The heart is a muscle that acts as a pump.

 It has four chambers: the left atrium, the right atrium and the left and right ventricles.

There are four valves in the heart.  These valves guard the exits of all four heart chambers to make sure that the blood cannot leak backwards and that it flows onward in the correct direction.

A diseased or damaged valve can affect the flow of blood in two ways:

If the valve doesn’t open fully or becomes stiff, it can obstruct the flow of blood.  This is called valve stenosis. (A stenosed valve means a valve that has become stiff and therefore narrow, causing an obstruction to the flow of blood).  If the valve does not close properly, it will allow blood to leak backwards.  This is called regurgitation or valve incompetence.

Both stenosis and regurgitation can put an extra strain on the heart.  If you have stenosis, the valve can obstruct the flow of blood, so your heart will have to pump harder to force the blood past the obstruction.  If you have regurgitation, your heart has to do extra work to pump enough blood forwards against the blood flowing backwards through the leaking valve.

As well as your heart having to work harder, the blood behind the affected valve will be under increased pressure, which is called back pressure.  This can result in a build-up of fluid either in your lungs or in your ankles or legs, depending on which valve is affected.

What are the symptoms of heart valve disease?

The symptoms of heart valve disease vary, depending on which valve is affected and to what extent it is affected.  People with mild heart valve disease may not notice any symptoms or may have very few symptoms.  However, increasing strain on the heart caused by heart valve disease can cause you to become tired easily, or cause pounding in the chest otherwise known as heart palpitations.  The back pressure can cause a build-up of fluid in the lungs which can lead to shortness of breath, and/or swelling in the ankles and legs.  Due to the forward flow of blood being severely obstructed, the person may feel dizzy or even faint because less blood is reaching the brain.  People with heart valve disease may experience chest pain, due to not enough blood flowing through the coronary arteries, the arteries that supply oxygen rich blood to the heart muscle.

Diagnosis of heart valve disease and abnormalities of the heart valves are often picked up during routine examination with a stethoscope by listening for a murmur.  Whilst some murmurs are completely normal, the doctor will be able to tell if you need further tests, depending on what type of murmur he or she hears.

If you do have a murmur which is suspicious, you will undergo several tests:

·      An electrocardiogram (ECG) which records the rhythm and electrical activity of your heart

·      A chest x-ray, and

·      An echocardiogram which produces an ultrasound picture of the heart and valves.

·      Another test which exists is the cardiac catheterisation, otherwise known as coronary angiogram. This test provides important information about the condition of the heart. A catheter (a longplastic tube) is passed into the artery in the groin or arm, and using x-ray screening, the catheter is directed through the blood vessels and into the heart. A special dye is then injected and a series of x-ray pictures which makes all the coronary arteries appear on the x-rays.

·      The coronary angiogram test can also find out how good the blood supply to your heart muscle is, and whether there is any narrowing of your coronary arteries. If the blood supply is not good, and if you need valve surgery, the doctors may do both the valve surgery and bypass surgery (to improve the blood supply to the heart muscle) at the same time.

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What causes heart valve disease?

·      Being born with an abnormal valve or valves(congenital heart disease)

·      Rheumatic fever

·      Ageing of the heart

·      Cardiomyopathy

·      Coronary heart disease, or

·      a previous infection with endocarditis

·      Congenital heart disease - Some people are bornwith an abnormal valve or valves. Fortunately, most of these people neverexperience any symptoms. However, in some people the condition can get worseover the years, causing stenosis or regurgitation, or both.

·      Rheumatic fever - A very small number of peoplestill get rheumatic fever. Some can be affected as children, but developsymptoms of heart valve disease as adults. Rheumatic fever can affect one, twoor three valves, causing stenosis or regurgitation or both. The most commonlyaffected valves are the aortic and mitral valves.

·      Ageing of the heart - As we age, the heartvalves, the aortic valve in particular, may thicken as a result of wear andtear, or uncontrolled high blood pressure. This means that the space throughwhich the blood flows becomes narrower. How sever this narrowing is candetermine how sever the symptoms are. The aortic valve can become stiffer ascalcium deposits from the blood settle on it, causing it to harden. In manypeople this doesn’t cause a problem, but others may get symptoms.

·      Cardiomyopathy - Cardiomyopathy is a disease ofthe heart muscle. Sometimes this disease causes the heart not to contractproperly because the muscle has become stretched. This may cause problems withone or more valves. The most common problem is that the mitral valve openinghas become stretched and it can no longer close properly.

·      Coronary heart disease - In people with coronaryheart disease, the heart muscle does not always get a good supply of blood.This can make the heart muscle pump less efficiently and cause the mitral valveto leak because i has become floppy.

·      A previous infection with endocarditis -Endocarditis is an infection of the lining of the heart. If you have previouslyhad endocarditis, this may have damaged one of the heart valves, meaning atsome stage you may require the affected valve to be replaced or repaired.

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Treatment for heart valve disease:

·      Regular echocardiograms are important for thoseof us suffering with heart valve disease. The decision on what sort oftreatment you need will depend on which valve, how badly it is affected, howmany are affected and how badly the heart’s ventricles are affected, yoursymptoms and your general health.

·      The main options include medicines, valvesurgery, which may involve replacing or repairing the valve, a procedure calledtranscatheter aortic valve implantation or a procedure called percutaneousmitral valve leaflet repair, valvuloplasty or a combination of medicines witheither surgery or one of these procedures.

·      Medicines commonly used for people with heartvalve disease include diuretics, ACE inhibitors and digoxin.

·      Diuretics encourage the body to produce urineand can relieve the build-up of fluid in the lungs and in the ankles and legs.

·      ACE inhibitors reduce the amount of work theheart has to do.

·      Digoxin slows the heart rate, stabilises theheart rhythm and helps the heart’s pumping action.

·      You may also be required to take anticoagulants– medicines that change the clotting mechanism of the blood, to reduce thechances of a clot forming. The most common anticoagulant is called warfarin.

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