What happens to your heart valves? Let's talk about Heart Valve Disease!

Do you sometimes feel tired? Or do you find it hard to breathe even when walking slowly? Maybe you feel a strange throbbing or pain in your chest? These could be signs of a problem with the valves that act like little doors in your heart. Today we are going to talk about this heart valve disease . Don't worry, it is very important to be aware of this.

What is Heart Valve Disease?

Simply put, heart valve disease is a condition in which one or more of the valves in your heart don't work properly. These valves are like doors. They help blood flow in only one direction. When our heart beats, the delicate flap-like parts (called `leaflets`) in these valves open and let blood flow forward. Then, during the second half of the heartbeat, these leaflets close and stop blood from flowing backward.

Imagine what happens if these valves don't work properly? Blood flow can be impaired, and the heart has to work harder. If left untreated, this condition can become serious and even life-threatening. But there's good news. In most cases, your doctor can repair or replace these valves with a minimally invasive procedure. Then you can get back to normal.

What are the four valves in your heart?

There are four main valves in our heart. They are:

• Mitral valve: This is located between the left atrium and the left ventricle.
• Tricuspid valve: This is located between the right atrium and the right ventricle.
• Aortic valve: This is located between the left ventricle and the aorta.
• Pulmonary valve: This is located between the right ventricle and the pulmonary artery.

It's very important that all of these valves work properly, so that blood can flow properly throughout our body.

What are the types of heart valve diseases?

There are several main types of heart valve disease. Sometimes more than one valve can be affected.

Stenosis

This is when the leaflets of the valve become thick and stiff, narrowing the opening through which the valve opens. Think of it like a clogged water pipe, making it difficult for water to flow. A small narrowing may not have much effect. However, if the valve becomes very narrow (which is why it is called `stenotic`), the heart's function is impaired, and it has to work harder to pump blood. This can reduce the amount of blood that reaches the entire body.

Regurgitation or valve leakage

This is also called `insufficiency`, and some people call it ``leaky valve.'' What happens here is that the valve leaflets don't close properly. Then the blood leaks back in. It's like when a door doesn't close properly, it comes back in through the closed side. This causes the heart to have to pump harder with that extra blood. It can also reduce the amount of blood going to the rest of the body.

Prolapse

This is especially true of the mitral valve. This is when the valve leaflets become too flexible, causing them to leak into the left atrium when the heart beats. Most of the time, this is harmless, but in some people, it can cause regurgitation.

Atresia

Valvular atresia is a condition in which a heart valve is not formed or does not open at birth. Doctors usually detect this at a very young age, in the neonatal period.

How common is heart valve disease?

In the United States, about 2.5% of the population, meaning a large number of adults, have these heart valve diseases. It is said that about 27,000 people die from this every year. Mitral valve prolapse is one of the most common of these conditions. This condition is also being seen more and more in Sri Lanka.

What are the first symptoms of heart valve disease?

Many people with heart valve disease don't show any symptoms at first. But as the condition worsens over time, symptoms begin to appear as the heart has to work harder.

See if you have any of these characteristics:

• Fatigue: This is probably the first symptom you will feel.
• Increased shortness of breath: Especially when you engage in any physical activity, such as walking or climbing stairs.
• Heart palpitations: A pounding in the chest, a feeling as if the heart is suddenly stopping and beating.
• Swelling (Edema): Swelling of the ankles, legs, or abdomen.
• Weakness or dizziness.
• Sudden weight gain.
• Chest pain: Especially when you are tired.

If you have one or more of these symptoms, it is best to seek medical advice.

What are the causes of heart valve disease?

There are various causes that can contribute to heart valve disease. Here are some of the main causes:

• Rheumatic fever: A condition caused by untreated strep throat.
• Heart damage due to a heart attack .
• High blood pressure ( when it gets too high).
• Congenital issues: For example, the pulmonary or aortic valve not developing properly.
• Over time, the valve tissue weakens or becomes less functional due to calcium deposits (calcification).
• Thoracic aortic aneurysm: This is a widening of the aorta. The aortic valve leaflets can then become stretched and leak.
• Heart failure.
• Heart infections, for example infective endocarditis.
• Autoimmune diseases such as lupus .
• Genetic conditions such as Marfan syndrome .

What are the risk factors?

There are also some risk factors that increase the risk of developing heart valve disease. These are:

• Use of tobacco products (smoking).
• Eating non-nutritious food.
• Lack of physical activity.
• Having medical conditions such as diabetes mellitus or high blood pressure.
• Having received radiation treatment for cancer.
• Having a pacemaker or defibrillator (ICD) installed.
• Being male (men are at slightly higher risk than women).
• Aging.

What complications can occur if left untreated?

If valve disease is not treated properly, complications such as these can develop over time:

• Heart failure.
• Heartbeat irregularities (Arrhythmia).
• Blood clots.
• High blood pressure in the pulmonary arteries (Pulmonary hypertension).
• Stroke.
• Sudden death from a heart attack (Cardiac arrest).

That is why it is important to see a doctor immediately if you have symptoms and begin the necessary treatment.

How is heart valve disease diagnosed?

When you go to see a doctor, they can sometimes find signs of heart valve disease during a physical exam. For example:

• They check to see if there is fluid accumulation in the lungs.
• Check to see if the heart is enlarged.
• A heart murmur is an abnormal sound heard with a stethoscope. It may indicate blood flowing through a narrowed or leaky valve.
• The ankles look swollen.

In addition, there are various medical tests that can be used to determine if you have heart valve disease. By repeating these tests over time, your doctor can see how your condition is changing and make decisions about treatment. Because valve disease can get worse over time, doctors sometimes give it a stage. It starts with A and ends with D. D is the most severe stage.

What tests are being done?

Here are some of the main tests used to diagnose heart valve disease:

• Echocardiogram (heart ultrasound): This involves placing a handheld device (`wand`) on the surface of the chest and using sound waves to create a moving image of the heart. It's similar to an ultrasound scan of a baby.
• Transesophageal echocardiogram (TEE): This is also an ultrasound test of the heart. However, this involves inserting a small camera-like device (a `probe with a transducer`) down your esophagus and examining it from much closer to your heart.
• Exercise stress echocardiogram: In this test, you are asked to walk on a treadmill or ride a bike, and then your valves and heart are checked for function.
• Chest X-ray: This is a quick chest X-ray test.
• Cardiac catheterization (angiogram): This involves taking X-ray images of the heart's coronary arteries, heart chambers, and valves.
• Electrocardiogram (EKG or ECG): Small electrode strips are attached to the skin and record the electrical activity of the heart.
• Magnetic resonance imaging (MRI): A combination of radio waves and a magnet produces very clear images of the heart.

How are heart valve diseases treated?

The treatment for heart valve disease depends on the cause of the disease and several other factors. The main treatments include:

• Protecting your valve from further damage.
• Providing medicines.
• If necessary, perform surgery or other non-invasive procedures.
• See your cardiologist regularly for advice.

Although damage to a heart valve cannot be completely undone, the problem can be treated. Whether it is treated with medication, surgical repair, or a new valve is decided based on several factors. These are:

• Type of valve disease.
• Severity of damage.
• your age.
• Your other illnesses and health history.

If you are pregnant and have heart valve disease, you may need to take extra rest and/or take certain medications that are safe for your baby. If you know about your valve disease before you get pregnant, it is a good idea to talk to your doctor before trying to get pregnant, get tested if necessary, and see a cardiologist. That way, you can get the right treatment before and during pregnancy. If you have a serious valve problem, your doctor may recommend that you have your valve repaired or replaced before you get pregnant.

Medications

Medications cannot completely cure heart valve disease. However, medications and a healthy lifestyle can help control symptoms and reduce the risk of stroke or cardiac arrest. Some medications can be stopped after valve surgery, but some medications must be taken for life.

Your doctor may prescribe medication for things like:

• Prevent heart rhythm irregularities (arrhythmias) or blood clots.
• Lower your blood pressure or cholesterol levels.
• Treat heart failure or coronary artery disease.

Surgical repair or replacement

Heart valve disease is a problem with the opening or closing of the valve flaps, and you may need surgery to repair or replace your valve. Some babies with congenital valve problems need surgery at a young age.

Usually, the surgeon and cardiologist know the best treatment before the day of surgery. But sometimes, the surgeon makes the decision during the operation, after actually seeing the valve.

Often, doctors perform valve surgery along with other surgeries (for example, bypass surgery or surgery for atrial fibrillation) to completely treat the heart disease.

Heart valve repair allows your surgeon to repair your faulty valve, often without using artificial parts. In some cases, for example, if your mitral valve is narrowed, your doctor may use a balloon on a catheter to widen the valve ( valvuloplasty ). Or they may do something called an annuloplasty to repair or strengthen the ring around the valve so that the valve can close properly.

Advantages of valve repair:

• The risk of infection is low.
• There is less need to take blood thinner medication for life.
• The strength and function of the heart muscle are preserved.

If the valve cannot be repaired, surgeons will have to replace it. Replacing your heart valve means removing your old valve and sewing a new one in place of the old valve. The new valve can be either mechanical or biological (made from human, cow, or pig tissue). If the repair is not possible, these new valves can do the job. However, depending on the type of valve you have, you may need to take medications to prevent blood clots or have a new valve inserted every 10 to 15 years.

Depending on the type of valve problem and your other medical conditions, you may be able to have a minimally invasive valve repair or replacement .

Complications of treatment

Older people and those with underlying health conditions are at higher risk of complications from valve replacement surgery.

These complications, although rarely fatal, are not usually fatal. They are:

• Infections.
• Atrial fibrillation or other abnormal heart rhythm.
• Bleeding.
• Blood clotting.
• Kidney failure.
• Stroke or Transient ischemic attack (TIA).

How long does it take to recover from heart valve surgery?

After heart valve surgery, you will need to stay in the hospital for about five to seven days. After that, it can take about four to eight weeks to fully recover. Your doctor may refer you to cardiac rehab , a closely monitored program that helps you recover.

How to reduce the risk of heart valve disease?

While some risk factors, like aging, cannot be changed, there are things you can do to reduce your risk of heart valve disease. These include:

• Treat infections promptly.
• Being physically active.
• Eating heart-healthy foods.
• Maintaining a healthy weight for you.
• If you have high blood pressure and/or high cholesterol, continue to take your prescribed medication.
• Not using tobacco products.
• Avoiding recreational drug use, especially intravenous drugs (IV drugs), which increase the risk of heart valve infection.

How can you protect your valve from further damage?

If you have heart valve disease, ask your doctor about your increased risk of developing an infection called infective endocarditis . This infection can damage or destroy your heart valves, and can be fatal. This risk exists even if you have had surgery to repair or replace your valve. Here are some things you can do to prevent infective endocarditis:

• Tell your doctors and dentists that you have valve disease.
• Call your doctor if you have signs of infection.
• Take good care of your teeth and gums.
• Ask your cardiologist if you need to take antibiotics before any dental treatment, major or minor surgery, or invasive tests.

What can you expect when living with heart valve disease?

If you have heart valve disease, it will be with you for the rest of your life. But how you experience the disease depends on which valve is affected and the severity of the problem.

Some people may have valve disease but never have symptoms. Others may have many symptoms and may need to have their valve repaired or replaced. Even if your doctor repairs or replaces your valve, you may need to continue taking medications and possibly have a new valve inserted again in 10 to 15 years.

The most important thing is to see a doctor regularly to monitor the progress of your valve disease over time.

How do I take care of myself?

Continue to take all medications prescribed by your doctor. And go to all follow-up appointments. It is also very important to maintain a healthy lifestyle.

When should I see a doctor?

You will need to see your cardiologist regularly to make sure your heart valves are working properly. Ask your doctor how often you should have these appointments. You may also need to have tests, such as an echocardiogram, again.

If your symptoms get worse or occur frequently, see your doctor first. You should also tell your doctor if you have infective endocarditis.

When should you go to the Emergency Treatment Unit (ETU) ?

If you have any of these symptoms after heart valve surgery, you should call 911 or your local emergency number:

• Syncope - loss of consciousness.
• Fever or chills.
• Stomach upset or diarrhea.
• Chest pain.
• Heart rate greater than 150 beats per minute.
• A severe headache, weakness, or numbness in an arm or leg without any warning.
• Difficulty breathing that does not subside even with rest.
• Coughing up blood (light red).
• Dark black stools or bright red blood with stools.

What questions should I ask my doctor?

Here are some questions you can ask your doctor:

• Will lifestyle changes help me?
• What physical activities are safe for me to do?
• How soon can I be physically active after surgery?

Finally, remember

It may also be a relief to know that your fatigue and shortness of breath are not just a normal part of aging, but could be a problem with your heart valve. The good news about heart valve problems is that they can be managed with medication and/or surgery. Your doctor will talk to you about the best options for you. Regardless of what treatment your doctor recommends, you can help yourself by staying physically active, eating a heart-healthy diet, and avoiding tobacco products. Be sure to take all your prescribed medications and keep all your appointments. You are not alone, and there are doctors and loved ones who can help you on this journey.

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