How the heart works
A healthy heart beats around 100,000 times a day. The heart’s job is to supply the body with oxygen-rich blood.
The heart has four chambers. Blood is pumped through the four chambers with the help of four heart valves.
The role of the heart valves
Heart valves open when the heart pumps to allow blood to flow. They close quickly between heartbeats to make sure blood does not flow backward.
- The pulmonary valve (1) controls the flow of blood to the lungs to get oxygen.
- The aortic valve (2) controls the flow of blood as it exits the heart and is pumped to the rest of the body.
- The tricuspid (3) and mitral valves (4) control blood flow as it moves between the chambers of the heart.
About heart valve disease
Heart valve disease can disturb the normal flow of blood through the heart.
The aortic valve, pulmonary valve, mitral valve, and tricuspid valve can develop one or both of these problems:
- The valve opening becomes narrow (stenotic), which makes the heart work harder to pump blood.
- The valve does not close completely (valve insufficiency or regurgitation), which means blood can flow backward instead of only forward. Backward blood flow reduces the heart's ability to pump blood to the rest of the body. This also causes a buildup of back pressure in the heart and lungs.
Causes of heart valve disease
Heart valve disease can develop before birth (congenital), be acquired during a persons lifetime, or be the result of an infection. Acquired heart valve disease is the most common. It involves changes in the structure of the heart valves as a result of mineral deposits on the valve or surrounding tissue. Infective heart valve disease causes changes to the valves because of diseases, such as rheumatic fever or infections.
Heart valve disease symptoms
There are a number of symptoms that may indicate heart valve disease, including:
- Shortness of breath or difficulty catching ones breath, especially after being active or lying down flat in bed
- Often feeling dizzy or too weak to perform normal activities
- Pressure or weight in the chest, especially during activity or exposure to cold air
- Heart palpitations or a feeling that the heart is beating irregularly, skipping beats, or flip-flopping in the chest
- Swelling in ankles, feet, or belly. Sudden weight gain with possibly as much as 2 to 3 pounds in 1 day
Symptoms can range from moderately severe to none at all and do not always indicate the seriousness of heart valve disease
Risk factors
There are risk factors that may be controlled and risk factors that may not be controlled. Factors that may be controlled include infections and untreated strep throat, which can lead to rheumatic fever. Advancing age and congenital heart problems (present from birth) are factors that may be beyond control.
Diagnosis
The doctor can detect a heart valve problem and evaluate the nature of the valve damage by talking about the symptoms and performing a number of tests. These tests may include:
- Listening to the heart to hear the valves opening and closing and the rush of blood through them
- Conducting an echocardiogram, which uses sound waves to produce detailed images of the heart valves moving as the heart beats
- Ordering a magnetic resonance imaging (MRI) scan, which uses a magnetic field and radio waves to get detailed images of the inside of the heart
- Taking an x-ray image of the chest to check the heart, its major vessels, and the lungs for abnormalities
- Using an ECG to measure the electrical impulses given off by the heart. An ECG gives the doctor important information about the heart's rhythm and its size.
Treatment options
There are several options for treating heart valve disease.
Medication
Certain medications may ease some severe aortic stenosis symptoms.
Surgical Aortic Valve Replacement (SAVR)
Open heart surgery is done to remove the diseased aortic valve and replace it with an artificial valve.
Balloon Valvuloplasty (BAV)
A tiny balloon is inflated in the aortic valve to try and improve blood flow.
Transcatheter Aortic Valve Implantation (TAVI)
TAVI is less invasive than open heart surgery. The doctor will make a small incision on the body. After, a thin, flexible tube is inserted into an artery to guide the artificial heart valve up to the heart to replace the diseased valve.
Valve Repair
During an annuloplasty procedure the surgeon reshapes the heart valve and may also attach the valve to its chords and may add support to the valve annulus.
Aortic valve disease
Mitral valve disease
1
Nkomo VT, Gardin JM, Skelton TN, et al. Burden of valvular diseases: a population-based study. The Lancet Online. August 18, 2006; Vol 368; pp 1005-1011.