Heart Valve Disease

by Dr Y.L.M

My daughter had a fever during childhood. When she was in her teens, she gradually became very weak and tired when she had to carry out sports activities. The doctor diagnosed her as having a heart valve disease. What is it?

A heart valve disease involves your heart valves. It can either be a leakage or constriction. You have 4 valves in your heart. These valves separate the chambers of your heart as well as the arteries from the chambers.

In the right side of your heart, there is the pulmonary valve and tricuspid valve. The tricuspid valve is the one that separates your right heart atrium and your right heart ventricle. The pulmonary valve separates your right heart ventricle and the pulmonary artery, which leads to the vessels in your lungs.

In the left side of your heart, the mitral valve separates your left heart atrium and your left ventricle. The aortic valve separates your left ventricle from your aorta.

These valves act as a one-way system to allow blood to move only one way through your heart. They resemble flap-like 'trapdoors', opening every time your heart pumps, and then closing tightly to prevent the blood from flowing back. These 'trapdoors' have cusps of leaflets.

A poorly functioning valve that allows leakage is not going to be very effective for blood pumping.

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What type of heart valve diseases are there?

There are 2 types of problems – leakage or constriction. Leakage is called regurgitation, or, alternately, insufficiency or incompetence. What happens here is the valve does not close adequately, so blood leaks backward into either the atrium or ventricle.

Your heart has to pump harder to overcome this problem, but over time, the leakage of blood adds extra volume to the atrium or ventricle, and their walls begin to dilate.

If uncorrected, your heart fails and cannot supply enough blood to meet your bodily needs.

The other problem is the opposite of leakage – that is, constriction. It is called stenosis. When the valves thicken, or stiffen, or fuse together, the hole within them is narrowed. Less blood pumps through. Your heart has to work even harder to pump blood through this narrowing, and with time, the walls become thickened with muscle (hypertrophy).

If uncorrected, your heart fails as well because it cannot supply enough blood to meet your bodily needs.

All 4 valves can be involved in either regurgitation or stenosis. Hence your valvular disease is named after the valve involved and the problem – either regurgitation or stenosis, e.g. aortic stenosis, mitral regurgitation, and so on.

What causes valve diseases? The doctor said it was linked to my daughter's fever in childhood.

In Malaysia, rheumatic fever is still the main cause of heart valve disease. It is caused by the Streptococcus A bacteria, which infects your throat. Then it causes an immune response that turns against your heart valves. This may happen as long as 20 to 40 years later. It commonly leads to mitral regurgitation.

Other causes include :

* Infective endocarditis : an infection of the heart's valves and inner wall linings (endocardium). This is different from rheumatic fever because the bacteria itself attacks the endocardium. Bacteria that cause this normally enter the bloodstream through IV drug usage, dental procedures, or contamination during surgery.

* Congenital : this means you were born with this defect, due to your heart not being properly formed when you were a foetus. This one most usually affects the aortic or pulmonary valve. The valves may be the wrong size, or have malformed leaflets (like having 2 leaflets instead of 3), or the leaflets are not attached to the valve ring properly.

* ·Calcific degeneration of the valves : where calcium builds up, especially on the aortic and mitral valves.

* Myxomatous degeneration : deposits occur in the valves of some elderly people, and this commonly involves the mitral valve.

* Coronary artery disease : when you have problems with the blood vessels that supply your heart and they become narrowed, your heart suffers lack of blood or ischaemia. This can affect your valves.

* Hypertension : when your heart has to pump for a long time against high blood pressure in your aorta, your aortic valve can finally be affected.

How would you know if you have valve disease?

Usually symptoms predominate when the valve disease becomes severe. That would lead to fatigue and tiredness and shortness of breath.

When it becomes even more severe, you may develop heart failure. Then symptoms like water collecting around your ankles, being unable to breathe properly while lying down, shortness of breath, and liver congestion, become predominant. You may also have palpitations.

More info on HEART here.

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