Heart Valve Disorders
(Mitral, Aortic, Tricuspid, and Pulmonary Stenosis and Regurgitation)
The heart has four valves that control the flow of blood passing in and out of its chambers. A defect or disease in any one of them will disrupt normal flow. There are two categories of disorder: stenosis, in which a valve fails to open fully, and insufficiency, or regurgitation, in which it does not close properly.
Congenital heart defects often produce valve problems; valves can also be , damaged by coronary artery disease, heart attacks, and infections, especially rheumatic fever, and endocarditis. In elderly people, calcium deposits may narrow the aortic valve. And many women have mitral valve prolapse, in which one or more of the mitral valve's leaflets fail to close completely.
Valvular disease can exist for years without causing symptoms or requiring treatment. When symptoms do develop, they may include breathlessness, fatigue, angina, and dizzy spells. Consequences of a diseased heart valve vary. Mitral valve stenosis and regurgitation can cause congestive heart failure. A diseased aortic valve can lead to enlargement and weakening of the left ventricle.
Diagnostic Studies and Procedures
An initial diagnosis is made when a doctor hears a heart murmur through a stethoscope. An electrocardiogram and a chest X-ray will provide important information about heart size and function, but to make a precise assessment, a physician will order echocardiography, an ultrasound examination that provides images of the valves and other heart structures.
Doppler echocardiography, in which the blood flow is measured, can be particularly useful when assessing valve disorders.
If these non-invasive procedures are not sufficient, or if valve replacement surgery is being considered, cardiac catheterization will be employed. This procedure, which involves inserting a catheter into an artery and then into the heart, will help pinpoint the valve problem and other abnormalities.
Medical Treatments
Symptoms can often be alleviated with medications, though they cannot cure the disease. The most frequently prescribed drug is digitalis, which helps the heart beat more forcefully. Diuretics may be given to reduce the body's fluid volume and ease the heart's workload. Vasodilators might be prescribed to widen small arteries. These include nitroglycerin; prazosin (Minipress); calcium-channel blockers, such as nifedipine (Procardia); and ACE inhibitors, such as captopril (Capoten). Anticoagulant drugs may also be needed to prevent blood dots, and antiarrhythmia drugs to control irregular heartbeats.
Balloon valvuloplasty is sometimes used to open a narrowed, or stenosed, valve. A balloon-tipped catheter is inserted through an artery into the heart and narrowed valve. The balloon is then inflated to widen the valve's opening. Although valvuloplasty is not as effective as surgical repair, it is safer and less expensive, and may be advised for elderly patients who are unlikely to tolerate heart surgery. It is most effective in treating a narrowed mitral valve and, to a lesser degree, the aortic valve.
Surgery is reserved for severe, progressive cases. Sometimes the damaged valve can be repaired, but more often it must be replaced with one made from synthetic materials or from animal or human tissue. If a synthetic valve is implanted, the patient must take anti-coagulant drugs to prevent blood clots.
All forms of valvular disease increase the risk of endocarditis, a serious infection of the heart's lining. Prophylactic antibiotic therapy is often recommended, especially before dental or surgical procedures that involve bleeding.
Alternative Therapies
Alternative approaches should be used only as additions to medical therapy.
Nutrition Therapy. A low-salt diet can reduce fluid accumulation. When taking diuretics, a patient should consume high-potassium foods to replace the excreted potassium. Good choices include bananas, tomatoes, potatoes, legumes, and whole-grain products. A low-fat diet that is high in fiber and carbohydrates is recommended for all heart patients. Supplements of vitamins E and C may also be advised.
Self-Treatment
Moderate exercise can usually be tolerated, but not strenuous physical activity. It is important to refrain from smoking, to abstain from alcohol or use it in moderation, to maintain ideal weight, and to control other cardiovascular disorders, such as high blood pressure and elevated cholesterol.
Other Causes of Breathlessness
Numerous lung diseases, including emphysema and tuberculosis, can cause shortness of breath, as can anemia and congestive heart failure.