Heart Valve Disease - Symptoms, Causes, Signs and Treatment

Disease Name	Heart Valve Disease
Alternative Name	Valvular Heart Disease
Symptoms	Chest pain, Fatigue, Heart palpitations, Dizziness, Heart murmur, Pulmonary oedema
Causes	Congenital and Acquired causes
Diagnosis	Chest X-Ray, MRI Scan, Echocardiogram, Cardiac Catheterization, Electrocardiogram
Treated by	Cardiovascular Surgeon
Treatment options	Surgery- Valvular Heart Surgery Non Surgical- Balloon Valvuloplasty

As the name suggests, heart valve disease is a disease that leads to the dysfunction of one or more valves in the heart. A human heart has four chambers: two atria (left and right atrium) and two ventricles (left and right ventricles).

These chambers have gate openings called the heart valves. There are four valves present in a human heart:

1. Pulmonary valve: Allows the blood to flow from the right ventricle to pulmonary arteries that carry oxygen-poor blood to the lungs.
2. Tricuspid valve: The door between the right atrium and right ventricle.
3. Mitral valve: The door between the left atrium and left ventricle.
4. Aortic valve: Allows blood to flow from the left ventricle to the aorta, carrying oxygen-rich blood to the body.

The primary function of these valves is to ensure that the flow of blood is in the forward direction within the chambers of the heart. Improper functioning of these heart valves can cause leakage of blood in the body. 

1. Valvular Prolapse
   Valvular prolapse is a condition in which the flaps of the valves, also known as leaflets, slip out of place or form a bulge backwards into the heart's upper left chamber. This can cause the blood to flow backwards through the valve and disrupt blood circulation.
2. Mitral Valve Prolapse
   Mitral valve prolapse is caused when the mitral valve’s flap does not close properly. Resultant - it can make the blood flow back into the left atrium. Normally, this does not require treatment. However, if a person with mitral valve disorder experiences symptoms (as explained later in the article), seeking immediate treatment is important.
3. Aortic, Pulmonary, and Tricuspid Valve Prolapse
   Like mitral valve prolapse, these valvular disorders are also caused when the leaflets of these valves do not close properly and cause the blood to flow in the backward direction through the valves.
4. Valvular Stenosis
   Valvular stenosis is when one or more valves in the heart get narrowed, due to which they do not open properly. This happens due to the stiffening of the heart valves. It can result in the restriction of blood flow.
5. Pulmonary Valve Stenosis
   The narrowing of the pulmonary valve restricts the flow of oxygen-poor blood from the right ventricle to the lungs through the pulmonary arteries. Due to this, the right ventricle has to pump blood with more effort, which often increases the pressure on the heart. Pulmonary valve stenosis reduces the blood’s ability to pick up oxygen and deliver oxygen-rich blood to the body.
6. Aortic Valve Stenosis
   Aortic valve stenosis is the narrowing of the aortic valve that affects the blood flow from the heart to the aorta, which is the body’s main artery. This restricts the blood flow to the rest of the body, due to which the left ventricle must contract harder to get the blood through the aortic valve.
7. Tricuspid Valve Stenosis
   The narrowing of the tricuspid valve results in the restriction of blood flow from the right atrium to the right ventricle. It can lead to the enlargement of the atrium, affecting blood flow in the surrounding veins and chambers. This can also make the right ventricle smaller, which leads to lesser circulation of blood to the lungs to pick up oxygen.
8. Mitral Valve Stenosis
   Mitral valve stenosis causes the narrowing of the mitral valve, which reduces the blood flow from the left atrium to the left ventricle. Due to this, the volume of oxygen-rich blood is reduced. This can cause fatigue and shortness of breath.
9. Valvular Regurgitation
   Valvular regurgitation occurs when the valve does not close properly and makes the blood flow backwards. This can cause leakage of the blood in the body. Regurgitation of the valves can put extra strain on the heart and reduce its functional efficiency.
10. Pulmonary Valve Regurgitation
    When the pulmonary valve does not close properly, it leads to pulmonary valve regurgitation. Due to this disorder, the heart's right ventricle forces the blood into the lungs through the pulmonary artery to pick up oxygen. However, since the pulmonary valve does not close completely, it causes the blood to leak back from the lungs to the heart.
11. Tricuspid Valve Regurgitation
    If the tricuspid valve does not close properly, it causes the blood to leak backwards into the right atrium from the right ventricle. This leads to the enlargement of the atrium.
12. Mitral Valve Regurgitation
    When the mitral valve does not close properly, the blood leaks backwards into the left atrium from the lower chamber through the mitral valve. This leaves less amount of blood available to flow through the rest of the body.
13. Aortic Valve Regurgitation
    In this condition, the oxygen-rich blood from the aorta leaks backwards into the left ventricle every time the heart pumps. Due to the aortic valve regurgitation, the body does not get enough blood, and the heart needs to work hard to pump more blood. This decreases the efficiency of the heart’s ability to pump blood and increases the risk of heart failure.
14. Defect in Valve Anatomy
    A defect in valve anatomy refers to improper development of the valves.
15. Bicuspid Aortic Valve Disease
    Bicuspid aortic valve disease refers to the problems caused due to valve anatomy. The average human heart has three flaps in the aortic valve. However, a person with bicuspid aortic valve disease has only two flaps in the aforesaid valve. Children are born with such a defect and may experience symptoms from day one. However, some may not experience symptoms until adulthood. The aortic valve can easily be repaired with surgery.

Classification Based on Time of Occurrence

1. Congenital 
   Congenital heart valve disease is a condition in which a child’s one or more valves do not develop properly before birth. 
2. Acquired
   Acquired heart valve diseases develop during a person’s life due to various causes (as explained later in the article). In this case, the valves are normal initially but later acquired a defect. 

Some people might not experience symptoms even though they suffer from heart valve disease. However, the commonly identifiable symptoms include:

1. Shortness of breath while doing physical activity or lying down
2. Chest pain
3. Fatigue
4. Heart palpitations
5. Dizziness
6. Heart murmur, which is an extra sound that one can hear in a heartbeat, and it is caused due to turbulent flow of blood in the heart valves (whooshing sound)
7. Pulmonary oedema (which is caused when the heart fails to pump blood efficiently, which can lead it flowing into the lungs)
8. Rapid weight gain due to lack of physical activities (physical activities lead to shortness of breath, so the affected person may not be able to perform them)
9. Swollen abdomen, which is caused due to water retention (it occurs because the heart is unable to pump enough blood to the kidneys due to the defect in the valves)

1. Congenital Cause
   1. Defect before birth, which is caused due to one or more valves not developing properly.
2. Acquired Causes
   1. Generic
      1. Inflammation of the heart tissues, also known as infective endocarditis
      2. A heart attack or other heart-related condition reduces the ability of the valves to allow blood flow in the chambers. This forces the valves to work harder to pump the blood leading to damage.
      3. Lupus, which is a chronic autoimmune disorder, causes inflammation in the heart leading to valvular disorder.
      4. Syphilis, which is a rare sexually transmitted infection that thickens the aortic valve.
   2.  Age-Related 
      1. Calcium deposits that settle in the heart from the bloodstream because of damaged or inflamed arteries (more common in people above 40 years) 
      2. Narrowing and hardening of the arteries that supply blood to the heart
      3. Degenerative changes in the heart muscle that cause cardiomyopathy
      4. Weakening of the connective tissues in the mitral valve, myxomatous degeneration

Controllable Factors

1. High blood pressure
2. Unhealthy eating patterns
3. Excessive smoking and alcohol consumption
4. Lack of physical activity
5. Obesity

Uncontrollable Factors

1. Congenital heart defects (anatomy related)
2. Arrhythmia (the irregular rhythm of the heartbeat)
3. Blood clots
4. Old age
5. Hereditary valve disease
6. Use of pacemakers and defibrillators as these medical devices can rub against a valve and create scar tissue. This can make the heartbeat lose its rhythm.

If a person is born with a valve defect, there is nothing he/she can do. Otherwise, one can lower the risk of a heart valve disease by taking these measures:

1. Following a certain workout routine, such as walking, weight lifting, yoga, etc., to make sure the body's blood flow remains optimal.
2. Keeping blood pressure and diabetes in control to reduce the risk rate. 
3. Taking medications on time and making some lifestyle changes can also help.
4. Eating healthy is as important as working out. A healthy diet keeps diabetes, blood pressure, and cholesterol levels in check and reduces the chances of getting the disease.

A doctor will check if the heartbeat sounds abnormal through a stethoscope. If it is so, the doctor may conduct the following medical tests:

1. Chest X-Ray
   With an x-ray, a picture of the heart is taken to check if it is enlarged.
2. MRI Scan
   This scan provides a detailed picture of the heart with which the doctor can diagnose the severity of the defect and provide treatment accordingly.
3. Echocardiogram
   Sound waves are used to create a picture of the heart valves and chambers in this test for diagnosis.
4. Cardiac Catheterization
   It is a test in which pictures of the heart and blood vessels are taken with a thin tube and a camera. 
5. Electrocardiogram
   With this test, the electrical activity of the heart is shown. It helps in checking abnormal heart rhythms.
6. Stress Test
   This test allows the doctor to determine the effect of exertion on the heart and check if there are heart valve disease-related symptoms due to the stress.

When to See a Doctor?

1. If the disease is congenital, regular check-ups and heart valve screenings are suggested. 
2. If it has been genetically inherited, getting medical supervision is advisable to ensure that no complication arises.

Depending on the severity of the condition and the symptoms, the doctor may suggest treatment.

Medications

A healthcare provider might suggest medications depending on the cause of the defect, such as:

1. Calcium channel blockers if calcium depots are causing the defect
2. Vasodilators to open blood vessels
3. Diuretics to reduce fluid retention

Surgery 

Surgery is required to repair or replace the valves to ensure proper blood flow through the heart chambers. 

In case of repair:

1. One’s own tissue may be used to remodel the abnormal valve.
2. Prosthetic rings are inserted to narrow the dilated valve.
3. In case of replacement, the defective valve may be replaced with:
4. A donated valve from a different person
5. An artificial or mechanical valve

Non-Surgical Options 

1. Balloon Valvuloplasty
   This is a less invasive method to treat heart valve diseases. In this method, a catheter (hollow tube) is induced into a blood vessel in the groin and guided towards the heart. At the tip of the catheter, a deflated balloon is attached, which is inflated as soon as it reaches the narrowed heart valve. This causes the valve to stretch open.    

Home Remedies to Keep Your Heart Health Optimal

Even though heart valve conditions cannot be treated with home remedies, there are certain measures a person can take to resist the progression of the disease and maintain their heart health.

1. Avoid high-cholesterol food items.
2. Cut back on salt as it can increase blood pressure.
3. Keep sugar levels in control if diagnosed with diabetes.
4. Maintain a workout routine to ensure better blood circulation.

If the heart valve disease is not treated on time, it can lead to:

1. Heart stroke
2. Blood clots
3. Heart failure

How to Prepare for the Doctor's Consultation?

It is important to inform the doctor about the following during the consultation:

1. Symptoms 
2. Other health complications such as diabetes, high blood pressure, etc.
3. Family history of heart-related health conditions.

The patient must also ask about their doubts related to their condition and treatment. These are some of the questions one can ask:

1. Can the condition be treated without surgery?
2. If not, when will the surgery be required?
3. What are the risks involved?
4. Can the progression of the disease be controlled?