What Is Valvular Heart Disease?
Valvular heart disease is characterized by damage to or a defect in one of the four heart valves: the mitral valve, aortic valve, tricuspid valve or pulmonary valve. The mitral and tricuspid valves control the flow of blood between the atria and the ventricles (the upper and lower chambers of the heart). The pulmonary valve controls the flow of blood from the heart to the lungs, and the aortic valve governs blood flow between the heart and the aorta, and thereby the blood vessels to the rest of the body. The mitral and aortic valves are the ones most frequently affected by valvular heart disease. (Read more about Heart Anatomy.)
Normally functioning valves ensure that blood flows with proper force in the proper direction at the proper time. In valvular heart disease, the valves become too narrow and hardened (stenotic) to open fully, or are unable to close completely (incompetent). A stenotic valve (e.g., Aortic Stenosis) forces blood to back up in the adjacent heart chamber, while an incompetent valve allows blood to leak back into the chamber it previously exited. To compensate for poor pumping action, the heart muscle enlarges and thickens, thereby losing elasticity and efficiency. In addition, in some cases blood pooling in the chambers of the heart has a greater tendency to clot, increasing the risk of stroke or pulmonary embolism.
The severity of valvular heart disease varies. In mild cases there may be no symptoms, while in advanced cases, valvular heart disease may lead to congestive heart failure and other complications. Treatment depends upon the extent of the disease.
What Causes Valvular Heart Disease?
- Rheumatic fever may cause valvular heart disease.
- Bacterial endocarditis, an infection of the inner lining of the heart muscle and heart valves (endocardium), is a cause of valvular heart disease.
- High blood pressure and atherosclerosis may damage the aortic valve.
- A heart attack may damage the muscles that control the heart valves.
- Congenital abnormalities of the heart valves may be present.
- Heart valve tissue may degenerate with age.
- Other disorders such as carcinoid tumors, rheumatoid arthritis, systemic lupus erythematosus or syphilis may damage one or more heart valves.
- Methysergide, a medication used to treat migraine headaches and some diet drugs may promote valvular heart disease.
- Radiation therapy (used to treat cancer) may be associated with valvular heart disease.
Symptoms of Valvular Heart Disease
- Symptoms of congestive heart failure: shortness of breath and wheezing after limited physical exertion; swelling of feet, ankles, hands or abdomen (edema)
- Palpitations; chest pain (may be mild)
- Rapid weight gain
- Dizziness or fainting (with aortic stenosis)
- Fever (with bacterial endocarditis)
- Periods of lightheadedness
Valvular Heart Disease Prevention
- A heart-healthy lifestyle is advised to reduce the risks of high blood pressure, atherosclerosis and heart attack.
Valvular Heart Disease Diagnosis
- Patient history and physical examination. The doctor listens for distinctive heart sounds, known as heart murmurs, that indicate valvular heart disease.
- An electrocardiogram (ECG), to measure the electrical activity of the heart, regularity of heartbeats, thickening of heart muscle (hypertrophy) and heart-muscle damage from coronary artery disease.
- Stress testing (measurement of blood pressure, heart rate, ECG changes and breathing rates while the patient walks on a treadmill).
- Chest x-rays, which utilize invisible electromagnetic energy beams to produce images of bones, internal tissues and organs onto film.
- Echocardiogram (use of ultrasound waves to create a moving image of the valves as the heart beats).
- Cardiac catheterization: the threading of a catheter into the heart chambers to measure pressure irregularities across the valves (to detect stenosis) or to observe backflow of an injected dye on an x-ray (to detect incompetence).
How to Treat Valvular Heart Disease
- Don’t smoke; follow prevention tips for a heart-healthy lifestyle. Avoid excessive alcohol consumption, excessive salt intake and diet pills—all of which may raise blood pressure.
- Your doctor may adopt a “watch and wait” policy for mild or asymptomatic cases.
- A course of antibiotics is prescribed prior to surgery or dental work for those with valvular heart disease, to prevent bacterial endocarditis.
- Long-term antibiotic therapy is recommended to prevent a recurrence of streptococcal infection in those who have had rheumatic fever.
- Antithrombotic (clot-preventing) medications such as aspirin or ticlopidine may be prescribed for those with valvular heart disease who have experienced unexplained transient ischemic attacks, also known as TIAs
- More potent anticoagulants such as warfarin may be prescribed for those who have atrial fibrillation (a common complication of mitral valve disease) or who continue to experience TIAs despite initial treatment. Long-term administration of anticoagulants may be necessary following valve replacement surgery, because prosthetic valves are associated with a higher risk of blood clots.
- Balloon dilatation (a surgical technique involving insertion into a blood vessel of a small balloon that is led via catheter to the narrowed site and then inflated) may be done to widen a stenotic valve.
- Surgery to repair or replace a damaged valve may be necessary. Replacement valves may be artificial (prosthetic valves) or made from animal tissue (bioprosthetic valves). The type of replacement valve selected depends on the patient’s age, condition, and the specific valve affected.
- Valve surgery can be performed to repair or replace a damaged valve.
When to Call a Doctor
- Call a doctor if you develop persistent shortness of breath, palpitations or dizziness.
- EMERGENCY Call an ambulance if you experience severe chest pain.
Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference
Simeon Margolis, M.D., Ph.D., Medical Editor
Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50
Updated by Remedy Health Media