Understanding Heart Valve Disease

Heart valve disease occurs when one or more of the heart's valves fail to open and close properly. The heart's valves are responsible for controlling the flow of blood through the heart's chambers, ensuring that it moves in the correct direction. When a valve malfunctions, it can either become too narrow, leading to restricted blood flow, or it may not close completely, causing blood to leak backward. In some cases, the valve may have both stenosis and regurgitation.

Causes of Heart Valve Disease

• Congenital Heart Defects: Some individuals are born with abnormal heart valves, which may not function properly from birth. These congenital heart defects can lead to valve problems later in life (Gelb, B.D., 2015. History of our understanding of the causes of congenital heart disease. Circulation: Cardiovascular Genetics, 8(3), pp.529-536).
• Rheumatic Fever: Rheumatic fever, a complication of untreated strep throat, can damage the heart valves. Although rheumatic fever is less common today due to the widespread use of antibiotics, it remains a significant cause of heart valve disease in some parts of the world.
• Age-Related Changes: As we age, the heart valves can become thickened and calcified, leading to valve stenosis or regurgitation. 
• Infections: Infections such as infective endocarditis can damage the heart valves (Hubers, S.A., DeSimone, D.C., Gersh, B.J. and Anavekar, N.S., 2020, May. Infective endocarditis: a contemporary review. In Mayo Clinic Proceedings (Vol. 95, No. 5, pp. 982-997). Elsevier). This condition occurs when bacteria or other microorganisms enter the bloodstream and attach to the heart valves.
• Radiation Therapy: People who have undergone radiation therapy to the chest for cancer treatment may be at risk of developing heart valve disease later in life.
• Other Medical Conditions: Certain medical conditions, such as high blood pressure, heart attacks or connective tissue disorders like Marfan syndrome, can weaken or damage the heart valves over time.

Heart Valve Disease Types

Heart valve disease can be classified into several types, depending on which valve is affected and the nature of the problem. The most common heart valve disease types include:

• Aortic Valve Stenosis: This condition occurs when the aortic valve becomes narrowed, restricting blood flow from the heart into the aorta and onward to the rest of the body (Kanwar, A., Thaden, J.J. and Nkomo, V.T., 2018, April. Management of patients with aortic valve stenosis. In Mayo Clinic Proceedings (Vol. 93, No. 4, pp. 488-508). Elsevier). This can cause symptoms like shortness of breath, chest pain and fainting.
• Mitral Valve Regurgitation: Mitral valve regurgitation occurs when the mitral valve does not close properly, allowing blood to leak backward into the left atrium. This can cause symptoms like fatigue, palpitations and shortness of breath.
• Mitral Valve Prolapse: Mitral valve prolapse is a condition in which the mitral valve's leaflets bulge into the left atrium during contraction (Hayek, E., Gring, C.N. and Griffin, B.P., 2005. Mitral valve prolapse. The Lancet, 365(9458), pp.507-518). Although it often doesn't cause significant symptoms, it can lead to mitral valve regurgitation.
• Pulmonary Valve Stenosis: Pulmonary valve stenosis is a narrowing of the pulmonary valve, which can obstruct blood flow from the right ventricle to the lungs. This condition may result in fatigue, shortness of breath and heart murmurs.

Symptoms of Heart Valve Disease

Heart valve disease symptoms often vary as per the severity of the condition as well as depending on which valve has been affected. In some cases, heart valve diseases may be asymptomatic, meaning they do not produce noticeable symptoms. However, when heart valve disease progresses, it may manifest as symptoms like: 

• Shortness of Breath: Difficulty breathing, especially during physical activity or when lying down, is a common symptom of heart valve disease.
• Chest Pain: Some people with heart valve disease experience chest pain, often described as a tightness or pressure in the chest (Maganti, K., Rigolin, V.H., Sarano, M.E. and Bonow, R.O., 2010, May. Valvular heart disease: diagnosis and management. In Mayo Clinic Proceedings (Vol. 85, No. 5, pp. 483-500). Elsevier).
• Fatigue: Feeling unusually tired or fatigued, even with minimal exertion, can be a sign of heart valve disease.
• Palpitations: Irregular or rapid heartbeats, known as palpitations, can occur with heart valve disease (Turi, Z.G., 2004. Mitral valve disease. Circulation, 109(6), pp.e38-e41).
• Swelling: Swelling in the legs, ankles, feet or abdomen may indicate that the heart is not pumping blood effectively.
• Dizziness or Fainting: Reduced blood flow due to valve problems can cause dizziness or fainting episodes.

Diagnosis of Heart Valve Disease

• Echocardiogram: This ultrasound test provides detailed images of the heart's valves and chambers, allowing doctors to assess valve function and detect abnormalities.
• Electrocardiogram: An ECG measures the heart's electrical activity, helping to identify irregular heart rhythms and other issues related to heart valve disease (Paul, O., Myers, G.S. and Campbell, J.A., 1951. The electrocardiogram in congenital heart disease: a preliminary report. Circulation, 3(4), pp.564-578).
• Chest X-ray: A chest X-ray can show the size and shape of the heart and detect any fluid buildup in the lungs, which may indicate heart valve disease.
• Cardiac Catheterization: This procedure involves inserting a catheter into the heart to measure pressure and blood flow (Kang, S.L. and Benson, L., 2018. Recent advances in cardiac catheterization for congenital heart disease. F1000Research, 7). It can provide valuable information about the severity of valve disease.
• MRI or CT Scans: These imaging tests may be used to get a more detailed view of the heart's structure and assess valve function.

Treatment for Heart Valve Disease

• Lifestyle Changes: For mild heart valve diseases, lifestyle changes can help manage symptoms and slow the progression of the disease. These changes may include:
• Diet and Exercise: Maintaining a heart-healthy diet low in saturated fats and cholesterol and regular exercise can improve overall cardiovascular health.
• Smoking Cessation: Quitting smoking is crucial for heart health, as smoking can worsen valve disease and increase the risk of complications (Rodés-Cabau, J., Taramasso, M. and T O'Gara, P., 2016. Diagnosis and treatment of tricuspid valve disease: current and future perspectives. The Lancet, 388(10058), pp.2431-2442).
• Monitoring: Regular check-ups with a cardiologist are essential for monitoring the progression of heart valve disease and making timely treatment decisions.
• Medications: Medications can help manage symptoms and prevent complications of heart valve disease.
• Surgical and Non-Surgical Procedures: In more severe cases, surgery or other procedures may be necessary to repair or replace the affected valve. These options include:
• Valve Repair: This procedure involves repairing the existing valve to restore its normal function (Gillinov, A.M., Blackstone, E.H., Nowicki, E.R., Slisatkorn, W., Al-Dossari, G., Johnston, D.R., George, K.M., Houghtaling, P.L., Griffin, B., Sabik III, J.F. and Svensson, L.G., 2008. Valve repair versus valve replacement for degenerative mitral valve disease. The Journal of thoracic and cardiovascular surgery, 135(4), pp.885-893). Valve repair is often preferred over replacement, as it preserves the natural valve and reduces the risk of complications.
• Valve Replacement: When repair is not possible, the damaged valve may be replaced with a mechanical valve or a biological valve made from animal tissue. Mechanical valves are durable but require lifelong blood-thinning medication, while biological valves may need to be replaced after several years.
• Transcatheter Aortic Valve Replacement: This is a minimally invasive procedure to replace a damaged aortic valve without open-heart surgery. It is an option for patients who are at high risk for traditional surgery.

FAQs

What are the most common symptoms of heart valve disease?

The most common symptoms of heart valve disease are chest pain, fatigue, palpitations, dizziness, high or low blood pressure, shortness of breath, leg swelling and abdominal pain.

Is there a cure for heart valve disease?

Medicines do not offer a cure for heart valve disease and treatment can only relieve its symptoms. These medicines help in reducing the symptoms by controlling the heart rate and helping to prevent the occurrence of abnormal heart rhythms.