Valvular Heart Disease
Symptoms of Valvular Disease
Valvular disease can be present and totally without demonstrated
symptoms. However, in some cases, symptoms of valvular disease
can be mild or very self-limiting. Symptoms may include weakness
and fatigue, irregular heart rhythms, rapid heart rate, shortness
of breath, chest discomfort, and dizziness.
Symptoms may depend on how advanced the valvular disease is and
which of the heart valves is involved. Valvular disease may become
progressive with time and lead to congestive heart failure, strokes,
blood clots, and heart attacks.
Diagnosis of Valvular Disease
Your physician will usually obtain an echocardiogram that reproduces
images of the valves and the heart chambers through utilization
of ultrasound waves. This echocardiogram assesses the function
of each of the heart valves as well as the efficiency of the heart
as it pumps blood to the body.
A chest x-ray may be ordered to determine any enlargement of the
heart. An electrocardiogram (EKG) can be assessed to reveal enlargement
of the heart chambers and to detect irregularity of the heart rhythm.
Cardiac catheterization can also be utilized to better clarify
valvular function and further analyze the possible abnormalities.
A special catheter is passed from a major vessel in the leg or
arm to the heart, and precise pressures can be analyzed across
the valves that indicate their degree of function and efficiency
in the management of blood flow across them. This study will allow
your physician to determine what corrective action is required
to effectively treat your valvular disease.
Treatment of Valvular Disease
Valvular disease may require no treatment measures at all. However,
when it is symptomatic and progressive, the goals of treatment
will be to effectively address the symptoms and alleviate the workload
of the heart. In some cases, this can be managed through the use
of medications alone. While in others, surgical or procedural intervention
may be required.
Medication management can be utilized to assist the heart in working
more effectively as a pump thus reducing its workload, maintaining
appropriate fluid balance, and addressing any heart rhythm abnormalities.
Digitalis may be prescribed to affect the contractility of the
heart and improve the pumping action. Diuretics may be required
to alleviate symptoms of fluid overload
and influence electrolyte balance. A wide variety of drugs may
be prescribed to lower blood pressure, decrease heart rate, and
reduce resistance so that the heart’s workload
is decreased.
Anticoagulants may be part of the treatment regimen to prevent
dangerous clot formation.
When valves are surgically replaced with mechanical materials,
patients must be maintained on therapeutic levels of anticoagulant
medication the remainder of their lives because the mechanical
nature of the valve predisposes the patient for clot formation.
When indicated, your physician may advise that you undergo balloon
valvuloplasty. Performed in the cardiac catheterization laboratory,
this procedure involves the use of a special catheter that can
be used to expand the valve area thus reducing the amount of valve
stenosis (narrowing) and improving blood flow across the valve.
More commonly performed on the mitral, tricuspid, and pulmonic
valves, the balloon valvuloplasty technique is not often utilized
to treat aortic stenosis.
Surgical intervention may involve either repair or replacement
of an abnormal heart valve. Repair can involve removing redundant
tissue, tightening the valve support ring,
or removing scar tissue. Actual valve replacement can occur with
either mechanical (metal, plastic, or carbon) valve replacement
or biological (human or animal) valve replacement. Mechanical valve
replacements require implementation of lifelong anticoagulation
maintenance therapy to prevent clot formation.
Biological valve replacements (those from human or animal tissues)
are not as durable as their mechanical counterparts. They may not
require the use of anticoagulation therapy.
Valve surgery is performed in an operating room and involves use
of the heart-lung bypass machine. It is an open-heart surgical
procedure accomplished through an incision in the chest. The recovery
period is similar to that of coronary artery bypass surgery. The
integrity and function of the valve replacement will require routine
check-ups and monitoring via echocardiogram by your physician for
the remainder of the patient’s life.
