Valvular Heart Disease

Valvular Heart Disease Overview

Valvular heart disease occurs when your heart valves do not work correctly, characterized by either damage or a defect in one of the four heart valves.

The mitral and tricuspid valves control the flow of blood between the upper chambers (atria) and the lower chambers (ventricles). The pulmonary valve controls the flow of blood from the right side of heart to the lungs, and the aortic valve regulates blood flow between the heart and the aorta. The mitral and aortic valves are most frequently affected by valvular heart disease.

Valves function normally when blood flows with proper force and direction through the heart. Valvular heart disease occurs when valves become too narrow or hard to open fully and blood flow is reduced (stenosis) or when valves are unable to close completely, thus allowing the blood to leak backward across the valve (incompetency, insufficiency or regurgitation). In general, valvular heart disease causes the heart to work harder to circulate the right amount of blood throughout the body.

Valvular heart disease has a variety of causes, some present at birth (congenital) and others acquired later in life. High blood pressure, atherosclerosis, heart attacks, cardiomyopathy and aging may severely affect the valves as well as some migraine and previously marketed diet medications. Some infections and disorders that may lead to valvular heart disease include:

Rheumatic fever, which can cause a common type of heart valve disease, rheumatic heart fever. This most often affects the mitral valve, causing it to become narrowed or leaky.
Endocarditis, a potential life-threatening infection in which bacteria attaches to the heart valves causing growths or scars. These germs most often enter the body through improper sterilization during surgery or through poor dental hygiene.
Carcinoid tumors, rheumatoid arthritis, lupus or syphilis.

Other causes include myxomatous degeneration, which is a weakening of valve tissue caused by energy changes in the body; calcific degeneration, which involves valves thickening due to a buildup of calcium on the aortic or mitral valves; and congenital defects involving an irregularly shaped aortic valve or narrowed mitral valve.

Symptoms

Many patients do not exhibit symptoms in the early stages of valvular heart disease, but signs can occur suddenly and increase in severity as the disease develops. Many of the symptoms are similar to those related to congestive heart failure, such as shortness of breath even with limited activity and swelling of the feet, ankles, hands or abdomen. A murmur detected by your physician may be a marker of valvular disease. Other symptoms include:

Rapid or irregular heartbeat or pulse.
Dizziness or fainting (with aortic stenosis).
Fever (with endocarditis).
Rapid weight gain.

Risk Factors

Older people are most at risk of developing valvular heart disease, based on estimates that 1 of 8 people aged 75 or older will suffer at least a moderate form of the condition. Also, people who have a history of endocarditis, rheumatic fever, heart attack or heart failure are more at risk.

Other major risk factors include:

High blood pressure
High cholesterol
Smoking
Diabetes
Obesity
Lack of physical exercise
Family history of heart disease

Valvular Heart Disease Prevention

A major step in preventing valvular heart disease is to get prompt treatment for a sore throat that lasts longer than 48 hours, especially if it is accompanied by a fever. Timely administration of antibiotics can prevent the development of rheumatic fever, which can lead to valvular heart disease. A heart-healthy lifestyle and good dental care can also prevent the factors that can lead to valvular heart disease.

Reduce Your Risk of Valvular Heart Disease

You can lower your chances of valvular heart disease through several methods:

Seek proper treatment for a sore throat.
Don’t smoke or drink alcohol.
Eat healthy foods and reduce sodium intake.
Exercise as recommended by your Wellstar physician.
Control certain physical conditions, including high blood pressure, high cholesterol and diabetes.
Maintain proper dental hygiene.

Tests and Screenings

In diagnosing for valvular heart disease, your Wellstar physician will take a careful medical history and perform a physical examination. Through a physical examination, your physician can determine if you have a heart murmur or other signs of the disease, such as fluid around the lungs (pleural effusion), an irregular heartbeat or fluid build-up in your legs or abdomen.

Based on the exam, your physician might order some of these tests:

Chest x-ray to reveal fluid build-up in the lungs or calcium deposits in your heart.
Blood tests to check your kidney and thyroid functions or for diseases that could affect the performance of your heart.
Electrocardiogram (ECG) to record the electrical activity of your heart and to reveal if there are rhythm abnormalities.
Echocardiogram, an ultrasound test, designed to show the pumping performance of your heart, a measurement known as the ejection fraction. In a healthy heart, the ejection fraction is about 55%, which means that just over half of your blood filling the ventricle with each cardiac cycle is pumped out with each beat.
Cardiac Stress Tests, which measure your hearts performance during exertion.
Coronary Catheterization or angiogram in which a thin, flexible tube (catheter) is inserted into your groin or arm and guided through the aorta into your heart. Dye is injected through the tube for fluoroscopic visualization.
Cardiac Computerized Tomography (CT) Scan or Magnetic Resonance Imaging (MRI), which can provide a three-dimensional image of your heart.

Valvular Heart Disease Diagnosis

If screening tests or check-ups reveal abnormal results, your Wellstar physician will perform further evaluations regarding valvular heart disease.

Procedures

Physical Examination
Chest x-rays
Electrocardiogram (ECG)
Echocardiogram
Cardiac Stress Tests
Cardiac Computerized Tomography (CT) Scan or Magnetic Resonance Imaging (MRI)
Coronary Catheterization or angiogram

Valvular Heart Disease Treatment

Currently, no medications can cure valvular heart disease. However, lifestyle changes and medicines can often treat symptoms and delay complications for years. In time, surgery may be necessary to replace or repair the valve or atrial wall or other heart condition.

Care at Home

Making lifestyle changes can help relieve the symptoms of valvular heart disease and prevent it from worsening. Among the most beneficial changes include:

Ensuring that you do not get rheumatic fever. See your Wellstar physician for lingering throat issues, particularly if you also have a fever.
Informing your dentist before any dental procedure about past afflictions of rheumatic fever or heart valve disease to avoid bacterial infection that can lead to endocarditis.
Stopping smoking and limiting alcohol consumption.
Restricting sodium intake.
Weighing yourself daily to keep track of fluid retention.
Maintaining a healthy weight and diet.
Exercising and reducing stress.
Elevating feet and legs if they become swollen.

Medications

Your Wellstar physician may prescribe a combination of medications if you have been diagnosed with valvular heart disease. Some of these medicines include:

Antibiotics to prevent a recurrence of streptococcal infection in those who have had rheumatic fever.
Blood thinners or Anticoagulant (Anti-clotting) drugs or anti-platelet therapy.
Digoxin (Lanoxin^®): This medication, also known as digitalis, may prevent episodes of congestive failure and control heart rhythm abnormalities.
Diuretics: Sometimes called “water pills,” these medications work on your kidneys to help your body eliminate sodium and water, thus reducing blood volume.
Beta-blockers: These medications reduce the heart’s workload and expand blood vessels, thus causing your heart to work slower with less force. These may include carvedilol (Coreg^®), metoprolol (Lopressor^®).
Calcium channel blockers: These may lower the pressure in the aorta, which the left ventricle has to pump against.

Ongoing Care for Valvular Heart Disease

Wellstar provides top-flight cardiac care throughout its physicians’ offices, urgent care centers and emergency rooms. Emergency departments at Wellstar Cobb, Wellstar Douglas, and Wellstar Kennestone hospitals provide comprehensive cardiac services. Wellstar Cobb and Wellstar Kennestone hospital’s cardiac diagnostic and treatment services provide the next level of defense against heart disease. The technologically advanced Cardiac Center at WellStar Kennestone Hospital and partnership with Emory Healthcare for adult open-heart surgery raises the bar on world-class cardiac care. Wellstar’s Cardiac Rehabilitation Services’ medically supervised programs focus on helping heart disease patients maintain a healthier heart through education and support groups.

Ongoing Care at Home

Although many aspects of heart failure cannot be reversed, treatment can often improve symptoms and help you live longer. You and your Wellstar physician can work together to make your life more comfortable so pay close attention to your body and your post-treatment regimen and keep your doctor updated. As part of your post-treatment care and in addition to maintaining a healthy diet and exercise, you should:

Keep track of all medications you take.
Avoid certain over-the-counter medications, such as non-steroidal anti-inflammatory drugs (ibuprofen, naproxen and others), cold medications and diet pills.
Keep track of your weight and blood pressure.
Write down your questions and never be afraid to ask your Wellstar physicians for clarification.