Valvular Heart Disease: What Your Patients Should Know

Valvular heart disease, when any heart valve struggles to allow adequate blood flow through and from the heart, can be fatal if not detected and managed in a timely manner. It has been estimated that 2.5% of Americans have valvular heart disease.¹

If caught in time, valvular heart disease can be managed without measures as intensive as surgery. Early detection may help patients avoid severe outcomes resulting from blood flow difficulties and thickening of the heart muscle. For this reason, patients who are at risk for developing valvular heart disease should know the different ways it can occur, how to detect symptoms, and what may be required if the condition is left unmanaged. When discussing valvular heart disease with patients who may not be aware of the risks, how can you break down the basics for them?

What is Valvular Heart Disease?

Valvular heart disease is a general term that encompasses any instance of disease or damage to a heart valve. The four valves of the heart – the mitral, tricuspid, aortic, and pulmonary valves – allow for blood flow through the four chambers of the heart.¹ These valves have flaps (two in the case of the mitral valve, three in the case of all other valves) that open and close to allow for a proper, regulated flow of blood. A damaged valve, however, may have difficulties fully opening or closing. This affects the amount of blood and the direction it can go in.

If a patient’s heart valves are struggling to flow blood through the heart, it will pump harder to get more blood flowing. This can increase their risk for heart failure, stroke, and sudden cardiac arrest.²

There are three general types of valvular heart disease: valvular regurgitation, stenosis, and atresia.

Regurgitation

Regurgitation is when the flaps of the valve do not close properly, which can cause blood to leak and flow backwards into the heart. With some of the blood flowing the wrong way, the heart may have to work harder to pump the correct amount of blood.³ Often, regurgitation can be the result of valve flaps bulge back, known as prolapse.²

Stenosis

In valve stenosis, the opening of the valve struggles to open properly. This could be a result of flaps fusing together, thickening, or stiffening.² Aortic stenosis, where the narrowed opening of the aortic valve struggles to provide enough blood from the left ventricle, is one of the most common forms of valvular heart disease.⁴

Atresia

Atresia is a congenital condition where the valve does not fully form and does not have an opening to allow for blood flow.

Who is at Risk for Valvular Heart Disease?

Certain risk factors for valvular heart disease are similar to those of other cardiovascular conditions, such as advanced age or a family history of heart disease; with valvular heart disease, early history of heart disease particularly increases risk.²

Other forms of heart disease can put a strain on the valves and increase a patient’s risk as well. Endocarditis, an infection in the lining of the heart, can settle into and damage the valves. Heart failure, atherosclerosis, and high blood pressure can also affect heart valves and potentially cause valvular heart disease.

Rheumatic disease can also bring about valve disease. Triggered by the same bacteria that causes strep throat to develop, rheumatic disease can scar the heart valve and increase risk over time. This is more common in older Americans, particular those born before 1943.¹

Other risk factors include:

• Diabetes
• High cholesterol
• Obesity
• Autoimmune disease
• Lack of exercise
• Marfan syndrome

Valvular Heart Disease Symptoms

It is important that at-risk patients know to detect potential symptoms of valvular heart disease. Unfortunately, symptoms are not always readily apparent. In a particularly slow-moving valvular heart disease, it can take years before symptoms appear, at which point the condition may be quite advanced. The disease can also develop and progress rapidly in some cases. Because of this, the best advice you can give your patients is to tend to their cardiovascular health as best they can.

When symptoms do appear, they often include:

• Fatigue
• Chest pain
• Dizziness
• Arrhythmia (irregular heartbeat)
• Shortness of breath
• Swelling or rapid weight gain

Valvular Heart Disease Diagnosis

Clinicians may notice possible valvular heart disease if they hear a heart murmur during a routine physical examination or cardiology appointment. An abnormal sound like that would potentially indicate that a valve is not working correctly, at which point a primary care physician would refer the patient to a cardiologist and a cardiologist would recommend further tests. This may include an echocardiography (using sound waves to create a moving image of the heart and its blood flow).

The location, sound, and rhythm of the heart murmur may also allow a health care professional to determine the affected valve and the type of valvular heart disease.¹

Valvular Heart Disease Management

Upon diagnosis of valvular heart disease, patients may receive immediate treatment in some cases but not others, depending on the severity of the symptoms and the damage to the valve. In mild cases, a patient may be recommended to simply make lifestyle changes to promote good overall health. Simultaneously, they may receive medications to alleviate their symptoms before further, more intensive treatment is needed. They may undergo regular follow-ups to determine how their symptoms are developing and if the valve is worsening.

Valvular Heart Disease Treatment

If the condition is serious enough, surgery may be required to repair or replace the damaged valve. Repair is often preferred to replacement if feasible, as valve replacement has more risks. Depending on the severity of the disease, however, replacement may be necessary.

The two types of replacement valves are biologic valves made of human or animal tissue and mechanical valves.² The type of surgery required will depend on the type of valvular heart disease. For example, in aortic stenosis, the transcatheter aortic valve replacement surgery has become a standard choice, particularly for those who are at a higher surgical risk.⁵ While this procedure is not without risk, it is minimally invasive and can mitigate the risks that come with open-heart surgery.