Valvular Heart Disease Basics

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Valvular Heart Disease Basics

What Is Valvular Heart Disease?

Heart valve disease occurs when your heart's valves do not work the way theyshould.

How Do Heart Valves Work?

Your heart valves lie at the exit of each of your four heart chambers and maintainone-way blood flow through your heart. The four heart valves make sure thatblood always flows freely in a forward direction and that there is no backwardleakage.Blood flows from your right and left atria into your ventricles through the openmitral and tricuspid valves.When the

ventricles

are full, the

mitral and tricuspid valves

shut.This prevents blood from flowing backward into the atria while the ventriclescontract (squeeze).As the ventricles begin to contract, the pulmonic and aortic valves are forcedopen and blood is pumped out of the ventricles through the open valves into thepulmonary artery toward the lungs, the aorta, and the body.When the ventricles finish contracting and begin to relax, the aortic and pulmonicvalves snap shut. These valves prevent blood from flowing back into theventricles.

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This pattern is repeated over and over, causing blood to flow continuously to theheart, lungs and body.

What Are the Types of Valve Disease?

There are several types of valve disease:

•

Valvular stenosis.

This occurs when a valve opening is

smaller than normal

due to stiff or fused leaflets. The narrowed opening may make the heart work veryhard to pump blood through it. This can lead to

heart failure

and othersymptoms (see below).All four valves can be

stenotic

(hardened, restricting blood flow); the conditionsare called tricuspid stenosis, pulmonic stenosis, mitral stenosis or

aortic stenosis

.

•

Valvular insufficiency.

Also called

regurgitation

,

incompetenceor"leaky valve",

this occurs when a valve does

not close tightly

. If the valves donot seal, some blood will leak backwards across the valve. As the leak worsens,the heart has to work harder to make up for the leaky valve, and less blood mayflow to the rest of the body.Depending on which valve is affected, the conditioned is called tricuspidregurgitation, pulmonary regurgitation, mitral regurgitation or aortic regurgitation.

What Causes Valvular Heart Disease?

Valve disease can develop

before birth

(

congenital

) or can be acquiredsometime during one's lifetime. Sometimes the cause of valve disease isunknown.

Congenital valve disease.

Most often affects the

aortic

or

pulmonic

valve.Valves may be the wrong size, have malformed leaflets, or have leaflets that arenot attached to the annulus correctly.

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Bicuspid aortic valve disease

is a congenital valve disease that affects the

aortic valve

.Instead of the normal three leaflets or cusps, the bicuspid aortic valve has onlytwo. Without the third leaflet, the valve may be stiff (unable to open or closeproperly) or

leaky

(not able close tightly).

Acquired valve disease.

This includes problems that develop with valves thatwere once normal. These may involve changes in the structure or your valve dueto a variety of diseases or infections, including rheumatic fever or endocarditis.

•

Rheumatic fever

is caused by an untreated

bacterial infection

(usually

strep. throat

). Luckily, the introduction of antibiotics to treat this infection hasdramatically reduced the numbers of this infection. The initial infection usuallyoccurs in children, but the heart problems associated with the infection may not beseen until 20-40 years later.At that time, the heart valves become inflamed, the leaflets stick together andbecome

scarred, rigid, thickened

and

shortened

. This leads to

mitralregurgitation

.

•

Endocarditis

occurs when germs, especially bacteria,

enter

the

bloodstream

and attack the heart valves, causing

growths

and

holes

in the valves and scarring.This can lead to leaky valves. The germs that cause endocarditis enter the bloodduring dental procedures, surgery, IV drug use, or with severe infections. Peoplewith valve disease (except

mitral valve prolapse

without thickening orregurgitation/leaking) are at increased risk for developing this life-threateninginfection.

There are many changes that can occur to the valves of the heart. The chordaetendinea or papillary muscles can stretch or tear; the annulus of the valve candilate (become wide); or the valve leaflets can become fibrotic (stiff) and calcified.

Mitral valve prolapse(MVP)

is a very common condition, affecting 1 to 2percent of the population. MVP causes the leaflets of the mitral valve to flop backinto the left atrium during the heart's contraction. MVP also causes the tissues ofthe valve to become abnormal and stretchy, causing the

valve to leak

. Thecondition rarely causes symptoms and usually doesn't require treatment.

Other causes of valve disease include:

coronary artery disease,heart attack,cardiomyopathy(heart muscle disease),syphilis(asexually transmitted disease), hypertension,aortic aneurysms, and connective tissue diseases. Less common causes of valve disease include tumors, some types of drugs and radiation.

What Are the Symptoms of Valve Disease?

•

Shortness of breath

and/or difficulty catching your breath.

You may noticethis most when you are active (doing your normal daily activities) or when you liedown flat in bed. You may need to

sleep

propped up on a few pillows to breatheeasier.

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