Heart Valve Disease
Basics
Heart valve disease is a problem with one or more of the valves that help keep the blood flowing in a forward direction through the heart. It's one of the most common forms of heart disease, affecting about five million Americans.
Your heart is a fist-sized muscle that pumps blood through a network of vessels to all parts of your body. It is made up of four chambers: the upper chambers, or the left and right atria, and the lower chambers, or the left and right ventricles. Each chamber is closed off by a valve with thin flaps of tissue (leaflets) that open to allow blood to flow forward, and then close to prevent it from flowing backward.
Heart valve disease most commonly affects the mitral and the aortic valves, which are located on the left side of the heart. The five most common types of heart valve disease are mitral valve prolapse, mitral stenosis, mitral regurgitation, aortic stenosis, and aortic regurgitation Figure 01.
Figure 01. The Heart and its valves
Causes
Heart valve disease can result when the valves are damaged or weakened Table 01.
The type of heart valve disease that occurs depends on the affected valve and how much bloodflow is disrupted. The forward movement of bloodflow can be affected in two ways: it either builds in a heart chamber when the valve does not open completely (stenosis), or it leaks backwards when the valve does not close completely (regurgitation). A valve can have stenosis and regurgitation at the same time. In all cases, the heart has to work harder to maintain bloodflow. Over time, the extra workload causes the heart to weaken, making it unable to move blood in an efficient manner.
Mitral valve prolapse (MVP)—also known as the “click-murmur” syndrome because of the sounds it makes through a stethoscope—occurs when the leaflets of the mitral valve become enlarged and can't close properly.
When these leaflets are enlarged, they often bulge into the atrium as the heart contracts, disrupting bloodflow. The mitral valve may also become displaced as the fibrous strings supporting the leaflets (chordae) become inflamed and stretched out.
Although its cause is not known, mitral valve prolapse is generally a condition in which the valve tissues become weak, flabby, and covered with starchlike deposits (myxomatous degeneration).
Mitral stenosis occurs when the leaflets become scarred, rigid, and covered with hardened tissue and calcium deposits.
When this happens, blood can’t flow forward easily, and pressure and fluid build-up are transmitted back to the lungs. This can lead to shortness of breath and, over time, congestive heart failure—a condition where the heart can’t pump adequate amounts of blood. The primary cause of mitral stenosis is rheumatic fever, an autoimmune disease of childhood that begins with strep throat and affects many tissues in the body, especially the heart valves.
With mitral regurgitation (also called mitral insufficiency), the mitral valve cannot close properly, and blood leaks backward into the left atrium.
Mitral regurgitation results when the muscles that control the closing of the valve malfunction, the strings (chordae) that support the leaflets rupture, or when the valve itself degenerates. Mitral valve prolapse, coronary artery disease, buildup of calcium deposits on the valve, injury to the muscles that support the valve, and connective tissue diseases such as lupus or Marfan syndrome or others can also lead to mitral regurgitation.
Aortic stenosis occurs when the leaflets are misshapen.
The aortic valve controls the flow of blood from the left ventricle into the aorta, your body's main artery and blood supplier. When the shape of the aortic valve's leaflets is distorted, the valve narrows, and bloodflow is slowed. About 1 in 20 people are born with only two leaflets instead of the standard three. Known as “bicuspid aortic valve,” this condition can eventually cause aortic stenosis. Although aortic stenosis can also be caused by rheumatic fever, this is rare. The condition is more likely to be caused by age-related degeneration and calcification of the aortic valve, making older people especially prone to aortic stenosis.
Aortic regurgitation occurs when the valve cannot close properly, and blood leaks back into the left ventricle.
Aortic regurgitation can result when the leaflets are deformed, or when the area where the aorta connects to the valve (aortic ring) widens. The two most common causes of leaflet deformity are a bicuspid aortic valve (two leaflets instead of the standard three) and bacterial endocarditis, a serious infection that damages heart valves. The exact cause of aortic ring widening is unknown. However, it may be related to connective tissue disorders, or to ankylosing spondylitis—a condition that causes pain and inflammation in the joints between the spine and pelvis, and between the vertebrae of the spine. Aortic stenosis can also lead to aortic regurgitation.
Table 1. Types and Causes of Heart Valve Disease
| Type | Definition | Cause(s) |
|---|---|---|
| Mitral valve prolapse | Tissue flaps of the mitral valve bulge, impairing bloodflow to the left atrium | Myxomatous degeneration: a condition that causes valve tissues to become weak and flabby and covered with starch deposits
Coronary artery disease Marfan syndrome: a disease of the body's connective tissue that causes joint dislocation and deformity. |
| Mitral stenosis | A narrowing of the mitral valve that occurs when the leaflets become scarred and rigid. Forward bloodflow is impaired, so pressure and fluid are transmitted back to the lungs. | Rheumatic fever: a childhood bacterial infection that begins with strep throat and causes scarring of the valves
Connective tissue disorders Tumors |
| Mitral regurgitation | The mitral valve cannot close properly and blood leaks backward into the left atrium. | Rheumatic fever Mitral valve prolapse Coronary artery disease A buildup of calcium deposits on the valve Injury to muscles supporting the valve Connective tissue disease, including lupus and Marfan syndrome, and unknown causes |
| Aortic stenosis | Valve leaflets are distorted, causing valve narrowing and bloodflow impairment. | Bicuspid aortic valve: (only two valve leaflets instead of the normal three) Calcium deposits and fibrous tissue buildup on leaflets Rheumatic fever |
| Aortic regurgitation | Valve cannot close properly, and blood leaks back into the left ventricle. | Bicuspid aortic valve Endocarditis (an infection that causes the lining of the heart and valves to become inflamed) Rheumatic fever Connective tissue disorders Aortic stenosis |
Symptoms
In most patients, mitral valve prolapse (MVP) produces no symptoms. However, some people experience mild symptoms such as fatigue, shortness of breath, or sharp chest pain.
The symptoms of heart valve disease vary depending on the valve affected and how bloodflow is disrupted. Often, symptoms develop gradually as the heart becomes increasingly taxed from its extra workload; mitral stenosis, mitral regurgitation, aortic stenosis, and aortic regurgitation may take decades to produce symptoms. A small number of patients with mitral valve prolapse may also develop tachycardia (rapid heartbeats). If mitral valve prolapse causes substantial valve leakage (regurgitation), it may cause symptoms of congestive heart failure.
Mitral stenosis can cause shortness of breath with any sort of effort or activity, fatigue, and heart palpitations.
In many people, symptoms don’t appear until the valve narrowing is severe. Shortness of breath is caused when the increased pressure needed to fill the left ventricle puts pressure on the blood vessels of your lungs. If your lungs have filled with fluid, you may cough up blood or bloody mucus. Some people also become quite hoarse if the pressure builds to the point where the left atrium presses on the nerves surrounding the vocal chords.
Mitral regurgitation can cause fatigue, palpitations, and shortness of breath. You may experience more severe symptoms depending on when the condition occurs.
Because the left ventricle adjusts to the extra volume of blood being pumped by your heart, it may take years before you notice any symptoms. Whether or not mitral regurgitation is a long-standing problem or appears suddenly seems to dictate the type of symptoms you'll have. If your condition is mild, it’s common to have no symptoms at all. Over time, however, the leakage places extra pressure on your lungs, resulting in fatigue, palpitations, and shortness of breath with effort, when lying down, or during sleep. If mitral regurgitation comes on suddenly, it can cause severe shortness of breath at rest, and shock.
Aortic stenosis can cause chest pain that worsens with exercise or appears after exercise; fainting, and shortness of breath.
These symptoms manifest as the condition worsens and the aortic valve becomes severely narrowed. Chest pain occurs because your heart has to pump harder to move the blood through the valve, creating a greater demand for oxygen than the blood can supply. Fainting is usually due to exertion; this causes your body's blood vessels to relax, lowering your blood pressure. In aortic stenosis, your heart isn't able to pump enough blood to offset this drop in blood pressure. Hence, bloodflow to your brain is reduced, causing you to faint.
As aortic regurgitation becomes severe, symptoms such as fatigue, dizziness, and shortness of breath with effort, when lying down, or suddenly during sleep will appear.
You might also experience ankle swelling, or rarely, chest pain with exertion or when at rest. It’s also common to notice a pulse in the neck when lying on the left side, and heartbeats that feel premature.
Risk Factors
Your risk for heart valve disease depends on a number of varying factors.
Diagnosis
Heart valve disease is a problem with one or more of the valves that help keep the blood flowing in a forward direction through the heart. It's one of the most common forms of heart disease, affecting about five million Americans.
Your heart is a fist-sized muscle that pumps blood through a network of vessels to all parts of your body. It is made up of four chambers: the upper chambers, or the left and right atria, and the lower chambers, or the left and right ventricles. Each chamber is closed off by a valve with thin flaps of tissue (leaflets) that open to allow blood to flow forward, and then close to prevent it from flowing backward.
Heart valve disease most commonly affects the mitral and the aortic valves, which are located on the left side of the heart. The five most common types of heart valve disease are mitral valve prolapse, mitral stenosis, mitral regurgitation, aortic stenosis, and aortic regurgitation Figure 01.
Figure 01. The Heart and its valves
Heart valve disease can result when the valves are damaged or weakened Table 01.
The type of heart valve disease that occurs depends on the affected valve and how much bloodflow is disrupted. The forward movement of bloodflow can be affected in two ways: it either builds in a heart chamber when the valve does not open completely (stenosis), or it leaks backwards when the valve does not close completely (regurgitation). A valve can have stenosis and regurgitation at the same time. In all cases, the heart has to work harder to maintain bloodflow. Over time, the extra workload causes the heart to weaken, making it unable to move blood in an efficient manner.
Mitral valve prolapse (MVP)—also known as the “click-murmur” syndrome because of the sounds it makes through a stethoscope—occurs when the leaflets of the mitral valve become enlarged and can't close properly.
When these leaflets are enlarged, they often bulge into the atrium as the heart contracts, disrupting bloodflow. The mitral valve may also become displaced as the fibrous strings supporting the leaflets (chordae) become inflamed and stretched out.
Although its cause is not known, mitral valve prolapse is generally a condition in which the valve tissues become weak, flabby, and covered with starchlike deposits (myxomatous degeneration).
Mitral stenosis occurs when the leaflets become scarred, rigid, and covered with hardened tissue and calcium deposits.
When this happens, blood can’t flow forward easily, and pressure and fluid build-up are transmitted back to the lungs. This can lead to shortness of breath and, over time, congestive heart failure—a condition where the heart can’t pump adequate amounts of blood. The primary cause of mitral stenosis is rheumatic fever, an autoimmune disease of childhood that begins with strep throat and affects many tissues in the body, especially the heart valves.
With mitral regurgitation (also called mitral insufficiency), the mitral valve cannot close properly, and blood leaks backward into the left atrium.
Mitral regurgitation results when the muscles that control the closing of the valve malfunction, the strings (chordae) that support the leaflets rupture, or when the valve itself degenerates. Mitral valve prolapse, coronary artery disease, buildup of calcium deposits on the valve, injury to the muscles that support the valve, and connective tissue diseases such as lupus or Marfan syndrome or others can also lead to mitral regurgitation.
Aortic stenosis occurs when the leaflets are misshapen.
The aortic valve controls the flow of blood from the left ventricle into the aorta, your body's main artery and blood supplier. When the shape of the aortic valve's leaflets is distorted, the valve narrows, and bloodflow is slowed. About 1 in 20 people are born with only two leaflets instead of the standard three. Known as “bicuspid aortic valve,” this condition can eventually cause aortic stenosis. Although aortic stenosis can also be caused by rheumatic fever, this is rare. The condition is more likely to be caused by age-related degeneration and calcification of the aortic valve, making older people especially prone to aortic stenosis.
Aortic regurgitation occurs when the valve cannot close properly, and blood leaks back into the left ventricle.
Aortic regurgitation can result when the leaflets are deformed, or when the area where the aorta connects to the valve (aortic ring) widens. The two most common causes of leaflet deformity are a bicuspid aortic valve (two leaflets instead of the standard three) and bacterial endocarditis, a serious infection that damages heart valves. The exact cause of aortic ring widening is unknown. However, it may be related to connective tissue disorders, or to ankylosing spondylitis—a condition that causes pain and inflammation in the joints between the spine and pelvis, and between the vertebrae of the spine. Aortic stenosis can also lead to aortic regurgitation.
Table 1. Types and Causes of Heart Valve Disease
| Type | Definition | Cause(s) |
|---|---|---|
| Mitral valve prolapse | Tissue flaps of the mitral valve bulge, impairing bloodflow to the left atrium | Myxomatous degeneration: a condition that causes valve tissues to become weak and flabby and covered with starch deposits
Coronary artery disease Marfan syndrome: a disease of the body's connective tissue that causes joint dislocation and deformity. |
| Mitral stenosis | A narrowing of the mitral valve that occurs when the leaflets become scarred and rigid. Forward bloodflow is impaired, so pressure and fluid are transmitted back to the lungs. | Rheumatic fever: a childhood bacterial infection that begins with strep throat and causes scarring of the valves
Connective tissue disorders Tumors |
| Mitral regurgitation | The mitral valve cannot close properly and blood leaks backward into the left atrium. | Rheumatic fever Mitral valve prolapse Coronary artery disease A buildup of calcium deposits on the valve Injury to muscles supporting the valve Connective tissue disease, including lupus and Marfan syndrome, and unknown causes |
| Aortic stenosis | Valve leaflets are distorted, causing valve narrowing and bloodflow impairment. | Bicuspid aortic valve: (only two valve leaflets instead of the normal three) Calcium deposits and fibrous tissue buildup on leaflets Rheumatic fever |
| Aortic regurgitation | Valve cannot close properly, and blood leaks back into the left ventricle. | Bicuspid aortic valve Endocarditis (an infection that causes the lining of the heart and valves to become inflamed) Rheumatic fever Connective tissue disorders Aortic stenosis |
In most patients, mitral valve prolapse (MVP) produces no symptoms. However, some people experience mild symptoms such as fatigue, shortness of breath, or sharp chest pain.
The symptoms of heart valve disease vary depending on the valve affected and how bloodflow is disrupted. Often, symptoms develop gradually as the heart becomes increasingly taxed from its extra workload; mitral stenosis, mitral regurgitation, aortic stenosis, and aortic regurgitation may take decades to produce symptoms. A small number of patients with mitral valve prolapse may also develop tachycardia (rapid heartbeats). If mitral valve prolapse causes substantial valve leakage (regurgitation), it may cause symptoms of congestive heart failure.
Mitral stenosis can cause shortness of breath with any sort of effort or activity, fatigue, and heart palpitations.
In many people, symptoms don’t appear until the valve narrowing is severe. Shortness of breath is caused when the increased pressure needed to fill the left ventricle puts pressure on the blood vessels of your lungs. If your lungs have filled with fluid, you may cough up blood or bloody mucus. Some people also become quite hoarse if the pressure builds to the point where the left atrium presses on the nerves surrounding the vocal chords.
Mitral regurgitation can cause fatigue, palpitations, and shortness of breath. You may experience more severe symptoms depending on when the condition occurs.
Because the left ventricle adjusts to the extra volume of blood being pumped by your heart, it may take years before you notice any symptoms. Whether or not mitral regurgitation is a long-standing problem or appears suddenly seems to dictate the type of symptoms you'll have. If your condition is mild, it’s common to have no symptoms at all. Over time, however, the leakage places extra pressure on your lungs, resulting in fatigue, palpitations, and shortness of breath with effort, when lying down, or during sleep. If mitral regurgitation comes on suddenly, it can cause severe shortness of breath at rest, and shock.
Aortic stenosis can cause chest pain that worsens with exercise or appears after exercise; fainting, and shortness of breath.
These symptoms manifest as the condition worsens and the aortic valve becomes severely narrowed. Chest pain occurs because your heart has to pump harder to move the blood through the valve, creating a greater demand for oxygen than the blood can supply. Fainting is usually due to exertion; this causes your body's blood vessels to relax, lowering your blood pressure. In aortic stenosis, your heart isn't able to pump enough blood to offset this drop in blood pressure. Hence, bloodflow to your brain is reduced, causing you to faint.
As aortic regurgitation becomes severe, symptoms such as fatigue, dizziness, and shortness of breath with effort, when lying down, or suddenly during sleep will appear.
You might also experience ankle swelling, or rarely, chest pain with exertion or when at rest. It’s also common to notice a pulse in the neck when lying on the left side, and heartbeats that feel premature.
Your risk for heart valve disease depends on a number of varying factors.
Symptoms such as shortness of breath or your heart skipping a beat may suggest a heart valve problem to your doctor.
Your primary care doctor may discover that you have heart valve disease because you are experiencing these symptoms. Other times, heart valve disease is discovered accidentally during a routine examination. If your disease is serious, you may be referred to a heart specialist (cardiologist) or a surgeon for treatment. However, your primary care doctor will likely be the one monitoring your condition.
Your doctor will take a complete medical history to determine if you have any symptoms—such as fatigue and palpitations—that point to valve disease.
Symptoms of valve disease are often vague and appear slowly. Other times, they come on very suddenly. That’s why it’s important to provide your doctor with as much information as possible. Be prepared to explain your exact symptoms, including the mildest (such as fatigue) or most severe (shortness of breath or chest pain while resting). Information about when and how symptoms first appeared is also important.
A physical examination is one of the most important ways to diagnose heart valve disease.
Normally, blood flows through the valves without making any noise. When a valve is damaged in any way, bloodflow will make a “whooshing” sound as it is forced through a narrowed opening or leaked backward; this is referred to as a “murmur.” Your doctor can determine if you have a murmur by listening to your heart with a stethoscope. Many types of valve diseases have characteristic sounds that help distinguish them. Your doctor will also consider where in the chest the murmur is the most distinctive, the timing of the murmur in relation to other normal heart sounds, and the presence or absence of symptoms. Remember that heart murmurs don't always indicate disease and can be present in perfectly healthy people.
In addition to listening to your heart, your doctor will take your blood pressure and pulse rate. Both of these help to rule out other forms of heart disease as well as additional reasons for abnormal heart sounds.
At least one of three tests will be done to confirm a valve disease diagnosis: a chest x-ray, an electrocardiogram (ECG), or an echocardiogram.
Your doctor may want to perform an extra procedure known as cardiac catheterization if other tests haven't provided enough information about your valve disease, or if surgery is being planned as treatment.
Cardiac catheterization is a test that involves inserting a thin tube into your heart through a blood vessel. A dye is then injected into the tube so that the heart and bloodflow can be seen on x-ray. Catheterization can also be used to measure blood pressure within your heart, and to determine if blockages exist in the coronary arteries.
Heart valve disease can increase the risk for a serious, life-threatening infection of the heart and valve linings called endocarditis. If you're at risk, your doctor may recommend that you take an antibiotic before certain dental and surgical procedures.
Endocarditis is an infection that affects the lining of the heart and valves. It occurs when bacteria that reside normally in other parts of the body, such as the mouth, and upper respiratory and urinary tracts, travel through the bloodstream and settle in the heart. Endocarditis is twice as common in men over the age of 50 than in women, and rarely occurs when the valves are healthy. Certain dental and surgical procedures can stimulate the release of these bacteria. These procedures include:
Some people with heart valve disease and a history of rheumatic fever may need to take an antibiotic to prevent future attacks.
Although rare in America and other Western countries, rheumatic fever is an important cause of several types of common valve diseases. If you’ve had rheumatic fever as a child and are younger than 35 years of age, your doctor may recommend that you take an antibiotic to prevent future episodes.
Prevention and Screening
Heart valve disease can increase the risk for a serious, life-threatening infection of the heart and valve linings called endocarditis. If you're at risk, your doctor may recommend that you take an antibiotic before certain dental and surgical procedures.
Endocarditis is an infection that affects the lining of the heart and valves. It occurs when bacteria that reside normally in other parts of the body, such as the mouth, and upper respiratory and urinary tracts, travel through the bloodstream and settle in the heart. Endocarditis is twice as common in men over the age of 50 than in women, and rarely occurs when the valves are healthy. Certain dental and surgical procedures can stimulate the release of these bacteria. These procedures include:
Some people with heart valve disease and a history of rheumatic fever may need to take an antibiotic to prevent future attacks.
Although rare in America and other Western countries, rheumatic fever is an important cause of several types of common valve diseases. If you’ve had rheumatic fever as a child and are younger than 35 years of age, your doctor may recommend that you take an antibiotic to prevent future episodes.
Treatment
Heart valve disease can sometimes disrupt heart rhythms or lead to blood clots. When this occurs, immediate hospitalization is necessary.
Sudden onset of palpitations, chest pain, fatigue, extreme shortness of breath even when resting, wheezing, and sweating can indicate a serious heart complication and require immediate medical attention.When valve disease becomes very severe, it can disrupt the regular beating of your heart. This can lead to a condition known as atrial fibrillation, where the heart’s upper chambers (atria) quiver erratically and rapidly instead of beating effectively. This allows the blood to gather in the atria instead of flowing forward, and increases the risk for a blood clot. If the clot dislodges itself, it can travel through the bloodstream and get stuck in a small blood vessel, blocking the flow of oxygen and blood. If the clot lodges in the brain, it can cause a stroke; elsewhere it can cause tissue to die. Atrial fibrillation can also lead to congestive heart failure, a condition where the heart cannot keep up its workload and fails to pump ample amounts of blood.
Lifestyle changes can often be helpful for managing mitral valve prolapse.
Most people with mitral valve prolapse have no symptoms. When symptoms do appear, they are often mild, and can be managed with lifestyle changes.
If you have mitral stenosis and shortness of breath during any sort of activity that requires effort, you might want to avoid extremely strenuous physical activity.
Many people with confirmed mitral stenosis become winded with any sort of physical activity. Therefore, it’s wise to avoid strenuous physical activity or emotional upset wherever possible. Both can increase heart rate, and aggravate already slowed bloodflow as the result of the valve narrowing. Your doctor may also recommend that you follow a no-salt diet to avoid fluid overload, since extra fluid that flows backward to the lungs can worsen breathing problems.
Your doctor is the best source of information on the drug treatment choices available to you.
Cognitive behavioral therapy (CBT) may be helpful for some people with mitral valve prolapse.
Stressful events can raise heart rate and blood pressure, and cause stress hormones to be released into the bloodstream. These hormones can exaggerate mitral valve prolapse symptoms such as chest pain, increased heart rate, and shortness of breath. Cognitive behavioral therapy is a form of psychotherapy that focuses on emotions raised by especially distressing symptoms as well as what they can mean to a person. Learning to recognize these feelings (and their triggers) can often lead to new ways of thinking and better ways of coping.
Surgery is usually needed when symptoms of heart valve disease become severe, or when complications such as heart failure, stroke, or significant interruptions in heart rhythm occur. Occasionally, surgery may be performed when symptoms are mild, so as to prevent further weakening of the heart.
Many people with heart valve disease can be effectively managed with drug therapy for many years before requiring any sort of surgery. Your doctor may refer you to a cardiologist and heart surgeon when symptoms suggest that the disease has progressed beyond the point where drug therapy is effective (for example, when severe aortic or mitral stenosis narrows the valve opening to less than a quarter of its normal size). A referral is also likely if tests indicate that you are heading for a serious complication, such as a stroke.
Three primary types of surgery are conducted for severe valve disease: percutaneous balloon valvuloplasty, valve repair, and valve replacement Table 02.
Table 2. Surgical Procedures for Heart Valve Disease
| Procedure | Valve Disease | Advantages | Disadvantages |
|---|---|---|---|
| Percutaneous balloon valvuloplasty | Mitral stenosis | Only requires local anesthesia (injected directly into area being worked on). May not completely rid of obstruction. Shorter recovery time than surgery (only 2 to 3 day hospital stay) Low death rate from complications ( |
May not completely rid of obstruction. |
| Valve repair | Mitral regurgitation Occasionally mitral stenosis |
Since the valve is not ?replaced,? it can't wear out. Does not normally require blood thinners following the procedure. |
May not completely get rid of an obstruction, but can lessen symptoms. May eventually need replacement. Recovery time is about one week in the hospital and several more weeks at home. |
| Valve replacement: artificial valve | Aortic stenosis Aortic regurgitation (if medical therapy does not prevent disease from worsening) Mitral stenosis and mitral regurgitation (if valvuloplasty and repair are not options) |
Often lasts a lifetime. About 80% of people can return to normal activities within the first year. |
Small but increased likelihood for a blood clot around the mechanical parts and therefore, a stroke. Increased risk for infection. Recovery time is up to two weeks in hospital and several more weeks at home. Lifetime blood thinners are required, and contact sports and other activities with high risk of injury must be avoided. Not an option if you have any type of bleeding disorder, such as an ulcer. |
| Valve replacement: biological valves | Aortic stenosis Aortic regurgitation (if medical therapy does not prevent disease from worsening) Mitral stenosis Mitral regurgitation |
Only requires 8 to 10 weeks of blood thinners following surgery | Usually wear out and need to be replaced every 10 years. Recovery time is up to two weeks in hospital and several more weeks at home. |
Herbal medicines containing ephedrine are particularly dangerous in anyone with heart disease, and should be avoided.
Pregnancy can cause symptoms that are similar to heart valve disease, and can aggravate already existing valve disease.
Pregnancy naturally causes symptoms that are similar to those of heart valve disease, such as fatigue, shortness of breath after activity or when lying down, heartbeats that appear to be premature, and swollen feet and ankles. Pregnancy can also worsen symptoms of already existing heart valve disease, and possibly pose a risk to the fetus. If you are pregnant and have heart valve disease, your condition must be managed by a team that includes a primary care doctor, an obstetrician, and a cardiologist.
In many cases, labor and delivery will be normal and the risk to the fetus is low, especially with modern advances in medical and surgical treatment. However, pregnant women with heart valve disease may need to avoid vigorous activity and omit salt from their diets. If you are pregnant and have an artificial heart valve, blood thinner therapy (which is required with artificial valves) can pose a risk to the fetus. Your team of doctors will recommend that you either continue warfarin up to week 35 of your pregnancy and then switch to another blood thinner call heparin, or switch to heparin earlier in the pregnancy. Close monitoring is required, because heparin poses a greater risk to both the mother and fetus than warfarin, and may lead to blood clot and bleeding.
Many people with confirmed heart valve disease continue to lead full and active lives.
In many cases, symptoms of heart valve disease can take 10 to 20 years to appear. By the time they do appear, the disease may be severe, and survival may be limited to two to ten years after diagnosis. However, advances in medical and surgical therapy have increased the likelihood for a symptom-free and normal lifespan if the disease is diagnosed early enough. Other factors that can influence survival include age at diagnosis, the type of valve disease, and whether or not you have other forms of heart disease. While valve replacement surgery used to be considered risky for older patients, statistics on survival rates, (both immediate and long term) and on quality of life have improved a great deal and continue to do so. The risk of operating on an older patient is often acceptable and results are often considered excellent.
It’s also important to keep in mind that many people with damaged heart valves never experience any problems whatsoever.
The number and type of follow-up visits to your doctor after your valve disease is diagnosed depends on the type of disease you have, its severity, and your specific treatment.
If you have confirmed heart valve disease and no symptoms, you doctor will likely ask you to return for follow-up tests such as echocardiography. If you’ve had surgery to repair or replace your heart valve, the surgeon will likely ask you to return within one to two weeks to make sure that there are no complications. After this visit, you may be asked to return every six months to a year. Follow-up visits during drug therapy will depend on the medications your doctor has prescribed. Regardless, you should seek immediate medical attention if your symptoms suddenly worsen, if you notice any unusual symptoms, or if you have sudden and severe chest pain, heart palpitations, or breathlessness.