Doctors Say These Are the Signs of Heart Valve Disease, Including Shortness of Breath

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Heart disease remains the leading killer in the United States and heart valve disease, which happens when a valve is damaged or diseased, is one of the most common types of heart disease. An estimated 2.5 percent of the population have the condition, but experts say the number of cases is rising. "As life expectancy in the United States has increased, valvular disease has become more prevalent and hence a bigger health concern," Abhishek Sinha, MD, FACC, FSCAI – Interventional Cardiologist, Structural Heart Interventionalist and Endovascular Specialist at Dignity Health Northridge Hospital Medical Center tells us. 

Valves serve an essential role and help make sure blood flows in the right direction. "Think of the heart valves as the doors within the heart. They are one way systems that allow blood to either enter or leave the chambers of the heart," Prabhdeep S. Sethi, MD, MPH, FACC, FSCAI, FSVM Program Director, Internal Medicine Residency Program Associate Program Director, Interventional Cardiology Fellowship Program Dignity Health – St. Bernardine Medical Center explains. " Any process that impairs their ability to open or close appropriately is generally called valvular heart disease."

Heart valve disease is a serious condition and if left untreated can cause irreparable damage. However, with advances in treatment, living a quality life with the condition is highly possible. Dr. Sinha says, "Over the last decade, there has been a revolution in the treatment of severe valvular heart disease through the advances in structural heart interventions. What once could only be treated by cardiac surgery, can now often be treated through minimally invasive procedures involving wires and catheter-based therapies." While there's good news for treatment options, knowing the signs of heart valve disease is essential for survival. Eat This, Not That! Health spoke with specialists who explain what to know about heart valve disease and signs to be aware of.


What to Know About Heart Valve Disease

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Raed Bargout, MD, Chief of Cardiovascular Disease at Dignity Health Glendale Memorial Hospital says, "The heart is a muscle, the size of a hand fist composed of four chambers pumping blood in both the Aorta and pulmonary artery. Heart valves separate those four chambers and hence there are four valves, The Aortic, Mitral, Tricuspid and pulmonic valve. Valves function to control and regulate blood flowing from one chamber to the other. Healthy heart valves are able to fully open and close during the cardiac cycle while diseased valves might not fully open or fully close and hence leads to a variety of symptoms and diseases."

Dr. Sinha explains, "The heart has four chambers and four valves. On the right side of the heart (which receives blood from the venous system and pumps it to the lungs), there is the tricuspid and pulmonic valve. On the left side (which receives oxygenated blood and pumps it to the rest of the body), there is the mitral valve and aortic valve. There is a wide variety of valvular disease, and it is difficult to summarize all of them in a short amount of time. For simplicity, valvular disease can be broadly categorized into two forms: 1. Stenosis – which is when blood has difficulty passing through a valve usually because of thickening of the valve leaflets and 2. Regurgitation – when the valve leaflets do not shut tightly and blood leaks backwards into the preceding chamber. Valvular disease typically would not have a hemodynamic effect and causes symptoms unless it becomes severe.

Valvular disease can be congenital or acquired. Two of the most common causes of acquired valvular disease in the United States that require treatment are aortic stenosis and mitral regurgitation. When aortic stenosis becomes severe, it prevents blood from leaving the heart and perfusing the rest of the body. There can be several causes of aortic stenosis, but in the United States, the most common cause is calcific or degenerative aortic stenosis. Mitral regurgitation, which causes blood to leak backwards, can also have many causes, but in the United States the most common causes are degenerative (from wear and tear, often of a valve with some baseline leaflet prolapse or abnormality), ischemic (from coronary artery disease), and functional (from heart failure)." 


Signs of Heart Valve Disease

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Dr. Bargout says, "When a heart valve doesn't fully close, it becomes leaky 'regurgitation' and when it becomes stiff and has a narrow opening it leads to "stenosis". Symptoms from either condition have a wide range including fatigue, dyspnea, shortness of breath, chest pain, dizziness and passing out, palpitation to progression of heart failure and enlarged heart."

Dr. Sethi tells us, "The signs of valvular heart disease are dependent on the valve involved. Generally speaking patients experience symptoms of shortness of breath, fatigue, difficulty completing tasks which previously were manageable and also chest discomfort. With advanced disease there can be frank congestive heart failure with fluid in the lungs or even loss of consciousness."

Dr. Sinha adds, "Limiting the discussion of valvular disease to two of the most common valvular conditions in the United States that would require treatment, common signs and symptoms of severe aortic stenosis would be shortness of breath, chest pressure, fatigue, decreased exercise tolerance, lightheadedness, and lower extremity swelling. Typically, an individual with severe aortic stenosis would have a loud murmur on heart exam. Severe mitral regurgitation has many of the same symptoms as aortic stenosis with shortness of breath, fatigue and decreased exercise tolerance being the most prominent. Individuals with this condition would often have a loud murmur. In more advanced conditions, individuals may also have abnormal breath sounds and swelling in their legs." 


Heart Valve Disease Can Be Deadly if Not Treated

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Dr. Bargout explains, "If a heart valve has severe stenosis or regurgitation that is left untreated, heart failure can progress leading to significant morbidity, hospitalization or even death. Untreated symptomatic severe aortic valve stenosis is a known cause of sudden death. Recognizing valvular heart disease early on, appropriate follow up with an Echocardiogram and timely intervention are essential in preventing progression where irreversible damage to the heart muscle can occur or even death."

According to Dr. Sethi, "Untreated valve disease can lead not just to unexpected death but also debilitating symptoms. In cases where there is acute congestive heart failure patients run the risk of needing temporary life support measures such as breathing machines known as ventilators."

Dr. Sinha says, "Degenerative valvular disease is progressive, and if not treated when it becomes severe, the hemodynamic effects and symptoms will worsen for aortic stenosis and mitral regurgitation. Individuals will have lifestyle limiting symptoms from shortness of breath and fatigue. Eventually, the individual will develop heart failure and die from untreated valvular disease." 


Heart Valve Disease Affects Mostly Older People

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Dr. Bargout says, "According to the CDC, about 2.5% of the U.S population has valvular heart disease, which means millions are affected. The majority are due to aging, mainly affecting the aortic valve which becomes calcified and thickened leading to Aortic valve stenosis. Other common etiologies include chronic hypertension and coronary artery disease both can lead to mitral valve regurgitation. Rheumatic heart disease is becoming less common here in the U.S. due to widespread use of antibiotics to treat Strep throat infection but still considered the most common cause of valvular heart disease worldwide."

Dr. Sethi says, "Most heart valve disease is what we term degenerative and tends to occur in people with other risk factors such as high blood pressure or high lipids. With age, there is excessive calcification which can impede the opening of the valves. In other cases there is wear and tear of the valve which impedes proper closing of the valve and causes blood to leak back into the chamber. In rare congenital cases, most commonly a bicuspid aortic valve, patients can develop symptoms at younger ages."

Dr. Sinha explains, "As the name implies, degenerative valve disease worsens with time, which is why it is more prevalent in elderly population. Degenerative or calcific aortic stenosis worsens as the aortic valve leaflets become more calcified and restricted through aging and inflammation. Degenerative mitral regurgitation also worsens over time due to wear and tear on the mitral valve leaflets and apparatus. Younger individuals may have mild or moderate forms of these valvular disease, but these wouldn't typically cause symptoms and often go undetected until they progress." 


You Can Lower the Risk of Heart Valve Disease

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According to Dr. Bargout, "Healthy lifestyle, screening with physical examination to detect "heart murmur" and treating hypertension and other risk factors for atherosclerosis are all essential in preventing valvular heart disease. Avoiding intravenous drug use can lower your risk of endocarditis, a common occurrence in IV drug users which can lead to valvular heart disease. Early treatment for strep throat in children will prevent later scarring of heart valves. And when the condition becomes too severe, valve replacement or repair is usually recommended, depending on the valve involved, cause of the disease and age of the patient. For some conditions, the valve can be replaced by either surgically opening the heart or by replacing the valve percutaneously without the need for open heart surgery."

Dr. Sethi says, "The most important thing is to prevent and/or treat underlying cardiac risk factors such as high blood pressure and abnormal lipids. Second, it is important to keep up with health care maintenance and regular primary care visits. Valvular heart disease is often manifested clinically as an abnormal heart sound when the physician listens over the chest. If these are detected early, they can be appropriately surveilled for progression."

According to Dr. Sinha, "Prevention of valvular disease depends on the type of valvular disease. The risk factors for degenerative calcific aortic stenosis are similar to risk factors for atherosclerosis. However, there hasn't been any lifestyle modification or medication that has been proven to prevent severe aortic stenosis . Would still recommend individually following a healthy diet that is low in fat and cholesterol, as this would help prevent other diseases that can often be found in individuals with severe aortic stenosis, such as coronary artery disease. Regarding degenerative mitral regurgitation, there isn't a clear dietary or lifestyle intervention that has been shown to prevent its cause or progression. However, ischemic mitral regurgitation (from coronary artery disease) can be prevented by preventing the coronary artery disease that causes it. A Mediterranean diet has been shown in some studies to reduce the risk of heart disease. A whole food, plant based diet has also been shown to reduce the risk of heart disease." 

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