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Aortic valve disease: causes, diagnosis and treatment

Your heart is a muscle that acts as a pump, pumping blood to your lungs and to the rest of your body. It has four chambers: the left atrium, the right atrium and the left and right ventricles. There are four valves in your heart. These valves guard the exits of all four heart chambers to make sure that the blood cannot leak backwards and that it flows onward in the correct direction.
These valves guard the exits of all four heart chambers

A diseased or damaged valve can affect the flow of blood in two ways.

• If the valve doesn’t open fully or becomes stiff, it can obstruct the flow of blood. This is called valve stenosis. (A ‘stenosed valve’ means a valve that has become stiff and therefore narrow, causing an obstruction to the flow of blood.)

• If the valve does not close properly, it will allow blood to leak backwards. This is called regurgitation or valve incompetence. Sometimes doctors refer to it as having a ‘leaky valve’.
Both stenosis and regurgitation can put an extra strain on the heart. If you have stenosis, the valve can obstruct the flow of blood, so your heart will have to pump harder to force the blood past the obstruction. If you have regurgitation, your heart has to do extra work to pump enough blood forwards against the blood flowing backwards through the leaking valve.

As well as your heart having to work harder, the blood behind the affected valve will be under increased pressure, which is called ‘back pressure’. This can result in a build-up of fluid either in your lungs or in your ankles or legs, depending on which valve is affected.

What are the symptoms of heart valve disease?

The symptoms of heart valve disease vary, depending on which valve is affected and how badly it is affected. People with mild heart valve disease may not notice any symptoms or may have very few symptoms. However, increasing strain on the heart caused by heart valve disease can cause tiredness, or an uncomfortable pounding in the chest known as palpitations. The back pressure can cause a build-up of fluid in the lungs which can lead to shortness of breath. It can also cause swelling of the ankles and legs.

People with heart valve disease may also get chest pains because there is not enough blood flowing through the coronary arteries – the arteries that supply oxygen-containing blood to the heart muscle. If the forward flow of blood is severely obstructed, the person may have spells of dizziness and fainting, because less blood is reaching the brain.

Some people with heart valve disease also develop an abnormal heart rhythm called atrial fibrillation. This is when different places in and around the atria (the upper chambers of the heart) fire off electrical impulses in an uncoordinated way, resulting in an irregular and sometimes fast pulse rate.
The symptoms of atrial fibrillation may include palpitations, dizziness or light-headedness, and breathlessness.

How is heart valve disease diagnosed?

Abnormalities of the heart valves are often picked up at a routine examination when the doctor listens to the heart with a stethoscope and hears an extra noise called a ‘murmur’. (However, sometimes, murmurs are also heard in hearts that are otherwise completely normal.)

The doctor will usually be able to tell, from the type of murmur he or she hears, whether you need to have further tests. Even after a valve condition has been diagnosed, it can sometimes be 10 or even 20 years before you have any symptoms. Important changes can happen to your heart muscle even if you don’t have any significant changes in your symptoms. This is why it’s important to have your heart function checked regularly. Your doctor or cardiologist will tell you how often.
• An electrocardiogram (an ECG), which records the rhythm and electrical activity of your heart
• A chest X-ray, and
• An echocardiogram, which produces an ultrasound picture of the heart and valves.

There is another test called a coronary angiogram, which is also known as cardiac catheterisation. This test is used to provide important information on the condition of your heart.
A catheter (a long, hollow plastic tube) is passed into the artery in the groin, or sometimes into the arm. Using X-ray screening, the operator then directs the catheter through the blood vessels and into the heart. A special dye is then injected and a series of X-ray pictures is taken. The dye makes all the coronary arteries show up on the X-rays.

What causes heart valve disease?

The main causes of heart valve disease are:
• Being born with an abnormal valve or valves (congenital heart disease)
• Rheumatic fever
• Ageing of the heart
• Cardiomyopathy
• Coronary heart disease, or
• A previous infection with endocarditis.

Treatment for heart valve disease

Many people with heart valve disease need little or no treatment and can live a good-quality or normal life for many years. Everyone who has heart valve disease benefits from having regular check-ups, which includes having an echocardiogram.
The decision on what sort of treatment you need for your heart valve disease will depend on:
• Which valve is affected
• How badly the valve is affected
• How many valves are affected
• How badly the heart’s ventricles are affected
• Your symptoms, and
• Your general health.

The main options for treatment are:
• Medicines
• Valve surgery, which could involve repairing or replacing the valve
• A procedure called transcatheter aortic valve implantation
• A procedure called percutaneous mitral valve leaflet repair
• A procedure called valvuloplasty, or
• A combination of medicines with either surgery


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