What is Heart Valve Disease? Symptoms and Treatment Methods

The human heart has four chambers. Depending on the position of the heart, the two chambers above are called the left and right atria, and the two chambers below are called the left and right ventricles (ventricle). There are 4 valves inside our heart, one at the exit of each chamber towards the direction of blood flow. Their job is to allow a continuous one-way flow of blood from the heart to the lungs and the rest of the body. 

These 4 covers are with their Latin names; They are Tricuspid valve, Pulmonary valve, Mitral valve and Aortic valve.

Normal physiological functions of these valves;

– Tricuspid valveThe valve is the heart valve between the right atrium and the right ventricle. Oxygen-poor blood coming from our body to our heart flows into the right atrium. This valve opens so that blood can be pumped into the right ventricle.

– Pulmonary valve, It controls blood flow between the right ventricle and the lungs. It opens to allow the heart to pump blood from the ventricles to the lungs into the pulmonary artery and closes when blood flow is complete. Thus, the blood reaching the lungs can receive oxygen.

– Mitral ax It is located between the left atrium and the left ventricle. Oxygen-rich blood flows back from the lungs to the left atrium. It opens so that oxygen-rich blood from the left atrium can be pumped into the left ventricle, and closes when blood flow is complete.

– Aortic valveIt controls blood flow from the left ventricle to the aorta (the main artery in your body). When this valve opens, oxygen-rich blood is pumped into your aorta and then out to fuel the rest of your body, closing when blood flow is complete.

When the heart contracts, the valves close between each step of circulation, preventing blood from flowing backwards and preventing oxygen-poor blood from mixing with oxygen-rich blood. Constant one-way blood flow provides oxygen and nutrients to your body.

Heart valve disease occurs when one or more heart valves do not open or close properly. When it affects more than one heart valve, it is called multiple heart valve disease.

How do diseases on the lids occur?

– Stenosis: The valve opening is not sufficient and restricts blood flow to the normal direction.

– Insufficiency: In cases where the valve cannot close completely, it causes blood to escape in the opposite direction (in the opposite direction) to its normal route.

-Prolapse (collapse of the lid, excessive stretching): A disabling subtype is a specific disease. It is when a valve slips out of place or the valve wings (leaflets) do not close properly. Therefore, it causes blood to escape in the opposite direction.

Today, heart valve disease is classified as “mild”, “moderate” or “severe”. If not treated in time, it may lead to permanent “Heart Enlargement” or “Heart Failure”. Heart failure is a serious medical condition in which the heart cannot pump enough blood to meet the body’s oxygen needs. Today, many heart valve diseases can be treated with medication, angiographic or closed/open surgeries, and procedures to repair or replace the valve.

Types of heart valve disease

Valve stenosis (stenosis):

Stiffening of the heart valves can prevent the valves from opening sufficiently and therefore restrict blood flow through the valve. This is called valve stenosis. In severe advanced cases, valve patency may be so reduced that adequate blood flow to the rest of the body may not be possible.

•  Tricuspid valve stenosis: If your tricuspid valve narrows, blood cannot flow adequately from the right atrium to the right ventricle. This may cause the right atrium to enlarge, affecting the pressure and blood flow in the surrounding chambers and vessels. It can also lead to decreased blood flow to your lungs to get oxygen.
•  Pulmonary valve stenosis: If your pulmonary valve narrows, the flow of oxygen-poor blood from the right ventricle to the lungs through the pulmonary arteries is restricted. This affects your blood’s ability to take in oxygen and deliver oxygen-rich blood to the rest of your body. With pulmonary valve stenosis, the right ventricle has to work harder to pump blood through the narrowed pulmonary valve, and the pressure in the heart often increases. And after a while, your circulation may deteriorate to the point of causing edema throughout the body.
•  Mitral valve stenosis: When the mitral valve narrows, blood flow from the left atrium to the left ventricle is reduced. This can cause fatigue and shortness of breath as the volume of blood carrying oxygen from the lungs and delivered to the whole body decreases. Since the blood cannot drain completely from the left atrium to the left ventricle, intracardiac pressure increases over time and may cause the left atrium to expand, causing fluid accumulation in the lungs (pulmonary edema).
•  Aortic valve stenosis: When the aortic valve narrows, blood flow from your heart to your aorta (the main artery leading to your body) and then to the rest of your body is restricted. As a result, the left ventricle has to work harder to move blood through the aortic valve. This often causes the left ventricle to thicken (left ventricular hypertrophy) and ultimately causes the heart to become less efficient, heading towards failure.

Prolapse (collapse, slippage, excessive stretching)

Prolapse is a condition in which the valve flaps (leaflets) slip out of place or create a collapse. This may cause the heart valve to close incorrectly or irregularly. As a result of valve prolapse, blood may leak from the valve against the flow direction and one-way blood flow may be disrupted. Prolapse is just one of the many causes of failure in one or more of the heart valves. Although it is considered a separate disease, it basically impairs the function of the heart by creating valve insufficiency.

• Mitral valve prolapse (mitral valve collapse): In mitral valve prolapse, the leaflets do not close evenly. When the left ventricle contracts, some or all of the leaflets of the mitral valve stretch towards the atrium. This causes blood to leak backwards from the valve, that is, in the opposite direction of flow. Mitral valve prolapse is also called “Barlow’s Disease” or “Mitral Valve Collapse”.
• Tricuspid, Pulmonary and Aortic valve prolapse: These diseases are less common than mitral valve prolapse. Similar to mitral valve prolapse, the leaflets of the valve do not close completely and cannot form a tight seal.

Insufficiency (leak):

Regurgitation occurs when the valve does not close properly and allows blood to flow backwards. This disruption of one-way blood flow through the heart strains your heart, reducing its efficiency and limiting its ability to provide oxygen-rich blood to your body. Prolapse is one of the causes of insufficiency.

• Tricuspid valve insufficiency: When the tricuspid valve does not close properly, some of the blood pumped from the right ventricle to the lungs may leak backwards into the right atrium and the right atrium may enlarge. Just like with the stenosis of this valve, circulation throughout the body may be impaired, causing edema (fluid accumulation).
• Pulmonary valve insufficiency: This occurs when the pulmonary valve does not close properly. The right atrium of the heart pumps blood through this valve to the lungs, allowing the blood to receive oxygen. When the pulmonary valve does not close completely, blood can leak from the lungs back to the heart. After a while, with increased pressure, the right ventricle may become dysfunctional and the basic step of blood oxygenation may be disrupted. As a result, your body may be left without oxygen.
• Mitral valve insufficiency: In mitral valve insufficiency, some blood leaks back from the left ventricle to the left atrium while the mitral valve contracts. This disrupts the body’s healthy circulation. As a result of the deficiency, blood volume and pressure in the left atrium increases. In severe cases, the increase in volume and pressure can lead to enlargement of the left atrium and accumulation of fluid in the lungs (pulmonary edema).
• Aortic valve insufficiency: Aortic valve insufficiency results in oxygen-rich blood leaking back from the aorta to the left atrium after each heartbeat. Your body doesn’t get enough blood and the heart has to work harder to compensate. Over time, your heart may enlarge. This can lead to heart failure.

Causes of Heart Valve Disease

Heart valve disease can develop in the womb or during birth before birth (congenital causes), or normal valves can become damaged during a person’s life (acquired causes).

The cause of heart valve disease is not always known. Detailed examinations may be needed to further investigate the causes of heart valve disease.

1.Congenital causes

• Congenital heart valve disease:  This is a birth defect that may involve the heart valve being the wrong size or shape, or the valve flaps (leaflets) not being attached to the heart properly.
• Bicuspid aortic valve disease:  It is a congenital defect that affects the aortic valve. Instead of the three leaflets found in a normal aortic valve, the bicuspid aortic valve has only two leaflets. Without the third leaflet, the valve cannot open and close properly and the aortic valve is more prone to stenosis and insufficiency.
• Marfan syndrome: This disease is a genetic disorder that affects the body’s connective tissue. Connective tissue holds all the body’s cells, organs, and tissues together, including the heart. People with Marfan syndrome may develop mitral valve prolapse (collapse) and aortic valve regurgitation.

2.Acquired causes

• Rheumatic fever: This disease is an inflammatory disease that can affect the heart valves, especially the mitral valve, if not treated properly. Rheumatic fever usually begins as a throat infection. As the body fights infection, heart valves can become damaged and deformed.
• Infective (bacterial) endocarditis: If there are common microbes in the blood, they can travel to the heart through the bloodstream and infect the surface of the heart, including the heart valves. People with heart valve disease also have a higher risk of developing infective endocarditis.
• Radiation therapy: People who receive radiation therapy to the chest for cancer are more likely to develop heart valve disease.
• Age: Heart valve problems can also result from degenerative changes or the normal wear and tear of aging.

3. Other Causes

• coronary artery disease
• Heart muscle damage from a heart attack
• Other diseases of the heart muscle (cardiomyopathy)
• Some metabolic disorders
• tumor in the heart
• Some drugs (Methysergide, Ergotamine, Pergolide, Cabergoline)

Heart Valve Disease Symptoms

Many people do not notice any symptoms until blood flow is significantly impaired due to heart valve disease.

Symptoms may include:

• Chest discomfort, pressure or tension, bloating along the front of your body between your neck and upper abdomen.
• Palpitations (irregular or rapid heartbeats caused by problems in the heart’s electrical system) can sometimes be a symptom of heart valve disease. Your heart may be working harder. This can cause your heart to enlarge and interfere with normal heart rhythm, leading to arrhythmia.
• Shortness of breath, especially when you are active. Heart valve disease reduces the amount of oxygen available to nourish your body, causing shortness of breath.
• Fatigue or weakness. You may have difficulty doing routine activities such as walking or doing housework.
• Feeling dizzy, light-headed or faint (most commonly seen in aortic stenosis).
• Valve problems can cause blood to pool in other parts of the body, leading to fluid accumulation in the tissues and swelling (edema) of the abdomen, feet and ankles.

If you don’t have many symptoms, or if the symptoms are mild and don’t affect you too much, your doctor may choose to monitor your condition carefully. However, it should not be forgotten that the symptoms of heart valve disease may not reflect the severity of the disease, and regular follow-up by a cardiologist should be maintained. You should make sure that you have regular check-ups and discuss any changes you notice in your health with your doctor. Women are more prone than men to rheumatic heart valve disease caused by rheumatic fever. Additionally, women with a history of heart disease should consult their doctor if they are planning a pregnancy. Pregnancy is often associated with significant changes in blood flow and blood pressure, which can worsen heart valve disease and increase the risk of an adverse cardiac event.

How Is Heart Valve Disease Diagnosed?

Diagnosing heart valve disease usually begins with the symptoms you report to your doctor and the results of a physical exam. During the exam, your doctor will listen to your heart with a stethoscope. An unusual sound called a heart murmur may be heard through a stethoscope. A heart murmur does not always mean that you have a heart problem, because people with normal hearts can also have a murmur. When in doubt, your doctor will listen to your lungs to check for fluid accumulation. He or she will also check for swelling in your abdomen, feet, and ankles.

Tests that can be done when necessary for heart valve disease:

• Echocardiography (Heart Ultrasonography)
• Angiography
• Chest x-ray (Lung x-ray)
• Electrocardiogram (EKG)
• Exercise test (treadmill test)
• Heart MRI.

How Is Heart Valve Disease Treated?

Treatment mainly depends on the severity of your heart valve disease. If your heart valve problem is very minor, you may not need any treatment. You will have regular check-ups to see if your condition is worsening. Medication may be prescribed if your heart valve problem is causing symptoms. If your condition is more serious, you may need more intensive treatment. Options include valve repair or replacement along with medication. The approach to be taken will depend on your age, your general health, which valve is affected, and the type and severity of the structural defect in the valve. You and your cardiologist will discuss treatment options and decide which is best for you. Sometimes the heart council, consisting of a cardiologist, cardiovascular surgeon and anesthesiologist, will discuss your situation and offer you appropriate treatment options.

Medicines

Your doctor may prescribe:

• Diuretics (diuretic pills) to reduce swelling and fluid accumulation in the body.
• Blood thinners (blood thinners) to prevent blood clots and reduce the risk of other heart problems.
• Antiarrhythmics to prevent irregular or fast heartbeats (arrhythmias).

If you have a heart condition in addition to valve disease (such as coronary heart disease or heart failure), you may be prescribed additional medications to reduce the workload on your heart.

Surgeries and other procedures

 If you have a diseased heart valve, you may need a procedure to repair your damaged heart valves or replace them with an artificial valve to prevent permanent damage to your heart.

• Valve repair (clipping (suturing) with closed angiographic method or suturing with open heart surgery)

1. Heart valves can be repaired by patching holes or tears, stitching them, reshaping the valve leaflets, or separating the attached valve leaflets so that they can open and close properly.
2. Valve stenosis can be opened by advancing a thin catheter with a balloon at the tip into the narrowed valve through a blood vessel. The balloon is then inflated to widen the valve opening. This procedure is called balloon valvulostia. In short, by inflating a balloon inside the valve with a narrowed opening, the adhesions that restrict its opening movement are permanently removed.
3. Annuloplasty is a technique used to repair an enlarged annulus (a ring to which the heart valve attaches). Stitches are placed around the ring to reduce the opening. Or, a ring-like device is attached to the outer perimeter of the lid opening so that it can close more tightly.

• Valve replacement (placement of a new valve by closed angiographic method or open heart surgery)

If a faulty heart valve cannot be repaired, it is removed or replaced by inserting a mechanical valve or a biological valve into it with angiographic closed or open heart surgery. You and your doctor will discuss the options and decide which is best for you.

1. Mechanical valves: made of durable metals, carbon, ceramics and plastic.
2. Biological valves are made from animal tissue, donated human tissue, or the patient’s own tissues.

Lifestyle change

 You can reduce your risk of other heart diseases and stroke by knowing and controlling your blood pressure, diabetes and blood cholesterol. It is important to maintain a healthy lifestyle.

• Do not smoke.
• Be more active.
• Aim for a healthy weight.
• Eat a healthy and balanced diet – there are some special diets, such as the Mediterranean diet, that have been proven to reduce the risk of heart disease.
• Drink less alcohol.
• Manage your stress.

 Talk to your doctor about lifestyle changes that will benefit you most.

Living with heart valve disease

Many people with heart valve disease can live full lives. Here are some things to consider as you learn to live with your heart condition.

• Heart valve disease can increase your risk of developing heart failure, where your heart muscle is not strong enough to pump enough blood throughout your body. Therefore, it is important to be aware of your symptoms and report any changes in your health to your healthcare unit.
• You may be at higher risk for infective endocarditis. If you need dental treatment, have your teeth cleaned, or have any medical procedure related to your respiratory system (for example, bronchoscopy, tonsillectomy, or adenoidectomy), see your heart doctor beforehand. You may need to take antibiotics before and after these procedures.
• Vaccinations to prevent flu and pneumonia are another proactive way to stay healthy. Many people with chronic heart problems may be less able to fight infections. You may be more susceptible to respiratory infections, which can lead to serious complications or even death. Talk to your doctor about the flu vaccine.
• Men’s and women’s hearts are different – ​​leading to differences in treatment and follow-up. This is especially true for women who plan to start a family.
• Cardiac rehabilitation is a personalized program of exercise, education, and counseling to help you recover from heart valve disease. Rehabilitation will help you regain your strength and reduce your risk of having other heart problems in the future. Talk to your doctor or contact community health centers or hospitals about how to find a program in your area.

OUR MESSAGE TO HEART VALVE PATIENTS

Heart valve diseases can often be treated completely or almost completely, thanks to modern diagnosis and treatment methods. Individuals with valve disease can live a normal life under appropriate treatment and follow-up conditions. Being treated by experienced specialist physicians in appropriate centers, with modern devices and methods, is the key step for successful management of the process.