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What is Valvular Heart Disease?

This is a disease of valves of the heart. Heart valves are exposed to a lot of wear and tear during the lifetime of a person since heart works without a break.

There are four valves in the heart, which serve as gates in the flow of blood. The four valves prevent the blood from flowing in reverse direction when the pressure in the heart chambers falls below the pressure in the blood vessels.

Throughout the lifetime of a person the valves are exposed to a lot of friction due to the flowing blood. The valves suffer the aging process like any other tissue in the body. The aging valves become rigid due to deposition of calcium. The result is that the valve orifice becomes narrower and flow through the valve reduces. This condition is called stenosis.

The most commonly affected valves are the aortic and the mitral valve in the elderly in the absence of any other heart disease. This is because this valve faces the maximum turbulence in the blood.

Stenotic valve diseases are more common than incompetent valves in elderly.

Aortic valve diseases can be classified as under:

1) Aortic stenosis: As the aortic valve stenosis, the blood flow to the organs of the body starts reducing. This stenotic aortic valve also causes the heart to exert more pressure to pump the blood into the aorta, ultimately leading to heart failure as the end result.

2) Aortic incompetence: It is due to underlying cause like:

In an acute aortic incompetence, the heart fails to pump forward and the failure sets in all of a sudden with no time for the heart or the body to adapt. This causes sudden appearance of extremely disabling symptoms of heart failure.

Mitral valve is the second most commonly affected valve in the elderly. Mitral stenosis is the over all the most common valvular involvement in the Indian elderly due to high prevalence of rheumatic heart disease in the younger age groups. Most of these young individuals are incompletely treated or not treated at all, and they get affected with a mitral valve disease in their old age.

Types

There are two kinds of valvular diseases:

  • Stenosis: It is a condition when the valve fails to open. This causes failure of forward flow of blood.
  • Incompetence:This condition occurs when the valve fails to close. This causes back flow of blood.

Another way of classifying valvular heart disease is according to the valves. There are four types of valves.

  • Mitral Valve: It is present between left atrium and left ventricle
  • Tricuspid Valve:It is present between right atrium and right ventricle
  • Aortic Valve: It is present between left ventricle and aorta (artery that sends out blood into the entire body)
  • Pulmonary Valve: It is present between right ventricle and pulmonary trunk (artery that sends out blood into lungs)

In an acute aortic incompetence, the heart fails to pump forward and the failure sets in all of a sudden with no time for the heart or the body to adapt. This causes sudden appearance of extremely disabling symptoms of heart failure.

Mitral valve is the second most commonly affected valve in the elderly. Mitral stenosis is the over all the most common valvular involvement in the Indian elderly due to high prevalence of rheumatic heart disease in the younger age groups. Most of these young individuals are incompletely treated or not treated at all, and they get affected with a mitral valve disease in their old age.

What are the chances of Valvular Heart Disease?

Aortic stenosis: 51% after the age of 80. In most patients some degree of asymptomatic aortic stenosis is diagnosed on autopsy.

Aortic incompetence: 25-35% of elderly above the age of 80. This is far less common than aortic stenosis. But the incidence is significantly higher in patients with connective tissue diseases like lupus in which the incidence is as high as 44%.

What are the symptoms of Valvular Heart Disease?

Aortic Stenosis:

  • Chest pain
  • Fainting episodes
  • Breathlessness
  • Night awakening due to shortness of breath
  • Transient episodes of palpitations
  • Sudden death

Aortic Incompetence:

  • Mild breathlessness after exertion
  • Palpitations
  • Fatigue
  • Chest pain
  • Swelling over feet

Who is at risk for Valvular Heart Disease?

The risk factors for development of valvular heart disease are:

  • High blood pressure
  • Increased cholesterol levels
  • Previous myocardial infarction
  • Diseased heart valves due to an infection (infective endocarditis)
  • Rheumatic heart disease
  • Connective tissue disorders
  • Congenital heart disease

What are the causes of Valvular Heart Disease?

The most common cause of involvement of cardiac valves, especially in the elderly, in India is rheumatic heart disease.

 What are the complications in Valvular Heart Disease?

The failure of valves whether it is stenosis or incompetence (regurgitation) leads to:

  • Heart failure
  • Acute shortage of blood supply to vital organs
  • Infarction of vital organs leading to stroke, kidney infarction, etc.

How is Valvular Heart Disease diagnosed?

Most of the valvular heart diseases have a diagnostic heart sound. The turbulence in the heart valves causes a murmur (a characteristic rough sound) which is specific in its quality and location according to the valvular condition. The sound is easily heard through a stethoscope.

The most commonly used investigations to diagnose these conditions are:

  • 2D-Echo
  • ECG
  • Chest X Ray
  • ASO titres (to diagnose the rheumatic heart disease)

How is Valvular Heart Disease treated?

Be it stenotic or incompetent, valve replacement surgery is the only definitive treatment of any valvular heart disease. The prosthetic valve is either completely synthetic or semi-synthetic with the natural component being derived from a porcine (Pig) origin.

How can Valvular Heart Disease be prevented?

Since the most common involvement is that of the aortic and mitral valves, the preventive strategies are directed towards these valves.

Aortic valve affection is mainly due to the metabolic conditions. Control of these conditions goes a long way in preventing or at least delaying the valvular affections which are stated as under:

  1. Control of blood pressure
  2. Control of blood cholesterol
  3. Regular exercise

Mitral valve disease is most commonly due to rheumatic involvement of the heart in adolescence and adulthood. Rheumatic heart disease is due to a bacterial throat infection wherein the antibodies against the bacteria cross react with the heart valves and damage them. The prevention can be targeted as:

  • Adequate and timely treatment of all throat infections
  • Prophylaxis with penicillin in known cases of rheumatic heart disease to prevent worsening of the valvular involvement

What lifestyle changes are required to manage Valvular Heart Disease?

  • See your doctor for regular check-ups
  • Keep your throat and gums infection free as any infection can travel to the heart
  • Do moderate exercise to promote heart health
  • Eat a heart-healthy diet and reduce salt in your food

How to take care of someone with Valvular Heart Disease?

  • Encourage them to lead a healthy lifestyle
  • Help them manage their diet
  • Take them for timely check-ups with the doctor
  • Help them to be active and go for a walk together

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