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HEART VALVE DISEASE

What is heart valve disease?

The heart is made up of four chambers and four valves. The body’s blood flows into one side of the heart and out the other. It is the job of the valves to prevent the blood from back-flowing into the heart’s chambers. When one or more of these valves does not function properly the heart’s valves are considered “diseased.”

The three types of heart valve malfunctions are:

  • Regurgitation : when the blood flows in the wrong direction into the heart because of a faulty valve. In this case, the valve does not close tightly allowing blood to flow backward into the heart’s chamber.

  • Stenosis : when the valve does not entirely open if blocks the blood from flowing through the heart’s chambers at the appropriate level. This is caused by a thickened valve that is not capable of completely opening.

  • Atresia : when the valve does not open at all; this prevents any blood from flowing.

Congenital heart valve disease refers to the disease when it is present at birth, whereas acquired heart valve disease refers to the disease when it develops over time.

What causes heart valve disease?

Heart conditions and other disorders, age-related changes, rheumatic fever, congenital, or infections can cause acquired heart valve disease. The cause of congenital heart valve disease isn't known, it occurs before birth as the heart is forming. Congenital heart valve disease can occur alone or with other types of heart defects.

What are the symptoms of heart valve disease?

It is important to note that there are people who have heart valve disease that never present with any symptoms and those that do may have one or more symptom. The most common symptoms are:

  •  Irregular heartbeat (heart murmur)

  •   Chest pain

  •  Heart flutter or racing

  •   Fatigue

  •  Dizziness

  •   Shortness of breath

  •   Severe headaches

  •   Low or high blood pressure

  •  Swelling of the ankles, feet, legs, abdomen or neck veins

How is heart valve disease diagnosed?

A cardiologist will perform a physical exam. The physician will listen to your heart and determine if there is a heart murmur or other abnormality in the heartbeat. The doctor will also listen to your lungs and check your ankles, feet, abdomen, etc. to determine if your body is retaining water.

If your cardiologist suspects heart valve disease, he/she may order further tests. These may include:

  • Echocardiography (echo) : This noninvasive test provides a moving picture of the heart through sound waves.

  • Electrocardiogram (EKG) : This noninvasive test uses electrodes to record the heart’s electrical activity.

  • Chest X-ray :This noninvasive test takes pictures of your lungs and heart.

  • Cardiac catheterization : During this test a catherter (thin flexible tube) is inserted into either your arm or groin ans is then threaded into the right or left side of the heart. Live X-rays are used to guide the catheter to the heart where blood and tissue samples and measurements may be taken.

  • Cardiac MRI : This noninvasive test uses magnet and radio waves to make detailed images of the heart.

How is heart valve disease treated?

Heart valve disease cannot be cured with medications however; it can be treated with a combination of lifestyle changes and medications. Science has found that this combo may delay the progression of the disease. In severe cases surgery is performed to repair or replace the faulty heart valve(s).

Lifestyle Changes:

  •  If you smoke, stop

  •   Eat a healthy diet of lean meats and high-fiber whole grains

  •  Exercise in moderation

  •  Take care of your mouth – flossing, brushing and regular visits to the dentist are important especially for patient who have man-made valves

Other Treatments:

  • Balloon Valvuloplasty : This procedure is most often used to treat patients suffering from stenosis. During the procedure a catheter (small plastic tube) with a balloon on the end is threaded from either the groin or the arm into the heart. Once the catheter reaches the defective heart valve, the balloon is inflated. This widens the opening of the valve. Once the valve has been stretched, the balloon is deflated and both the balloon and catheter are removed from the body.

  • Transcatheter Aortic Valve Replacement (TAVR) : Screening for TAVR takes place at Lutheran with the SCL Health Heart team. Our sister hospital, Saint Joseph Hospital is one of the few hospitals performing the TAVR procedure in Colorado. This alternative to open-heart surgery is a less invasive surgery that only requires a small incision to either the ribs or the groin area. During this surgery, a catheter (small plastic tube) with a balloon on the end is inserted in the body. Once the catheter reaches the diseased heart valve the balloon is inflated with fluid and breaks open the diseased valve. The balloon is then deflated and removed. The new valve, which will be compressed at this time, will then be placed on the balloon and inserted into heart. Once in place in the heart, the balloon will be inflated, stretching the new valve into place. Then the balloon will be deflated and removed. During this surgery, cardiac bypass will not be necessary. However, there will be moments when your heart rate will be increased, which lower the body’s normal blood flow to organs. This increase usually last for a few seconds at a time. Currently only patients who are not optimal candidates for open heart surgery are considered for this procedure.

Smoking is a major risk for several diseases including heart disease, stroke, and several cancers. Even low-tar cigarettes and light smoking can increase the risk of heart disease substantially. There are now several alternative approaches to helping people stop smoking. These include nicotine-replacement patches and gum as well as oral medication.

If you are able to stop smoking, your risk of a heart attack or stroke decreases within a few weeks. The risk goes down to that of a nonsmoker within about 2 years. In addition, a lot of patients comment that they feel healthier and have more energy after they've stopped smoking.

Hypothyroidism can increase blood cholesterol levels and that contributes to heart disease; however, if the hypothyroidism is being treated with a thyroid hormone, then the cholesterol returns to normal.

Birth control pills can cause a small increase in the risk of thrombosis and heart attack. That occurs mainly in people who have been on the pill for more than 10 years and who smoke cigarettes.

There is an increase in the risk of heart attack if a first-degree relative (parent or sibling) has had a heart attack or stroke. That is mainly seen when the relative has had a heart attack before the age of 45 if they are male, 55 if they are female. Obviously, you cannot change your family history, but a positive history should suggest the need to improve all the other risk factors like stopping smoking and decreasing cholesterol.

Heart disease is potentially reversible by attending to risk factors like cholesterol, blood pressure, and smoking. Several studies have shown, for example, that aggressive lowering of blood cholesterol with LDL levels below 100 can open up blocked coronary arteries at least partially. Perhaps I should explain that LDL cholesterol is the "bad" cholesterol component.

I would suggest a diet that is balanced among all the main food groups, with fat content making up no more than 30 percent of calories and most of that fat being unsaturated. I would not advise patients to eat a diet that is restricted in carbohydrates or fruits and vegetables, because this may adversely affect vitamin intake and blood cholesterol.

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