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Valvular Heart Disease
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Valvular heart disease is a condition of the heart where one or more of the four valves in the heart are damaged and are structurally abnormal or function abnormally. Valves are designed to open and let blood flow through the heart. They also keep blood from flowing backwards when the heart contracts. Sometimes valves get floppy and fail to close properly. This is what happens in a condition called mitral valve prolapse. Sometimes a valve doesn't open wide enough in a condition called valvular stenosis.
Problems with the heart valves can be present at birth or can come as a result of heart disease or heart attacks. Some valvular problems are minor, asymptomatic and don't need surgery. Others seem to get better with medications while others require surgery. The four valves of the heart are the tricuspid valve, the mitral valve, the aortic valve and the pulmonic valve.
Valve problems can be present at birth or caused by infections, heart attacks, or heart disease or damage. Some valve problems are minor and do not need treatment. Others might require medicine, medical procedures or surgery to repair or replace the valve.
In valvlular insufficiency or prolapse, the condition is also called valvular insufficiency or valvular incompetency. Valvular prolapse is when the valve bows back on itself when the heart is beating. It generally does not always leak. In valvular insufficiency or regurgitation, the blood actually leaks backwards into the chamber before it.
In valvular stenosis, the valve becomes stiff and sometimes the different leaflets of the valve fuse together so the blood cannot pass through to the next chamber or out of the heart. The body is then starved of oxygenated blood which has to push out of the heart with increasing pressure. This puts extra pressure on the heart to push blood through to the next chamber or to the aorta. A stenotic or narrowed valve makes the heart pump harder and it can go through heart failure trying to pump extra hard. In a regurgitant valve or leaky valve, the heart also has to pump harder to make up for blood that has leaked backward and needs to flow again through the heart valve.
The causes of valvular heart disease are many. Congenital heart disease is present at birth and can happen as a result of some kind of insult that happens while the fetus is in the uterus. It can result in an irregularity in the way the leaflets are attached, leaflets that are malformed or leaflets that have fused. Usually it is the pulmonic valve or the aortic valve that is involved in congenital heart disease.
A bicuspid aortic valve is one of the congenital diseases affecting the aortic valve. Normally, the aortic valve consists of three valve leaflets. In the bicuspid aortic valve disease, there are only two leaflets making up the valve. The valve can be stenotic in such a condition or it can be leaky or both. Twenty five percent of those people also have an enlarged aorta above the damaged valve. This affects about two percent of the US population.
Valvular heart disease can be acquired. It can be due to infection of the heart, such as you'll find in infectious endocarditis and rheumatic fever. The leaflets of the valve become inflamed and can stick together causing the valve to scar and become thickened and/or shortened. This is typically found in the mitral valve, especially in rheumatic fever.
Rheumatic fever can come from a streptococcal infection that is untreated and passes to the heart. Not all cases of strep infection can lead to rheumatic heart disease. It can take years until the valvular heart disease makes itself known after the initial infection. It is actually the antibodies against the infection that react with the valves of the heart to cause the scar tissue to form.
In bacterial endocarditis, the heart itself is infected. It can be a serious and life-threatening infection. Bacteria attach to the valves of the heart and cause growths of bacteria and blood clots to form on the valves. The valve can get holes in it or can become scarred. This can lead to narrowing or stenosis of the valve.
Other causes of valvular heart disease include heart attacks or coronary heart disease, syphilis, heart muscle disease, aneurysms of the aorta, connective tissue diseases, high blood pressure, certain drugs, radiation to the heart and some tumors.
In mitral valve prolapse, the leaflets of the valve flop back into the left atrium so that blood flows backwards during a heart contraction. The valve can leak all the time or just during a contraction of the heart. It occurs in one to two percent of people and is usually a benign condition. Only about ten percent really need surgery to correct the problem. If the cords that hold the valve in its proper shape become torn, there is an increased need for surgery.
The major symptoms of valvular heart disease is shortness of breath, especially with exertion, swelling of the abdomen, feet or ankles, palpitations or rapid heartbeat, irregular heartbeat, weakness or dizziness, weight gain from excess fluid or discomfort in the chest area.
The doctor can diagnose valvular heart disease by doing an echocardiogram, which is an ultrasound study of the heart. The valves can be visualized easily and the flow of blood through the heart can be studied.