Valvular Heart Diseases

Valvular heart diseases (VHD) affect the function of the heart valves, which are essential for maintaining proper blood flow through the heart. There are four heart valves: the mitral, aortic, tricuspid, and pulmonary valves. When these valves become diseased, they may not open or close properly, leading to serious cardiac complications.

1. Stenosis

Definition:
Narrowing of the valve opening, restricting blood flow.

Common Causes:
Rheumatic heart disease, congenital defects, calcification (e.g., aortic stenosis in the elderly).

Symptoms:
Shortness of breath, chest pain, fatigue, syncope (fainting).

2. Regurgitation (Insufficiency, Incompetence):

Definition:
Incomplete closure of the valve, causing backward leakage of blood.

Common Causes:
Infective endocarditis, myxomatous degeneration, mitral valve prolapse, ischemic heart disease.

Symptoms:
Heart palpitations, breathlessness, swelling in the legs, fatigue.

3. Combined Disease

Some patients have both stenosis and regurgitation in the same valve.

Causes and Risk Factors

Aging and Degeneration:

Leads to calcification and thickening of valves.

Rheumatic Heart Disease:

Resulting from untreated streptococcal infections.

Congenital Abnormalities:

Some individuals are born with defective valves (e.g., bicuspid aortic valve instead of tricuspid).

Endocarditis (Infection of the Heart Valves):

Can damage valves and cause regurgitation.

Hypertension & Coronary Artery Disease:

May contribute to secondary valve dysfunction.

Diagnosis

Echocardiography (Ultrasound of the Heart):

Gold standard for assessing valve function.

Electrocardiogram (ECG):

Detects arrhythmias associated with valvular disease.

Chest X-ray:

Identifies heart enlargement due to valve disease.

Cardiac MRI and CT Scans:

More detailed imaging of valve structure.

Cardiac Catheterization:

Used in complex cases to evaluate pressure changes across the valves.

1. Medical Treatment (For Symptom Management)

Diuretics: Reduces fluid overload and heart strain.
Beta-blockers: Helps control heart rate and reduce workload.
Anticoagulants: Used in patients with atrial fibrillation and valve disease to prevent clots.
Antibiotics: In cases of infective endocarditis or for prophylaxis before dental procedures (if indicated).

2. Surgical Treatment

Valve Repair: Whenever possible, surgeons favor repairing rather than replacing the valve (e.g., mitral valve repair).
Valve Replacement:

Mechanical Valves: Durable but require lifelong anticoagulation therapy.

3. Catheter-Based Interventions

Transcatheter Aortic Valve Replacement (TAVR): A minimally invasive option for patients with severe aortic stenosis.

Balloon Valvuloplasty: Used in cases of stenosis to widen the valve opening.

Preventive Measures

Treat infections promptly (especially streptococcal throat infections to prevent rheumatic heart disease).

Maintain good oral hygiene to reduce the risk of bacterial endocarditis.

Control risk factors such as hypertension, diabetes, and cholesterol.

Regular cardiac check-ups in high-risk individuals.

Conclusion

Valvular heart disease is a serious but manageable condition. Early diagnosis and appropriate treatment—whether through medications, surgery, or minimally invasive procedures—can significantly improve a patient’s quality of life. Patients with valve disease require lifelong follow-up with a cardiologist.

Information resources recommended

1. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease

https://www.ahajournals.org/doi/10.1161/CIR.0000000000000923

https://pubmed.ncbi.nlm.nih.gov/33332149/

https://www.ahajournals.org/doi/10.1161/CIR.0000000000000932

https://pubmed.ncbi.nlm.nih.gov/33342586/

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

2. 2021 ESC/EACTS Guidelines for the Management of Valvular Heart Disease

https://academic.oup.com/eurheartj/article/43/7/561/6358470

https://pubmed.ncbi.nlm.nih.gov/34453165/

https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Valvular-Heart-Disease-Guidelines

https://www.jacc.org/doi/10.1016/j.jacc.2023.05.061

https://www.eacts.org/clinical-practice-guideline/esc-eacts-guidelines-for-the-management-of-valvular-heart-disease/

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