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Cardiac


Cardiac
Cardiac Diseases Valvular Disease


Definition

Atria, Ventricles and Interventricular Septum

The heart's four valves help direct the flow of blood through its chambers. All of these valves are composed of thin leaflets that when closed prevent a backflow of blood and when open permit the blood to move forward to its next destination. When a valve fails to close properly, as is the case in a common disorder called mitral valve prolapse, there is a regurgitation or backflow of blood. A valve that fails to open properly—a condition called valvular stenosis—impairs the forward flow of blood to the body. In either case, the heart has to work harder to pump enough blood to the body, eventually leading to heart muscle damage. Congestive heart failure, syncope (fainting), and arrhythmias are common signs of valve disease.


Cause

A number of conditions can lead to heart valve disease. Congenital defects and infections, such as rheumatic fever, are among the most common. Rheumatic heart disease, although greatly diminished since the advent of antibiotics to treat streptococcal infections, still affects more than 1 million Americans and causes about 6,000 deaths per year.


Diagnosis

In many cases, people can have a diseased heart valve for many years without suffering any symptoms or even being aware of the problem. Diseased valves can be detected by murmurs or other unusual sounds heard through a stethoscope. Ultrasound examination of the heart, also called echocardiography, in which sound waves are used to map internal structures, is also helpful. The most precise diagnosis is made by cardiac catheterization and angiocardiography. Depending upon the type of valvular problem, patients often can go for many years without any special treatment.


Medical Therapies

Opened Right Ventricle - Anterior View

Drugs to treat heart valve disease do not provide a cure; they are used to relieve symptoms and prevent complications. For example, in mitral valve prolapse, a beta-blocking drug may be prescribed to treat worrisome symptoms such as palpitations and chest pain, even though the condition itself is not serious.

In other forms of valvular disease, digitalis or other drugs to slow the heartbeat and increase its output may be prescribed. A diuretic may be added to prevent retention of salt and water; a salt-restricted diet may be recommended for the same reason. Anticoagulant drugs may be prescribed to prevent blood clots and antiarrhythmic drugs may be used to maintain a normal heart rate and rhythm.

Since diseased heart valves are highly susceptible to a serious infection called bacterial endocarditis, it is important to take antibiotics before any dental or surgical procedure that may release bacteria into the blood-stream. Depending upon the severity of the disease, a doctor also may recommend avoiding strenuous activities and taking frequent rest periods during the day to minimize the workload on the heart.


Surgical Treatment

Opned Right Atrium - Right  Lateral View

When the heart valves are seriously damaged and impairing blood flow to the rest of the body or causing heart muscle damage, surgery to replace the defective valve may be recommended. For example, in rare cases of mitral valve prolapse, the valve may become so weakened that there is excessive backflow of blood or a danger of the valve's rupturing, which can lead to death. In such unusual circumstances, replacement of the defective valve is necessary. A number of durable and highly efficient artificial valves have been developed from animal parts, plastic, and metal. There also are newer surgical techniques to reconstruct defective heart valves. Physician-scientists at Columbia are currently investigating the potential of a non-invasive procedure for mitral valve repair procedure known as Evalve.


Balloon Valvuloplasty

To palliate valvular stenosis, a balloon-tipped catheter can be threaded through an artery until it reaches the center of the valve opening, where it is inflated.


Home Remedies and Alternative Therapies

Some alternative therapies such as relaxation techniques may be helpful in living with symptoms of heart valve disease, but none exist to actually treat the disease itself.


Prevention

Swift and thorough treatment of streptococcal throat infections with antibiotics can prevent most cases of rheumatic fever, one of the leading causes of heart valve disease.


Mitral Valve Prolapse

Left Ventricle - Flap Opened in Posterolateral Wall

This condition, which is also referred to as the floppy mitral valve syndrome, is very common, especially among women. In fact, many experts consider it a variation of normal function rather than a disease per se. Mitral valve prolapse is characterized by failure of a mitral valve leaflet to close properly. This makes a characteristic clicking sound that a doctor can usually hear. The floppy valve also may allow a backflow of some of the blood that normally should pass through the valve to the left ventricle.

Most of the time, the condition is benign and entirely asymptomatic. In other instances, it can cause a variety of rather vague symptoms, including palpitations, chest pain, easy fatigue, feelings of breathlessness, and perhaps fainting. In rare cases, the person may develop serious cardiac arrhythmias. Recurrences can be prevented by establishing the proper diagnosis—an echocardiogram can detect the abnormal valve—and administering beta-blockers or other medication to control the heart rhythm.


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