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It's February, fall in love with your heart valves and learn the symptoms of heart valve disease.

Jan 29, 2019

Author: Dr. Neil Galindez, MD

February is Heart Month and February 22nd is National Heart Valve Disease Awareness Day. I want to take this opportunity to talk about heart valve disease.

What is heart valve disease?

For us to talk about heart valve disease, we have to understand how the heart and its valves work. The heart is a complex structure made out of specialized muscle and connective tissue. It has 4 chambers that fill with blood and contract to make circulation possible, the atria and the ventricles. It also has 4 one-way valves made of thin and pliable connective tissue flaps called leaflets that open and close with each heartbeat. The blood flows from the right atrium to the right ventricle through the tricuspid valve, from the right ventricle to the pulmonary artery and the lungs through the pulmonic valve, from the left atrium to the left ventricle through the mitral valve, and from the left ventricle to the aorta and rest of the body through the aortic valve.

Heart valve disease occurs if one or more of the heart valves don't work well. The valves can have three basic kinds of problems: If the valve does not close well and allows for blood to backflow it is called regurgitation. When the valve is thickened or stiff and does not open well it is called stenosis, and when the valve is completely closed and sealed it is called atresia, this is usually a congenital problem (something the person was born with). The disease can be complex having multiple valves involved and having regurgitation and stenosis on the same valve. A disease valve or valves can create significant pressure changes in the heart chambers and the blood flow will not be as efficient. If this happens, the heart will work harder trying to compensate and with time irreversible damage can develop.

Commonly, the most involved valves in adults in the United States are the aortic and mitral valves. Mitral prolapse occurs when the leaflets of the valve flop back into the left atrium during contraction preventing the valve from closing well. Many valve problems develop because of age-related factors but some valve conditions develop due to illnesses, such as infective endocarditis which is the infection and subsequent destruction of a heart valve. Rheumatic fever is another cause of valve disease; it is an inflammatory reaction that can occur after a streptococcal infection of the throat. It can affect the heart by producing inflammation of the heart valves with subsequent scarring and damage.

Symptoms of heart valve disease:

In some people the condition stays stable throughout their lives without causing problems or symptoms. However, heart valve disease can worsen with time when the degree of stenosis or regurgitation increases causing symptoms. These symptoms depend on the valve affected and could include worsening shortness of breath with physical activity or at rest, fatigue, dizziness, loss of consciousness, chest pain or discomfort, palpitations, chest fluttering, leg or ankle swelling. Overtime, heart valve disease can also cause heart failure, stroke or death due to sudden cardiac arrest. Symptoms do not always relate to the degree of valve disease.

Evaluation:

Individuals with suspected heart valve disease should have a detailed history and physical examination done by a cardiologist. An echocardiogram (ultrasound of the heart) should be done to assess the structure and the function the heart and each valve. The echocardiographic findings in conjunction with symptom status are used to determine treatment options and timing of valve intervention. In patients that need surgical intervention the evaluation is best done by a group of specialists including cardiologists, structural interventional cardiologist, and heart surgeons to recommend the best therapeutic option as a group (heart team approach). Other tests like an electrocardiogram, chest x-rays, stress testing, cardiac catheterization could be needed in the evaluation of patients with known or suspected heart valve disease. Patients with heart valve disease and changes in symptoms should have a new evaluation.

Treatment:

The goal of treatment is to protect the heart from long-term complications, to relieve symptoms, and to fix the valve problem if needed. Heart valve disease without symptoms is usually treated with medications to relieve symptoms and with lifestyle modifications to decrease the risk of developing heart failure and long-term complications. When a patient develops severe regurgitation or stenosis with symptoms heart valve surgery is indicated. All interventions should be based on individual risk-benefit assessment. For example, If the patient has high or prohibitive risk for mortality or complications with heart valve surgery then the recommendation should be a lesser invasive approach like a catheter-based therapy. We now have the technology to deploy valves in the heart with small catheters that are passed through the peripheral blood vessels, usually the femoral arteries. This kind of therapy is only reserved for high risk patients. Surgical intervention is the gold standard and includes repairing or replacing the heart valve. There are several kinds of valves and materials used for this purpose and their use is tailored to the specific valve problem and patient. Heart valve surgery can be done through a midline incision in front of the chest or through a smaller incision through the side of the chest. The approach option is based on the surgeon’s experience and preference. The good news is that valve surgery is very likely to provide good outcomes, recovery time is usually 4-8 weeks. During recovery time patients gradually regain their energy and return to their normal activity level.

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