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Valvular Heart Disease

Overview

The disorder involving your heart valves is referred to as valvular heart disease. Your heart is a muscular organ located in the center of the chest. Its function is to pump blood with oxygen and nutrients throughout the body and bring back the blood containing carbon dioxide taken to the lungs to exit the body.  It consists of four chambers; the upper two are atria, and the lower two are called ventricles. These chambers are separated by valves that allow the blood to flow in one direction only to avoid mixing the blood to prevent disruption of heart function. Your heart contains four valves. The two are between the atria and ventricle, while the other two are at the commencement of main blood vessels taking blood away from the heart to the body and the lungs, i.e., the aorta and pulmonary artery.

Any condition affecting these valves results in the disruption of heart function, and so the symptoms depend on the valve type involved. They are cured either with medicines, surgery, or both.

The disorder involving your heart valves is referred to as valvular heart disease. Your heart is a muscular organ located in the center of the chest. Its function is to pump blood with oxygen and nutrients throughout the body and bring back the blood containing carbon dioxide taken to the lungs to exit the body.  It consists of four chambers; the upper two are atria, and the lower two are called ventricles. These chambers are separated by valves that allow the blood to flow in one direction only to avoid mixing the blood to prevent disruption of heart function. Your heart contains four valves. The two are between the atria and ventricle, while the other two are at the commencement of main blood vessels taking blood away from the heart to the body and the lungs, i.e., the aorta and pulmonary artery.

Any condition affecting these valves results in the disruption of heart function, and so the symptoms depend on the valve type involved. They are cured either with medicines, surgery, or both.

Causes

Several conditions can affect the heart valves like;

  • Birth defects: Sometimes, the valves are not formed properly during the pregnancy and are present at birth. The symptoms may be shown just after the birth or may even appear later in life.
  • Aging: The valves undergo a process of calcification with aging.
  • Connective tissue disorders: Heart valves are made up of dense connective tissue. Connective tissue disease may affect the heart valves also like Marfan's syndrome, osteogenesis imperfect, etc.
  • Inflammatory disorders: Heart valves can be affected via inflammation in diseases like bacterial infections, cancers, and autoimmune diseases(SLE).
  • Heart disease: valves can be affected by heart conditions like myocardial infection, dilation of ventricles, cor pulmonale, etc. 

    Several conditions can affect the heart valves like;

    • Birth defects: Sometimes, the valves are not formed properly during the pregnancy and are present at birth. The symptoms may be shown just after the birth or may even appear later in life.
    • Aging: The valves undergo a process of calcification with aging.
    • Connective tissue disorders: Heart valves are made up of dense connective tissue. Connective tissue disease may affect the heart valves also like Marfan's syndrome, osteogenesis imperfect, etc.
    • Inflammatory disorders: Heart valves can be affected via inflammation in diseases like bacterial infections, cancers, and autoimmune diseases(SLE).
    • Heart disease: valves can be affected by heart conditions like myocardial infection, dilation of ventricles, cor pulmonale, etc. 

Types

Types of valvular disorders  are based on the type of valve involved, which can be;

  • Mitral valve (Mitral Stenosis and Mitral Regurgitation): This valve is between the left atrium and ventricle. It can either become stiff and narrow, called mitral stenosis, or become loose and not close properly called mitral regurgitation. In stenosis, the difficulty lies in emptying blood from the atrium to the ventricle and causes the back pooling of blood in the lungs. In regurgitation, the valves are not closed properly, and instead of blood going ahead in the aorta, it goes back in the left atrium.
  • Tricuspid valve ( Tricuspid Stenosis and Tricuspid Regurgitation): This valve is between the right atrium and ventricle. It can either become stiff and narrow, called tricuspid stenosis, or become loose and not close properly called regurgitation. In stenosis, the difficulty lies in the emptying of blood from the atrium to the ventricle and causes the back pooling of blood in the peripheries of the body. In regurgitation, the valves are not closed properly, and instead of blood going ahead in the pulmonary artery, it goes back in the right atrium.
  • Aortic valve (Aortic Stenosis and Aortic Regurgitation): This valve is at the commencement of a large blood vessel called the aorta, which carries oxygenated blood from the left ventricle to the body. It can either become stiff and narrow, called aortic stenosis, or become loose and not close properly called aortic regurgitation. In stenosis, the difficulty lies in the ejection of blood from the left ventricle to the aorta. In regurgitation, the valves are not closed properly, and instead of blood going ahead in the aorta to the body, it goes back in the left ventricle.
  • Pulmonary valve (Pulmonary Stenosis and Pulmonary Regurgitation): This valve is at the commencement of a large blood vessel called the pulmonary artery, which carries deoxygenated blood from the right ventricle to the lungs. It can either become stiff and narrow, called pulmonary stenosis, or become loose and not close properly called pulmonary regurgitation. In stenosis, the difficulty lies in the ejection of blood from the right ventricle to the pulmonary artery. In regurgitation, the valves are not closed properly, and instead of blood going ahead in the pulmonary artery to the lungs, it goes back in the right ventricle.

    Types of valvular disorders  are based on the type of valve involved, which can be;

    • Mitral valve (Mitral Stenosis and Mitral Regurgitation): This valve is between the left atrium and ventricle. It can either become stiff and narrow, called mitral stenosis, or become loose and not close properly called mitral regurgitation. In stenosis, the difficulty lies in emptying blood from the atrium to the ventricle and causes the back pooling of blood in the lungs. In regurgitation, the valves are not closed properly, and instead of blood going ahead in the aorta, it goes back in the left atrium.
    • Tricuspid valve ( Tricuspid Stenosis and Tricuspid Regurgitation): This valve is between the right atrium and ventricle. It can either become stiff and narrow, called tricuspid stenosis, or become loose and not close properly called regurgitation. In stenosis, the difficulty lies in the emptying of blood from the atrium to the ventricle and causes the back pooling of blood in the peripheries of the body. In regurgitation, the valves are not closed properly, and instead of blood going ahead in the pulmonary artery, it goes back in the right atrium.
    • Aortic valve (Aortic Stenosis and Aortic Regurgitation): This valve is at the commencement of a large blood vessel called the aorta, which carries oxygenated blood from the left ventricle to the body. It can either become stiff and narrow, called aortic stenosis, or become loose and not close properly called aortic regurgitation. In stenosis, the difficulty lies in the ejection of blood from the left ventricle to the aorta. In regurgitation, the valves are not closed properly, and instead of blood going ahead in the aorta to the body, it goes back in the left ventricle.
    • Pulmonary valve (Pulmonary Stenosis and Pulmonary Regurgitation): This valve is at the commencement of a large blood vessel called the pulmonary artery, which carries deoxygenated blood from the right ventricle to the lungs. It can either become stiff and narrow, called pulmonary stenosis, or become loose and not close properly called pulmonary regurgitation. In stenosis, the difficulty lies in the ejection of blood from the right ventricle to the pulmonary artery. In regurgitation, the valves are not closed properly, and instead of blood going ahead in the pulmonary artery to the lungs, it goes back in the right ventricle.

Epidemiology

Valvular heart disease affects about 2.5% of the population In the United States. The frequency of these disorders increases as the person ages, and it is prevalent in 13 % of 75 year-olds in the United States. The most common cause of valve diseases in developing countries is rheumatic disease, which makes up to 65% of valve disorders. Aortic stenosis and regurgitation are affected mainly by age, and their prevalence is 12.4% and 13% in the age group of 55-80 years, respectively. Mitral stenosis is almost always caused by rheumatic heart disease, and it is prevalent in 0.1% of people in the US. 9% of people over 75 years have mitral regurgitation due to aging. 

Valvular heart disease affects about 2.5% of the population In the United States. The frequency of these disorders increases as the person ages, and it is prevalent in 13 % of 75 year-olds in the United States. The most common cause of valve diseases in developing countries is rheumatic disease, which makes up to 65% of valve disorders. Aortic stenosis and regurgitation are affected mainly by age, and their prevalence is 12.4% and 13% in the age group of 55-80 years, respectively. Mitral stenosis is almost always caused by rheumatic heart disease, and it is prevalent in 0.1% of people in the US. 9% of people over 75 years have mitral regurgitation due to aging. 

Risk Factors

Having one or more of the following risk factors puts you at an increased chance of having a valvular disease:

  • Older age
  • History of heart attack
  • Diabetes mellitus
  • High blood pressure
  • High blood cholesterol
  • Autoimmune diseases
  • Connective tissue diseases
  • Congenital diseases

    Having one or more of the following risk factors puts you at an increased chance of having a valvular disease:

    • Older age
    • History of heart attack
    • Diabetes mellitus
    • High blood pressure
    • High blood cholesterol
    • Autoimmune diseases
    • Connective tissue diseases
    • Congenital diseases

Signs And Symptoms

The following symptoms may point towards a heart valve disease, and you should plan to consult a physician.

  • Chest pain
  • Fatigue
  • Shortness of breath
  • Feeling faint
  • Swelling in the body, especially feet or abdomen
  • Breathing difficulty on lying flat
  • Irregular heartbeats

    The following symptoms may point towards a heart valve disease, and you should plan to consult a physician.

    • Chest pain
    • Fatigue
    • Shortness of breath
    • Feeling faint
    • Swelling in the body, especially feet or abdomen
    • Breathing difficulty on lying flat
    • Irregular heartbeats

Diagnosis

Your doctor will inquire about the symptoms and the previous medical records to diagnose the disorder. He will examine with particular emphasis on the heart examination using a stethoscope for hearing the heart sounds and murmurs to determine valvular heart disease. The following tests can be used:

  • Electrocardiogram: Electrical impulses in the heart are recorded during this simple test. Many cardiac disorders, such as irregular heartbeats and clogged arteries, can be diagnosed with an ECG. ECG is sometimes taken when you work out, usually on a bike or treadmill. A stress test is a name for this approach.
  • Echocardiogram: In this test, ultrasound waves create an image of your heart. Your physician would suggest this test to check how your heart's structures work.
  • X-ray of the chest: Changes in the size and form of your heart, as well as abnormalities in your lungs, can be shown on these scans.
  • Transesophageal echocardiography: It is a type of echocardiogram performed through the esophagus. A transesophageal echocardiogram may be recommended if more precise pictures of your heart are required. A thin pipe holding the sensor is directed down your throat and into the tube that connects your mouth and stomach(esophagus). The procedure is carried out when you are anesthetized.
  • CT scan and an MRI: Pictures of the heart are created throughout this investigation. It is a more detailed investigation than simple x rays.
  • Catheterization of the heart:  Your physician may use it to check the heart's normal blood flow and pressure. You'll be provided sedatives to help you fall asleep. The doctor will then carefully place a cannula into a blood channel in your pelvis or shoulder and guide it to your heart. With the help of X-rays, the cannula is placed in the appropriate location. Color dye is often infused inside the cannula. It aids in the assessment of heart arteries more clearly.

    Your doctor will inquire about the symptoms and the previous medical records to diagnose the disorder. He will examine with particular emphasis on the heart examination using a stethoscope for hearing the heart sounds and murmurs to determine valvular heart disease. The following tests can be used:

    • Electrocardiogram: Electrical impulses in the heart are recorded during this simple test. Many cardiac disorders, such as irregular heartbeats and clogged arteries, can be diagnosed with an ECG. ECG is sometimes taken when you work out, usually on a bike or treadmill. A stress test is a name for this approach.
    • Echocardiogram: In this test, ultrasound waves create an image of your heart. Your physician would suggest this test to check how your heart's structures work.
    • X-ray of the chest: Changes in the size and form of your heart, as well as abnormalities in your lungs, can be shown on these scans.
    • Transesophageal echocardiography: It is a type of echocardiogram performed through the esophagus. A transesophageal echocardiogram may be recommended if more precise pictures of your heart are required. A thin pipe holding the sensor is directed down your throat and into the tube that connects your mouth and stomach(esophagus). The procedure is carried out when you are anesthetized.
    • CT scan and an MRI: Pictures of the heart are created throughout this investigation. It is a more detailed investigation than simple x rays.
    • Catheterization of the heart:  Your physician may use it to check the heart's normal blood flow and pressure. You'll be provided sedatives to help you fall asleep. The doctor will then carefully place a cannula into a blood channel in your pelvis or shoulder and guide it to your heart. With the help of X-rays, the cannula is placed in the appropriate location. Color dye is often infused inside the cannula. It aids in the assessment of heart arteries more clearly.

Differential Diagnosis

Some other disorders may present like valvular heart disease that needs to be excluded from making an efficient diagnosis:

  • Congenital heart diseases
  • Thyrotoxicosis
  • Pregnancy
  • Severe anemia
  • Acute Coronary Syndrome
  • Heart Failure
  • Infective Endocarditis

    Some other disorders may present like valvular heart disease that needs to be excluded from making an efficient diagnosis:

    • Congenital heart diseases
    • Thyrotoxicosis
    • Pregnancy
    • Severe anemia
    • Acute Coronary Syndrome
    • Heart Failure
    • Infective Endocarditis

Treatment And Medications

Children with valvular defects due to congenital heart disease can be cured entirely in infancy by surgical repair. Adults with valvular heart disease are treated differently depending on the severity of their condition. You could need to be watched or need medicine or surgery.

Minor heart defects may only necessitate periodic health checks with your specialist to help that your illness does not deteriorate. Inquire with your physician about how frequently you should be seen.

Medications

Medications that assist the heart to perform better can be used to cure some moderate heart abnormalities. Several classes of medicines have been used depending on the type of the condition and the symptoms needed to be controlled, like anticoagulants (Heparin, Warfarin) are used to avoid blood clots or Beta Blockers (Atenolol, Propranolol), and Calcium Channel Blockers (Amlodipine, Diltiazem ) are used to manage an abnormal heart rhythm. Diuretics (Furosemide, Bumetanide) are used to treat edema associated with heart disease.

Surgical repair

You may need surgical correction of the heart valves, including tightening the ring at the base of the valve, separating the fused leaflets of the valves, etc. Valve replacement procedure can be performed using catheterization or open-heart surgery. 

Children with valvular defects due to congenital heart disease can be cured entirely in infancy by surgical repair. Adults with valvular heart disease are treated differently depending on the severity of their condition. You could need to be watched or need medicine or surgery.

Minor heart defects may only necessitate periodic health checks with your specialist to help that your illness does not deteriorate. Inquire with your physician about how frequently you should be seen.

Medications

Medications that assist the heart to perform better can be used to cure some moderate heart abnormalities. Several classes of medicines have been used depending on the type of the condition and the symptoms needed to be controlled, like anticoagulants (Heparin, Warfarin) are used to avoid blood clots or Beta Blockers (Atenolol, Propranolol), and Calcium Channel Blockers (Amlodipine, Diltiazem ) are used to manage an abnormal heart rhythm. Diuretics (Furosemide, Bumetanide) are used to treat edema associated with heart disease.

Surgical repair

You may need surgical correction of the heart valves, including tightening the ring at the base of the valve, separating the fused leaflets of the valves, etc. Valve replacement procedure can be performed using catheterization or open-heart surgery. 

Prognosis

Prognosis depends on the valve involved and how well the disease is managed. Some are managed well by medications and follow-ups, while others are cured using surgeries. For untreated patients, the outlook is poor. 

Prognosis depends on the valve involved and how well the disease is managed. Some are managed well by medications and follow-ups, while others are cured using surgeries. For untreated patients, the outlook is poor. 

Prevention

Adopting the following lifestyle changes may prevent you from developing valvular heart disease.

  • Quit smoking
  • Take a healthy balanced diet and avoid oily fried food.
  • Perform some kind of exercise regularly.
  • Keep your health status in check by regularly getting assessed for Diabetes Mellitus, high blood pressure, etc.
  • If you are suffering from any risk factors, keep it controlled very well by adhering to its treatment. 

    Adopting the following lifestyle changes may prevent you from developing valvular heart disease.

    • Quit smoking
    • Take a healthy balanced diet and avoid oily fried food.
    • Perform some kind of exercise regularly.
    • Keep your health status in check by regularly getting assessed for Diabetes Mellitus, high blood pressure, etc.
    • If you are suffering from any risk factors, keep it controlled very well by adhering to its treatment. 

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on June 02, 2023.

References

Global epidemiology of valvular heart disease | Nature Reviews Cardiology

https://www.nature.com/articles/s41569-021-00570-z

Heart Valve Disease | American Heart Association

https://www.heart.org/en/health-topics/heart-valve-problems-and-disease

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