A Primer on Heart Valve Disease

Irving Herling, MD
Director, Clinical Cardiology
Main Line Health

Each year, about 5 million people are diagnosed with heart valve disease, according to the American Heart Association. The condition disrupts the one-way flow of blood through the heart, forcing it to work harder to circulate blood through the body.

ANATOMY OF THE HEART

Before delving further into heart valve disease, a quick refresher on the heart: The heart is divided into four chambers—the upper right and left atria, and the lower right and left ventricles. The heart also has four valves—the pulmonary and tricuspid on the left, and aortic and mitral on the right. Each valve has a set of flaps, known as leaflets or cusps. Valves keep blood flowing in one direction through the atrium into the ventricles, opening and closing with each heart beat.

BASIC VALVE MALFUNCTION

Heart valves can malfunction in one of two ways: stenosis, in which the valve doesn’t open fully, forcing the heart to work harder to get blood through the narrowed opening; and leaky (or insufficiency), in which the valve doesn’t close properly to allow blood to flow backwards. Valve disease is most commonly found in the mitral and aortic valves, and more than one can be affected at the same time.

Mitral Valve Prolapse

The most common heart valve problem is mitral valve prolapse, where the valve bulges back a little after it closes. It occurs in 4 to 5 percent of the population, and genetics can increase your chance of having it. For the most part, mitral valve prolapse is not dangerous and can go undetected, but in some cases, it can cause the valve to become stretchy and leak. This results in blood flowing back into the upper chamber of the heart. Over time, this can damage the heart and require treatment to correct it.

CAUSES OF HEART VALVE DISEASE

Heart valve disease can be congenital (i.e. you’re born with it) or acquired (i.e. develops over time). Congenital valve disease typically affects the aortic or pulmonic valve, and may be related to improper valve size, malformed leaflets or irregularity in the way leaflets are attached.

Acquired heart valve disease can be caused by a number of factors including coronary artery disease, heart attack, cardiomyopathy, hypertension and connective tissue disease, which stretches and distorts heart valves. Men over the age of 65 and women over the age of 75 are at greater risk of developing it.

Less common causes today include infections like rheumatic fever, an inflammatory disease more common in children caused by letting strep throat go untreated, and endocarditis, an infection of the inner layer of the heart that can occur after dental procedures, surgery, IV drug use, and severe infections.

SIGNS & DIAGNOSIS

Many times people with heart valve disease can be asymptomatic, but some patients will notice chest pain or palpitations, shortness of breath, fatigue, weakness, lightheadedness, and/or swollen ankles, feet or abdomen. If you have symptoms, it’s important to notify your physician.

Heart valve disease is often detected in the doctor’s office. Your doctor can hear a murmur, a “whoosh” sound as blood flows from one chamber to the next or an extra click if a valve allows blood to flow backwards. Tests to confirm the initial diagnosis include an echocardiogram (ultrasound of the heart), EKG, which tracks the electrical activity of the heart, or angiogram (cardiac catheterization).

The presence of a valvular abnormality does not necessarily present a problem or a risk. The severity and its likelihood of progression are best evaluated by your cardiologist to determine the potential impact. Next week we will examine how valve disease is evaluated, followed, and treated.

Join Dr. Herling live at Lankenau’s Web Chat, tomorrow, Aug. 7 at 7 p.m.: Living With Heart Valve Disease: Your Own & Your Loved One’s. Sign up now.

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