WHAT WE TREAT
HEART VALVE DISORDER
It is important to learn how your heart works and how each of the valves function. When you understand the specifics of what your doctor or healthcare team is trying to evaluate and accomplish through treatment, you’ll be better equipped to help make great decisions.
Any heart problem can seem overwhelming at first, but recovery statistics are very good for people who receive proper treatment.
If you’re seeking to better understand a heart valve problem, you may want to learn more about the possible link between a heart murmur and eventual valve disease. Not all heart murmurs lead to later problems, so it’s good to understand why some are considered to be “innocent murmurs.”
Many heart valve problems are first identified by the presence of a “murmur” or sound that can be heard when a healthcare provider listens to the heartbeat with a stethoscope. A murmur may sound like a “whooshing” noise of blood flowing under pressure as it moves from one chamber to the next, or it may sound like an extra click when a valve allows back flow.
Some murmurs are harmless, and others can indicate an underlying problem with the valve. If you or your healthcare provider notice a murmur, here are some of the things he/she may be looking into further.
Murmurs may indicate valve problems including:
- Stenosis: a narrowing or stiffening of the valve that prevents adequate blood supply from flowing through
- Regurgitation: when valves allow blood to flow backward into the chamber
- Prolapse: a valve that has improperly closing leaflets
- Atresia: a valve that is improperly formed or missing
Causes of valve problems:
The causes of valve problems can often be linked to birth abnormalities, related to age, or brought on by another condition.
Congenital defects (abnormalities present at birth):
Aging and age-related valve disease, such as:
- Degenerative valve disease — Most commonly affecting the mitral valve, over time valves can slowly degenerate. For example, mitral valve prolapse, a condition that affects 4–5 percent of the general population, may eventually turn into mitral valve regurgitation requiring treatment.
- Calcification due to aging — Sometimes calcium can accumulate on the heart’s valves, most commonly affecting the aortic valve, and can lead to aortic stenosis.
Related illnesses and conditions that can cause valve problems:
These conditions can cause one or more of the heart valves to leak blood back into the heart chambers or fail to open fully, making your heart work harder and lessening its ability to pump blood. Although valve problems can potentially be severe and life-threatening, most valve conditions are also highly treatable.
Symptom of Heart Valve Problems:
How would I know if I am having symptoms of valve disease?
Some people have no symptoms.
It’s important to know that some patients do not experience any symptoms, yet they can still have a valve problem that needs treatment. Some people suddenly experience very noticeable symptoms. Valve disease symptoms can also develop very quickly if the condition is severe. For some people, the disease progresses very slowly, and the heart is able to compensate over time so that the symptoms are barely noticeable.
However, the risk and damage may still be significant, so education and awareness about the possible causes for a gradual onset of symptoms is important for patients who may be at risk.
Some physical signs of heart valve disease can include:
- Chest pain or palpitations (rapid rhythms or skips)
- Shortness of breath, difficulty catching your breath, fatigue, weakness, or inability to maintain regular activity level
- Lightheadedness or loss of consciousness
- Swollen ankles, feet or abdomen
Symptoms do not necessarily determine the seriousness of a person’s valve problems.
A valve problem can be severe with no symptoms. A valve problem can also be insignificant in terms of leakage, but problematic because of the uncomfortable symptoms. It is important to tell your healthcare provider any time you notice new or irregular symptoms that may relate to your condition.
Download a Heart Symptom Tracker so that you can track your symptoms over time.
A change in symptoms is important to discuss with your physician.
Risks for heart valve problems:
Who is at risk for heart valve disease?
Although the population of people affected by heart valve disease is considerably smaller than the number of people who have the more common conditions, like high blood pressure and coronary artery disease, valvular disease has become an increasing problem in recent years due to the increase in life expectancy.
Valve disease and age
Heart valve disease is more common among older people. Today, thanks to improved quality of medical care and increased attention on prevention, people are living longer. As a result, heart valve disease has become a more common problem. As we age, our heart valves can become lined with calcium deposits that cause the valve flaps to thicken and become stiffer.
Valve disease and related health conditions
People who have had rheumatic fever or a case of infective endocarditis are at greater risk for heart valve problems. Heart problems like a heart attack, heart failure, arrhythmia, or previous heart valve conditions from birth (called congenital heart defects) can also increase the likelihood for developing valve problems.
Valve disease and health risks
Many people live long and healthy lives and never realize they have a mild valve problem. However, valve disease can seriously increase a persons’ risk for sudden death or cause rapid development of problems in and around the heart that can become fatal without treatment.
People who have been diagnosed with a heart murmur, a defect like a bicuspid aortic valve, mitral valve prolapse or a mild form of valve disease should maintain regular check-ins with a healthcare provider and should be aware of possible symptoms should they start or become worse.
If surgery is needed to repair or replace a valve, antibiotics might be needed before dental procedures to help protect against endocarditis. You should discuss your individual risk and the recommendations with your doctor.
Aging people should also be aware of changes that may come on very gradually. Not all declines in energy or stamina are related to “the normal problems of getting older.” When the heart fails to pump enough oxygen-rich blood to the body, symptoms may appear. Problems like fatigue, shortness of breath, chest pain or discomfort and lightheadedness can indicate treatable problems related to the heart.
Do you notice that routine activities like walking faster or taking the stairs have become more difficult?
Have you stopped doing enjoyable activities that you used to do with relative ease?
Be sure to take notes on any changes like these and describe them to your healthcare provider.
Understanding Heart Valve Treatment Options
Good news: recovery statistics are very good for people who receive proper treatment.
Some people live long and full lives with mild valvular problems and never require surgery. But once a heart valve begins to affect the heart’s ability to pump blood, it is likely to require a repair or replacement.
Treatment for valve disease will include a plan to:
- Protect your heart from further damage.
- Assess your need for medication to help manage symptoms.
- Repair the valve problem if needed
- Communicate steps for management, self-care and the importance of follow-up care.
Generally, once it’s determined that a diseased heart valve needs treatment, the available choices are valve repair or valve replacement:
- Valve repair — which preserves the patient’s valve and leaflets. Sometimes repairs require a minimal surgery procedure and other times repairs need a more extensive surgery. Repair is most often possible for mitral valve regurgitation and tricuspid valve regurgitation.
- Valve replacement — which may include TAVR (or TAVI) or other minimally invasive procedure. In many cases, the best long-term solution may require a more involved surgery such as the Ross procedure or the insertion of a new tissue or manufactured valve.
Options and Considerations for Heart Valve Surgery
Is it possible to treat valve diseases with medications alone?
Most valve conditions can’t be treated with medication alone. However, sometimes the problem is not severe enough to require surgical repair, but it is bothersome enough to cause symptoms or risks. In cases like these, a condition might be effectively managed for a while with medication.
- In some cases, medications may be prescribed for patients with valvular disease to:
- Reduce unpleasant symptoms that accompany milder forms of the disorder.
- Maintain heart rhythm if a related arrhythmia is present.
- Reduce calcification in and around coronary arteries.
- Lower the patient’s risk for clotting and stroke.
Valve dysfunction is usually a progressive disease, and among those who receive no treatment, the outlook can be poor. But many who do receive treatment go on to live very full and healthy lives, especially when their cardiovascular risks are otherwise low.
What happens if I don’t treat my condition or choose to ignore the recommended procedures?
Valve disease is not a condition that should be ignored when treatment is recommended. When a person’s aortic stenosis becomes severe, the average survival rate without surgical intervention is only 50 percent after two years and only 20 percent after five years.
Evidence is also clear that with proper treatment, most people enjoy a return to good health and add many years to their life.
Understanding your heart valve problem: Which solution may be right for you?
Walk through a step-by-step interactive guide explaining your valve issue and treatment options with helpful videos, text summaries and links along the way.
What are the risks associated with valve disease treatment?
As with all surgeries, there are inherent risks. You can reduce your risks by choosing a surgeon and surgery center with well-documented experience treating patients with similar conditions as yours. Because every patient’s risk factors are different, your doctor and your hospital personnel will be able to assess your risks and choose the best treatment for you.
People who have damaged, repaired or replaced heart valves are also at increased risk for developing an infection of the valve (endocarditis).
Is it true that even dental work can increase risks for people with heart valve problems?
It depends. Until recently, the American Heart Association recommended giving antibiotics to prevent endocarditis to these patients before they had dental work. However, those guidelines have changed – the American Heart Association no longer recommends antibiotics before dental procedures, except for patients at the highest risk for bad outcomes from endocarditis. If a person has had heart valve surgery, but had not had a heart valve replaced, their cardiologist or surgeon will tell them if they need antibiotics. Read more about the antibiotic prophylaxis guidelines for infective endocarditis.
Medications for Heart Valve Symptoms
How do medications help people with valve problems?
Although medications can serve a very important purpose, there is no medication that will stop a valve from leaking. Likewise, there is no medication that will open a valve that is too tightly constricted.
Still, there are times when the medication is determined to be the best course of action. This decision may be most appropriate for someone whose valve condition is very mild or for a person for whom surgery is not an option.
When should surgery be considered over medications for valve replacement or repair?
Medications cannot always protect the heart and the diseased valve may continue to damage the heart. Further actions may be needed. Your healthcare team can help you understand and evaluate options for heart valve repair or valve replacement surgery. Highly effective procedures are available for treating heart valve conditions. Some people find that medications are no longer needed within a few weeks after surgery.
Below are some of the types of medications that heart valve patients may be prescribed.
|Medication Class||Purpose for a Valve Disease Patient|
|Ace inhibitors||Vasodilator: Which means it opens blood vessels more fully and can help reduce high blood and slow heart failure|
|Anti-arrhythmic medications||Helps restore a normal pumping rhythm to the heart|
|Antibiotics||Can help to prevent the onset of infections|
|Anticoagulants (“blood thinners”)||Reduces the risk of developing blood clots from poorly circulating blood around faulty heart valves. Blood clots are most dangerous because they can lead to stroke|
|Beta-blockers||Can reduce the heart’s workload by helping the heart beat slower. Some patients find them helpful for reducing palpitations|
|Reduces amount of fluid in the tissues and bloodstream which can lessen the workload on the heart|
|Vasodilators||Can lower the heart’s work by opening and relaxing the blood vessels; reduced pressure may encourage blood to flow in a forward direction, rather than being forced backward through a leaky valve|
Please visit http://www.heart.org/HEARTORG/Conditions/More/HeartValveProblemsandDisease/ for more information and resources