Valvular Heart Disease (VHD)

There are four valves in the heart which directs and control the blood flow in the heart from one chamber to another. Pulmonary valves control the flow of blood to the lungs. Aortic valves control blood flow to the whole body through aorta.

Mitral and tricuspid valves controls flow of blood from atria to ventricles respectively.

Mitral and Aortic valves are the ones most commonly affected by valvular heart disease.

Types of Valvular Heart Disease:

• Congenital
• Acquired

Causes of VHD

• Missing cusp at birth
• Degeneration of valves with age
• Rheumatic fever causing VHD
• Bacterial endocarditis ( Infection of inner lining of heart valves and heart muscle)
• High BP and atherosclerosis may damage the aortic valve
• Radiation
• Certain medicines, e.g. methysergide

How the disease develops?( Pathogenesis)

• The structure of heart valves get damaged and the smooth flow of the blood from one side to the other is disrupted. To cope with the load of hampered blood, chambers get enlarged and thickens and looses its efficiency and elasticity.

Symptoms:

• If the disease progresses slowly, heart has the time to adjust and may go unnoticed, till the disease is far advanced.
• If the disease occur rapidly, then severe symptoms will be present.

General Symptoms:

• Shortness of breath
• Palpitation
• Fatigue
• Dizziness
• Fever
• Swelling of ankles and feet.
• Pressure on chest.

Diagnosis of VHD:

• ECG: depicts heart rate, regularity or irregularity of rhythm, heart muscles damage, thickening of heart muscle.
• Stress testing: measures, blood pressure, heart rate, ECG changes, and breathing rate during exercise.
• Chest X-rays:
• Echo-cardiogram: to reveal the internal structures of the heart.
• Cardiac Catheterization: It measures pressure across valves, to detect the disease.

Treatment of VHD:

• Lifestyle modification: smoking cessation, stop excess salt consumption. Maintain healthy weight.
• Follow up for mild and asymptomatic patients.
• Prophylaxis for bacterial endocarditis by using antibiotic, every month.
• A course of antibiotics prior to surgery or dental work, to prevent infection reaching the heart valves.
• For irregular heart rate (Atrial fibrillation), anticoagulation may be required to prevent from stroke or TIA.
• Balloon dilatation of narrowed mitral valve may be done to widen it.
• Valve surgery may be done for calcified valves, where prosthetic valve may be placed in place of diseased valves.
• Pregnancy with VHD is a risk to the mother as well as to the fetus. Decision to get pregnant and the later implications must be discussed with the treating doctor.

References

• Cupido, B.J., Peters, F. and Ntusi, N.A., 2016. An approach to the diagnosis and management of valvular heart disease. South African Medical Journal,106(1), pp.39-42.
• Guilherme, L., Köhler, K. and Kalil, J., 2012. Rheumatic heart disease: genes, inflammation and autoimmunity. Rheumatol Curr Res. doi, 10(4172), pp.2161-1149.
• Maganti, K., Rigolin, V.H., Sarano, M.E. and Bonow, R.O., 2010, May. Valvular heart disease: diagnosis and management. In Mayo Clinic Proceedings (Vol. 85, No. 5, pp. 483- 500). Elsevier