Heart Valve Disease-Health Geeku

Causes of Heart Valve Disease | Symptoms And Treatment

Understanding Heart Valve Disease

Causes of heart valve disease about one out of every four deaths and are the leading killer in the United States. One common form of heart disease is valve disease if you or a loved one has been diagnosed with this condition it’s important that you understand how it occurs and what you can do about it.

The heart has four valves, aortic, mitral tricuspid and pulmonary these valves are designed to open and close every time your heart beats when they are working like they should your heart valves ensure that your body is getting the oxygen-rich blood that it needs.

Heart valve disease is a condition that occurs when one or more of your four heart valves stop working properly certain infections of birth defects or age-related changes can cause heart valve disease.
The affected valves may not open fully or they may allow blood to leak back into the heart chambers.

When this happens, your heart has to work harder and its ability to pump blood is affected.
There are many types of heart valve disease, but they generally fall into two categories valvular stenosis occurs.

When the valves leaflets become stiff or fused and won’t open fully all four of the valves can develop stenosis leading to the conditions.

Four Heart Valves Stenosis

Stenosis

Tricuspid stenosis
Pulmonic stenosis
Mitral stenosis and Aortic stenosis.

Valvular regurgitation is also known as a leaky valve and is the result of a valve not closing tightly depending on which valve is affected this is known as pulmonary regurgitation mitral regurgitation may or aortic regurgitation or tricuspid regurgitation.

The most common heart valve problems involve the Aortic and Mitral valves and each year according to the American College of Cardiology about five million people are diagnosed with some sort of heart valve disease.

Knowing what can causes heart valve disease and knowing its symptoms can help you catch the disease early and get the medical attention you need to prevent it from getting worse.

Also Read:
Human Cardiovascular System
Diagnosis and Management of Rheumatic Heart Disease

Heart Valve Disease Symptoms and Causes Of Heart Valve Disease

Many people who are creating valve issues usually have no symptoms at all. And the progression of the conditions in most people is very, very gradual. And so many times the symptoms are hard to find out from just getting older or maybe getting deconditioned, not exercising as much.

Thus the symptoms are fatigue that may come if the valve isn’t opening enough to let the blood flow out to your body, you might get tired.

You might get short of breath if the valves aren’t opening or closing normally because the heart has to generate higher pressures to pump the blood through these tight valves. It’s like trying to open a rusty gate.

Extra Pressure and Higher Pressure

It takes some extra pressure and those with higher pressures can transmit themselves back into your lungs and make you feel short of breath. Some valve conditions can likewise cause chest distress very similar to the symptoms.

One might be concerned about a heart attack, chest pressure or pain. Some patients can get lightheaded if not insufficient blood is flowing through the valves and getting up to your brain. Lightheadedness or even fainting may be a symptom also.

None of these symptoms tell you that it’s a valve. The important thing is if you are having a symptom like that, check with your physician cause it might be a valve or it might be something else going on with your lungs, heart or other organs. It is not normal and must be checked out.

Usually, physicians know you have a valve problem because when the valve is not working normally. it causes noise, a cause of what’s called a heart murmur. Most physicians have told you that you have a heart murmur, in most cases.

This should not be ignored and to start looking for any possible signs that it could be related to this valve getting tighter or maybe, more importantly, any symptoms you might be having that could be related to this valve as it progresses.

What is Heart Murmur?

Causes of Heart Valve Disease

A heart murmur is a sound of your heartbeat cycle, it made by turbulent blood near to your heart. This sound can be heard with a stethoscope. A heart murmur may be present at birth or lt develop later in life, it’s not a disease but it indicates an underlying heart problem.

A heart murmur is harmless and doesn’t need treatment but sometimes its require to follow-up some tests to be sure that it is not caused by a serious underlying heart condition. This needs to be followed and to start looking for any possible signs.

That it could be related to this valve getting tighter or maybe, more importantly, any symptoms you might be having that could be related to this valve as it progresses.

Tricuspid stenosis

Tricuspid stenosis

The Tricuspid valve has three leaflets. The anterior, posterior, medial or septal leaflets and in sync,they separate the right atrium from the right ventricle during systole or muscle contraction the tricuspid valve closes and during diastole or heart relaxation.

The tricuspid valve opens and let’s plug fill the right ventricle tricuspid valve regurgitation happens at the tricuspid valve doesn’t close completely and blood leads back from the right ventricle into the right atrium.

That the tricuspid valve doesn’t close completely and flood leads back from the right ventricle into the right atrium tricuspid stenosis happens. If the tricuspid valve can’t open completely and it becomes difficult to fill the right ventricle.

How about we start with tricuspid valve regurgitation often regurgitation is due to pulmonary hypertension which causes an increase in right ventricular pressure which then dilates the tricuspid valve allowing blood to go backward.

Another Cause

Causes of heart valve disease, another well-known cause of rheumatic heart disease an autoimmune reaction involving the valve leaflets causing inflammation the chronic inflammation leads to leaflet fibrosis which makes it so that they don’t form a nice seal and instead let blood leak through.

Another cause of tricuspid regurgitation includes damage to the papillary muscles from a heart attack. If these papillary muscles die they can’t anchor at the chordae tendineae which then allows the tricuspid valve to flop back and allow blood to go from the right ventricle to the right atria.

There are also congenital causes like Epstein anomaly which is when a person is born with leaflets that are located too low and are in the ventricle rather than being between the atria and the ventricle which makes it hard to form a nice seal so in all these situations blood flows back into the right atrium.

During systole or heart contraction this movement of blood can be heard as a hollow systolic murmur because it’s possible to hear the blood flowing through for the duration of systole there also might be Carvalho sign.

This is when the murmur gets louder with inspiration because the negative pressure in the chest brings more blood back into the heart and more blood makes the murmur even noisier now the extra blood, that flowed back into the atrium during systole ends up draining right back into the ventricle.

During diastole

During diastole, this means that there’s an increase in right ventricular preload it’s kind of like if you were digging a hole and every time you shoveled some dirt out half of it would fall back in which is a lot of wasted work.

Eventually to deal with this extra blood and extra work to pump it out the right ventricle gets larger a process called eccentric ventricular hypertrophy

In this situation, new sarcomeres are added in series to existing ones this remodeling or structural change in the heart stretches the annulus or a ring of the valve letting even more blood lead back and, therefore, worsening the regurgitation.

Which is a pretty a vicious cycle this compensation works for a while but eventually the right ventricle might not be able to keep up then it can lead to right-sided heart failure which can cause symptoms like distended neck veins swelling of the ankles and feet and blood backed up to the liver causing hepatosplenomegaly.

Diagnosis is usually done with an echocardiogram and treatment for tricuspid regurgitation is usually named at maintaining good food balance only rarely as valve repair or replacement needed all right so now let’s switch gears to tricuspid valve stenosis.

When the tricuspid valve doesn’t open during diastole or filling this is most often caused by rheumatic fever and if the tricuspid valves affected then the mitral and aortic valve are almost always affected as well in this case as a result of the inflammation.

Commissural fusion

The leaflets came fused called commissural fusion when this happens the normal tricuspid valve opening narrows down and this makes it a lot harder for blood to flow from the right atrium to the right ventricle and when that blood finally pushes open the fibrotic valve.

It makes a distinctive snapping sound which is followed by a diastolic Rumble as blitz forced through the smaller opening since it’s harder for blood to get through blood volume and pressure increase in the right atrium, this increased right atrial volume and pressure causes it to dilate which can result in blood getting backed up into the veins.

also when the right atrium dilates the muscle walls stretch and the pacemaker cells that run through the walls become more irritable and this increases the risk of arrhythmias like atrial flutter and atrial fibrillation.

Just like regurgitation tricuspid valve stenosis can lead to right-sided heart failure which again leads to symptoms like distended neck veins swelling of the ankles and feet and blood getting back to the liver which causes hepatosplenomegaly.

Finally thinking about the heart concerning other structures in the chest if the atrium dilates and gets large it can compress its neighbor the esophagus and patients might have dysphasia which is difficulty swallowing solid foods.

Diagnosis is again usually done with echocardiogram and treatment of tricuspid valve stenosis usually involves a balloon valvuloplasty which means that a balloon is inserted and then inflated to open the narrowed valve and a lot more blood to flow through it.

Pulmonic stenosis

Pulmonic stenosis

Inherent pulmonary stenosis is a heart condition present during childbirth it is characterized by obstruction to blood flow from the right ventricle to the pulmonary artery this obstruction may be caused by narrowing hasta gnosis at one or more points from the right ventricle to the pulmonary artery the pulmonary.

The valve consists of three thin and pliable leaflets which open easily as the right ventricle ejects blood to the lungs for oxygenation it functions as a one-way door allowing blood to flow in a forward direction into the pulmonary artery with pulmonary stenosis.

The valve sometimes has two leaflets instead of three this is called the bicuspid pulmonary valve the problem with the pulmonary valve makes it harder for the leaflets to open therefore disrupting normal blood flow at times.

The diameter of the pulmonary valve or pulmonary artery may be small or hypoplastic resulting in obstruction.characterized by obstruction to blood flow from the right ventricle to the pulmonary artery this obstruction may be caused by narrowing hasta gnosis at one or more points from the right ventricle to the pulmonary artery the pulmonary.

The valve consists of three thin and pliable leaflets which open easily as the right ventricle ejects blood to the lungs for oxygenation it functions as a one-way door allowing blood to flow in a forward direction into the pulmonary artery with pulmonary stenosis.

The valve sometimes has two leaflets instead of three this is called the bicuspid pulmonary valve, the problem with the pulmonary valve makes it harder for the leaflets to open, therefore disrupting normal blood flow at times the diameter of the pulmonary valve or pulmonary artery may be small or hypoplastic resulting in obstruction.

Newborn

A newborn with extreme pulmonary stenosis presents an emergency. This is because the right ventricle cannot eject sufficient blood flow to the pulmonary artery to maintain a normal blood oxygen level.

In such an instance the blue blood bypasses the right ventricle flowing to the left side of the heart through a normal cardiac structure found in all newborns called the foramen ovale

New bonds with critical pulmonary stenosis, therefore, will have cyanosis different blue discoloration of lips and nail bits due to lower levels of oxygen in their blood.

This group requires early intervention to restore blood flow to the lungs either through catheter-based intervention or surgery one of the most common procedures is known as balloon dilation.

A balloon at the tip of the catheter is placed across the valve and is then inflated to open up the narrow valve once the catheter is placed in the valve to be opened a large balloon is inflated until the leaflets of the valves are opened.

Once the valve has been opened the balloon is drained and the catheter is removed.

Treatment depends on

Treatment will be resolved by a child’s doctor, based on the condition of your child’s age and overall health tolerance for specific medication or procedures.

Mitral stenosis

Mitral stenosis

The mitral valve has two leaflets the anterior and posterior leaflet and together they separate the left atrium from the left ventricle during systole. The valve closes which means blood as just one option to be ejected out the aortic valve and into circulation.

If the mitral valve doesn’t shut all the way blood can leak back into the left atrium called mitral valve regurgitation during diastole II the mitral valve opens in let’s blood fill into the ventricle if the mitral valve doesn’t open enough it gets harder to fill the left ventricle called mitral valve stenosis.

Let’s start with mitral valve regurgitation the leading cause of mitral valve regurgitation and the most common of all valvular conditions is mitral valve prolapse when the left ventricle contracts during systole a lot of pressure is created so the blood can be pumped out the aortic valve so a lot of pressure pushes on that closed mitral valve.

Normally the papillary muscles and connective tissue called chordae tendineae or heartstrings keep the valve from prolapsing or falling back into the atrium with mitral valve prolapse the connective tissue of the leaflets and the surrounding tissue are weakened called Myxomatous degeneration.

Why this happens isn’t well understood but it sometimes associated with connective tissue disorders like Marfan syndrome and Eilers danlos syndrome degeneration results in a larger valve leaflet area and elongation of the chordae tendineae which can sometimes rupture.

Something that usually happens to the ones on the posterior leaflet that can allow the posterior leaflet to fold up into the left atrium patients with a mitral valve prolapse is usually asymptomatic but often have a classic heart murmur which includes a mid-systolic click.

Causes Of Murmur

Sometimes followed by systolic murmur the click is a result of the leaflet folding into the atrium and being suddenly stopped by the chordae tendineae although mitral valve prolapse doesn’t always cause mitral regurgitation it oftentimes does if the leaflets don’t make a perfect seal a few drops of blood leaks backward from the left ventricle into the left atrium and causes a murmur.

The mitral valve prolapse murmur is somewhat unique in that one patient squat down the click comes later in the murmur shorter but when they stand or do a Valsalva maneuver the click comes earlier and the murmur lasts longer.

The reason this happens is that squatting increases venous return which fills the left ventricle with slightly more blood and this means that the left ventricle gets just a little bit larger.

The larger leaflets, therefore, have more space to hang out and as the ventricle contracts and gets smaller it takes just a little longer for the leaflet to get forced into the atrium standing, on the other hand, reduces venous return meaning a little less blood in the ventricle and so a little less room to hang out.

The leaflet gets forced out earlier during contraction the other heart murmur that follows this pattern is like the one in hypertrophic cardiomyopathy.

Papillary muscles

In addition, to buy travel prolapse other causes of mitral regurgitation include damage to the papillary muscles from a heart attack if these papillary muscles die they can’t anchor the chordae tendineae which then allows the mitral valve to flows back and allow blood to go from the left ventricle to the left atrium.

Also, left-sided heart failure that leads to ventricular dilation can lead to mitral regurgitation as well because as the left ventricle dilates it stretches the mitral valve annulus or ring open and blood leak into the left atrium.

Rheumatic Fever

Mitral regurgitation can also be caused by rheumatic fever an inflammatory disease that can affect the heart tissue and lead to chronic rheumatic heart disease the chronic inflammation leads to leaflet fibrosis which makes it so that they don’t form this nice seal and instead let blood leak through patients with mitral valve regurgitation.

Typically have a hollow systolic murmur meaning it lasts for the duration of systole now even though we said that left-sided heart failure can cause mitral regurgitation. It also goes the other way mitral regurgitation can be a cause of left-sided heart failure with mitral regurgitation every time the left ventricle contracts.

Some blood is inadvertently pumped out into the left atrium which to an increased preload as that blood is again drained back into the left ventricle after contraction it’s kind of like if you were digging a hole and every time you shovel some dirt out half of it would fall back in.

It’s lots of wasted work right in this way both the left atrium and left ventricle experience volume overload to better manage this larger volume the left side of the heart undergoes eccentric hypertrophy where new sarcomeres are added in series to existing ones and so it grows larger.

This compensation works for a while but eventually, the left ventricle might not be able to keep up and it can lead to left-sided heart failure alright now let’s switch gears over to mitral valve stenosis which is most often again caused by rheumatic fever.

Commissural fusion

In this case instead of having inflammation caused the leaflets to not form a good enough seal the leaflets can fuse called commissural fusion.

When this happens the normal mitral valve opening which is about four to six centimeters squared can narrow down to two centimeters squared, this makes it a lot harder for blood to flow from the left atrium to the left ventricle and so the volume of blood in the left atrium increases leading to higher pressures.

In the left atrium higher pressures flowing through a fibrotic valve make a snap sound when it opens which is followed by a diastolic rumble as blood is forced through the smaller opening a constant elevation in both blood volume and pressure in the left atrium causes it to dilate and can allow blood to back up.

Into the pulmonary circulation causing pulmonary congestion in pulmonary edema which can lead to symptoms like dyspnea or difficulty breathing all this extra blood volume in the pulmonary circulation causes higher pressures in the pulmonary circulation or pulmonary hypertension.

This can ultimately make it harder for the right ventricle to pump blood to the lungs and over time. The right ventricle can hypertrophy and ultimately fail which is called right-sided heart failure.

Also when the left atrium dilates the muscle walls stretch and the pacemaker cells that run through the walls become more irritable increasing the risk of atrial fibrillation, during atrial fibrillation the right and left atrium don’t contract properly anymore.

This allows more blood to stagnate since the left atrium is already pretty dilated static pools of blood can become a major risk for thrombus formation and if a blood clot forms, it can directly get into the systemic circulation.

Finally

Thinking about the heart with other structures in the chest if the atrium dilates and gets large it can compress its neighbor the esophagus and patients might have difficulty swallowing solid foods called dysphasia.

Patients with severe problems related to mitral regurgitation or stenosis treatment involve valve repair or surgical replacement of the valve.

Aortic stenosis

Aortic stenosis

The aortic valve serves to ensure one-way flow of oxygen-rich blood from the left ventricle to the aorta and the body it opens when the left ventricle contracts and pumps blood and closes when the ventricles refill to avoid blood from flowing back to the left ventricle the aortic valve consists of three leaflets or cusps a defective valve is one that fails to or open or close properly.

Aortic stenosis happens when the aortic valve does not open fully compressing blood flow. Aortic regurgitation, on the other hand, occurs when the valve does not close tightly causing the backward flow to the ventricle.

The common outcome of both situations is that the heart does not pump enough blood to the body and heart failure may result in symptoms that may develop suddenly or slowly over decades and may include fatigue shortness of breath.

Especially when doing any activity chest pain or tightness dizziness fainting swelling in the ankles and feet and poor feeding and growth in children in attempts to compensate for the low blood. As a result, the left ventricle becomes larger to produce higher pressure and pump harder this enlargement may help to relieve symptoms.

At first but eventually, it causes the ventricle to become unsteady and fail risk factors for both conditions include congenital heart valve disease some people are born with abnormal structures that increase the risks of valve malfunctioning.

Common Defects

Common fault includes having two leaflets instead of three fused leaflets and dilation of the aortic root stiffened valve due to calcium deposits as a result of aging and valve damage due to infection or inflammation and conditions such as endocarditis and rheumatic fever.

Aortic valve diseases develop unique heart murmurs that are useful for diagnosis. The aortic stenosis gives rise to a crescendo decrescendo systolic murmur which starts shortly after the first heart sound it is often preceded by an ejection click caused by the open of the stenotic valve the murmur is loudest in the aortic area and the sound radiates to the neck.

The Aortic regurgitation develops a diastolic murmur which is heard with the left sternal border it peaks at the beginning of diastole when the flow is largest then rapidly decreases as the ventricles are filled examination is usually confirmed by echocardiography.

An impaired valve normally requires surgical repair or replacement several repair procedures are available depending on the type of defect valve replacement is often preferred as a long-term solution, especially for aortic stenosis in which the valve contribute to becoming tighten again after a repair procedure.

Artificial valves can be mechanical or bioprosthetic mechanical valves last longer but usually require lifelong administration of anticoagulant medications to prevent the formation of blood clots.

Four Basic Treatment Options For Heart Valve Patients

It’s helpful to have a general knowledge of what the treatments are for valvular heart disease. They can fall into four different categories, so let’s start with number one.

Do nothing, and do nothing isn’t do anything, it’s a program of surveillance that a doctor may layout. Maybe that valve isn’t bad enough to do anything right now. It’s leaking a little bit, but the treatments aren’t benign, they carry risks.

If the risk of that little bit of leakage is less than the risk of treatment, surveillance, we do that for some time.

Some valve disease can be treated with medication. This tends to be when a valve’s leaking rather than when it’s blocked. So if a valve is leaking, there are medical therapies that we can put a patient on, and treat them with medication for a period that’s combined with surveillance, and under medical therapy, the heart can get powerful.

We can alter the loading conditions, lessen the amount of leakage of that valve, and allow the heart to get stronger or go long before we need to pull the trigger to intervene and do something about that valve.

Now, we’re going to intervene and do something about that valve, traditionally that thought has been surgery, so let’s talk about surgery first.

When we talk about surgery, it can fall into two broad categories.

One, fix the valve,

Two, replace the valve.

And those have different implications.

Aortic Valve Disease and Mitral Valve Disease

We’re talking about aortic valve disease. We’re just now entering the realm where we’re starting to fix more, and more, and more aortic valves. But for many years, and still, prevalently, the replacement of the aortic valve is a way of treatment.

The mitral valve is a much more complex valve. A lot of different things are controlling whether or not that mitral valve leaks, or is blocked. So repair plays a much more prominent role in the mitral valve. We can put rings on that lessen the diameter,

So, the leaflets can now meet in the middle again instead of out here. If there’s a problem with the chordae tendineae “broken”, we can replace that, we have a lot of repair techniques for mitral valves.

If one part of the mitral valve is badly destroyed and the rest is working, we can actually take that part out and repair the rest so that it comes together. How we get to the valve to fix it frequently gets confused with the fix itself, and they’re two different issues.

Principles of Repair and Replacement

The principles of repair and replacement stay the same whether you access that valve through a median sternotomy, which is an incision through the breastbone, a small incision between the ribs over on the side, which some people might call port access.

Whether you use port access and you use a robot to help you throw the stitches, those are all matters of access, not matters of repair, or replacement.

So don’t confuse those two things. Issues of access have to do with short term healing. Maybe a smaller incision heals faster than a larger one, maybe one hurts less than the other.

They have nothing to do with the repair that we’re affecting.

Also Read: Human Cardiovascular System

Share

Leave a Comment