Disease

The primary rationale behind the treatment of valvular heart disease is preventing the exacerbation of the disease and providing relief of symptoms. 

  • Medications –
  • Diuretics – Furosemide, torsemide, etc., to reduce the swelling and fluid buildup in the body by increasing urine output.
  • Vasodilators – Enalapril, fosinopril, etc., to relax the blood vessels and ease the work of the heart muscles.
  • Beta-blockers – Acebutalol, nebivolol, etc., to control heart rate and prevent abnormal heart rhythms.
  • Digoxin and calcium channel blockers like verapamil, diltiazem – These are given to reduce the symptoms of heart valve disease.
  • Surgery – 
    • Heart valve repair – This surgical procedure is done to ease the symptoms and rectify the abnormality of the heart valve. It generally includes remodeling the abnormal heart valves or inserting prosthetic rings to narrow the dilated valves.
    • Heart valve replacement – Severely malformed or destroyed valves cannot be remodeled or repaired and hence require replacement with a new valve. The new valve can be either animal valves, donated human aortic valves, or mechanical valves, although the latter is preferred over the others.
  • Non – surgical procedure – Balloon valvuloplasty is a non – invasive procedure used to treat stenosis. In this, a thin catheter with a balloon at the tip is inserted through the blood vessel to the narrowed valve and then inflated at this region to widen the valve opening. 

Read How is Valve Replacement Surgery performed?

Consult a cardiologist in Mumbai

When to see a doctor? :

Consult immediately with a cardiologist if there is a sudden aggravation of chest pain, shortness of breath, or an inability to maintain the regular activity level. The average cost of heart valve replacement surgery is around INR 2.5 L to 8.5 L. 

Prevention of Valvular Heart Disease

  • Living with valvular heart disease – 
    • Seek immediate medical care if the symptoms aggravate.
    • Getting vaccinated against flu and pneumonia to prevent serious complications.
    • Consuming a low–sodium diet.
    • Cardiac rehabilitation.
    • Getting regular exercise.
    • Quitting smoking.
  • Preventing valvular heart disease –
    • Being more active.
    • Limiting alcohol intake.
    • Managing stress.
    • Managing a healthy weight.
    • Eating a healthy diet.

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