Valvular Heart Disease

Introduction

Valvular heart disease (VHD) refers to any condition affecting one or more of the four heart valves: the aortic, mitral, tricuspid, and pulmonary valves. These valves ensure unidirectional blood flow through the heart. When they malfunction, the heart's efficiency can be compromised, leading to serious complications such as heart failure, arrhythmias, or stroke.

Types of Valvular Diseases

1. Stenosis

• A valve becomes narrow, making it harder for blood to pass.
• Increased pressure forces the heart to work harder.
• Common examples: Aortic stenosis, Mitral stenosis.

2. Regurgitation (Insufficiency)

• A valve does not close completely, causing blood to leak backward.
• This increases volume load on the heart, leading to dilation and eventual heart failure.
• Common examples: Mitral regurgitation, Aortic regurgitation.

3. Prolapse

• Occurs primarily in the mitral valve when it bulges back into the left atrium, sometimes causing regurgitation.

Causes of Valvular Heart Disease

• Congenital defects (e.g., bicuspid aortic valve)
• Rheumatic fever (post-streptococcal infection damage)
• Aging-related degeneration (calcification of valves)
• Endocarditis (infection leading to valve damage)
• Autoimmune diseases (e.g., lupus affecting valve structure)

Symptoms

• Shortness of breath
• Fatigue
• Dizziness or fainting
• Swelling in legs and feet
• Heart murmurs (often detected by a doctor)

Diagnosis

• Echocardiography (ultrasound imaging of the heart)
• Electrocardiogram (ECG)
• Cardiac MRI & CT scans
• Cardiac catheterization (in complex cases to assess pressure and flow)

Treatment Approaches

1. Medical Therapy (Symptom control)

• Beta-blockers, Diuretics, ACE inhibitors for heart failure symptoms
• Anticoagulants if there's an increased stroke risk

2. Interventional Procedures

• Balloon valvuloplasty (for stenosis)
• Transcatheter Aortic Valve Replacement (TAVR)

3. Surgical Valve Repair or Replacement

• Mechanical Valves: Require lifelong anticoagulation (e.g., warfarin)
• Bioprosthetic Valves: Shorter lifespan but no need for lifelong anticoagulation

Prevention and Lifestyle

• Treat infections promptly (prevent rheumatic fever and endocarditis)
• Manage hypertension and cholesterol
• Maintain a healthy lifestyle (diet, exercise, no smoking)
• Regular echocardiographic follow-ups in diagnosed patients

Conclusion

Valvular heart disease can significantly impact heart function if left untreated, but with proper monitoring and timely interventions, patients can lead a normal, healthy life.

Source recommendations

1. American College of Cardiology/American Heart Association Guidelines for the Management of Patients With Valvular Heart Disease

1. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2024/03/13/18/13/2024-acc-aha-clinical-performance-valvular
2. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000923
3. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2020/12/16/21/58/2020-ACC-AHA-VHD-GL-Pt-1-GL-VHD
4. https://pubmed.ncbi.nlm.nih.gov/9809971/
5. https://professional.heart.org/en/science-news/2020-acc-aha-guideline-for-the-management-of-patients-with-valvular-heart-disease

2. European Society of Cardiology Guidelines for the Management of Valvular Heart Disease

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Valvular-Heart-Disease-Guidelines
2. https://academic.oup.com/eurheartj/article/43/7/561/6358470
3. https://pubmed.ncbi.nlm.nih.gov/34453165/
4. https://eurointervention.pcronline.com/article/2021-esc-eacts-guidelines-for-the-management-of-valvular-heart-disease
5. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000923