The heart pumps blood through the body through four main valves. The mitral, aortic, tricuspid, and pulmonary valves regulate blood flow in one direction and prevent it from flowing backwards. When one of the valves does not open or close properly, blood flow may be affected, and the heart may be stressed. This condition is known as heart valve disease and can cause serious complications if not treated. In this article, we will review the causes, symptoms, and diagnosis of heart valve disease, as well as the most prominent modern treatment methods.
What are heart valve diseases?
Heart valve disease occurs when one of the four valves malfunctions and interferes with its normal function of regulating blood flow within the heart, and these disorders include the following types:
- Valve stenosis: It occurs when the valve leaflets become thicker and less flexible, causing the valve opening to narrow and less blood to pass through. In severe cases, the heart has to work harder to pump blood. The most common type is aortic valve stenosis.
- Valve regurgitation: Also known as regurgitation or a leaky valve, it occurs when the valve doesn’t close tightly and blood leaks backwards, putting extra strain on the heart and impairing blood flow to the body. This defect can affect any valve, with mitral regurgitation being a common condition.
- Valve prolapse: In this condition, the leaflets of the valve (often the mitral valve) become overly flexible and push back towards the atrium when the heart contracts. This prolapse may be mild but can lead to regurgitation in some cases.
More than one valve can be affected at the same time, and some patients may have a combination of stenosis and regurgitation in the same valve.
Common causes of heart valve disease
There are many causes of heart valve disease, depending on the nature of the defect and the type of valve affected:
- Congenital defects: Some people are born with underdeveloped valves or with a bicuspid aortic valve instead of a tricuspid, which increases the risk of later injury.
- Rheumatic fever: This is a late complication of strep throat and can lead to permanent changes in the shape and damage to valves, especially the mitral valve.
- Heart infections (endocarditis): A bacterial infection affects the lining of the heart and can damage the valves and affect their function.
- Aging: With age, the valve leaflets may calcify and lose their elasticity, especially in the aortic valve, leading to stenosis or regurgitation.
- Myocardial infarction (heart attack): May damage the muscles that close the valve, affecting its ability to close completely, especially in the mitral valve.
- Other heart diseases: Such as heart failure, cardiomyopathy or aortic stenosis, which affect the function of the valves.
- Autoimmune and genetic diseases: Such as SLE or Marfan syndrome, which can weaken the tissues that maintain the structure of the heart and lead to sagging or malfunctioning valves.
- Radiation or chemotherapy: Exposure to radiation or certain cancer drugs can cause degenerative changes in valve tissue.
Heart valve disease is more likely to occur in older people, those with a family history, or those with chronic diseases such as diabetes, high blood pressure, high cholesterol, or an unhealthy lifestyle.
Symptoms of heart valve disease
In many cases, the symptoms of heart valve disease do not appear in the early stages, and the patient may live for years without feeling any issue, but as the disease progresses and the valve function deteriorates, the heart begins to work harder to compensate for the lack of blood flow and symptoms gradually begin to appear. Some of the most prominent symptoms include
- Shortness of breath, especially during physical activity or when lying down
- General fatigue or feeling tired easily, even with minor exertion
- Chest pain or discomfort, especially during exertion
- Dizziness or lightheadedness, and in some cases, fainting
- Palpitations or irregular heartbeat
- Swelling in the feet, ankles, or abdomen
- Sudden weight gain due to fluid retention
Symptoms of heart valve disease can mimic other medical conditions, so it’s always important to see a doctor for a diagnosis.
How is heart valve disease diagnosed?
Diagnosis of heart valve disease usually begins with a clinical examination, where the doctor listens to the sound of the heart using a stethoscope and may hear an abnormal sound known as a heart murmur that indicates a possible malfunction of one of the valves, after the clinical examination, a set of tests are performed to assess the health of the valves and heart function, the most important of which are:
- Echocardiography: The most important test for diagnosing valve disease, it uses sound waves to create moving images of the heart showing blood flow and valve movement, and can be performed from the chest or, in some cases, through the esophagus.
- Electrocardiogram: Records the electrical activity of the heart and shows the speed and regularity of the heartbeat, and helps detect arrhythmias associated with valve dysfunction.
- Chest X-ray: Shows the size of the heart and lungs and can reveal an enlarged heart or fluid around the lungs.
- Cardiac stress test: Used to assess the heart’s response during physical activity and may reveal symptoms that are not seen at rest. It is performed on a treadmill or bicycle, or with simulated exertion medication if exercise is not possible.
- Cardiac magnetic resonance: Provides accurate images of the heart’s structure and valves and helps determine the severity of the injury.
- Cardiac catheterization: It is not usually used as the first option for diagnosing valve disease, but may be used in specific cases when other tests are insufficient, or to accurately determine the severity of the injury. A thin tube (catheter) is inserted through a blood vessel in the groin or wrist and guided to the heart, then a special dye is injected that shows blood and valve movement clearly on X-ray images.
Treatment options for heart valve disease
The choice of the appropriate treatment for heart valve diseases depends on several factors such as the type of valve affected, the severity of the disease, and the presence of symptoms. In some mild cases, the doctor may be satisfied with periodic follow-up, while in advanced cases, drug treatment or surgical intervention may be required.
- Drug therapy: Medications do not directly treat valve dysfunction, but are used to control symptoms, reduce stress on the heart, and prevent complications.
- Diuretics: Used to reduce fluid retention in the body and relieve swelling.
- Antihypertensives, Such as ACE inhibitors, to reduce the burden on the heart.
- Blood thinners: These are given in certain situations to reduce the risk of clots forming, such as a mechanical valve or a heart rhythm disorder, such as atrial fibrillation.
- Interventional and surgical procedures: When valve function deteriorates or severe symptoms occur, surgical intervention or an interventional procedure may be recommended. Options include:
- Valve replacement (mechanical or biological): The damaged valve is replaced with an artificial valve. Mechanical valves are long-lasting but require lifelong blood thinners. Biological valves, on the other hand, are taken from human or animal tissue and do not require long-term blood thinners, but may deteriorate over time.
- Transcatheter valve repair (such as TAVI/TAVR): An interventional procedure performed via a catheter without the need for open-heart surgery, such as minimally invasive aortic valve replacement (MIVR) for patients who are not candidates for traditional surgery.
- Open-heart surgery: Used when catheter repair is insufficient, the valve is repaired or replaced through a surgical incision in the chest.
Possible complications if the disease is not treated
If valvular heart disease is neglected, the condition may gradually worsen and lead to serious complications, most notably heart failure, where the heart strains itself to compensate for the imbalance in blood flow, heart rhythm disorders such as atrial fibrillation may occur, which increases the risk of clots forming and traveling to the brain causing a stroke, and with time the heart may enlarge and lose its systolic efficiency and some advanced cases may end in sudden death due to severe heart dysfunction or a sudden electrical disturbance.
Can heart valve disease be prevented?
Not all cases of valvular heart disease can be prevented, especially diseases resulting from aging or congenital defects, but the risk of injury or disease progression can be minimized through a healthy lifestyle that includes treating throat infections quickly, maintaining oral and dental health to avoid endocarditis, avoiding smoking and intravenous drugs, eating a balanced diet, regular physical activity, maintaining a healthy weight, and controlling blood pressure, cholesterol, and diabetes. Regular medical follow-up is essential, especially for those with risk factors or a history of heart disease.
In conclusion, heart valve disease can be managed effectively with early diagnosis and adherence to treatment. Ignoring symptoms can lead to serious complications, so it is important to consult a cardiologist when you feel any abnormality in your breathing or heartbeat. With regular follow-up and a healthy lifestyle, the condition can be improved and deterioration can be prevented, and early attention can make a big difference in quality of life.
Sources:
- National Heart, Lung, and Blood Institute. (n.d.). Heart valve diseases. U.S. Department of Health and Human Services.
- Centers for Disease Control and Prevention. (n.d.). About heart valve disease. U.S. Department of Health & Human Services.
