Valvular heart disease is characterized by damage to or a defect in one of the four heart valves: the mitral, aortic, tricuspid or pulmonary.
The mitral and tricuspid valves control the flow of blood between the atria and the ventricles (the upper and lower chambers of the heart). The pulmonary valve controls the flow of blood from the heart to the lungs, and the aortic valve governs blood flow between the heart and the aorta, and thereby the blood vessels to the rest of the body. The mitral and aortic valves are the ones most frequently affected by valvular heart disease.
Normally functioning valves ensure that blood flows with proper force in the proper direction at the proper time. In valvular heart disease, the valves become too narrow and hardened (stenotic) to open fully, or are unable to close completely (incompetent).
A stenotic valve forces blood to back up in the adjacent heart chamber, while an incompetent valve allows blood to leak back into the chamber it previously exited. To compensate for poor pumping action, the heart muscle enlarges and thickens, thereby losing elasticity and efficiency. In addition, in some cases, blood pooling in the chambers of the heart has a greater tendency to clot, increasing the risk of stroke or pulmonary embolism.
The severity of valvular heart disease varies. In mild cases there may be no symptoms, while in advanced cases, valvular heart disease may lead to congestive heart failure and other complications. Treatment depends upon the extent of the disease.
When to Call an Ambulance
When to Call Your Doctor
When to Call an Ambulance
Call an ambulance if you experience severe chest pain.
When to Call Your Doctor
Call your physician if you develop persistent shortness of breath, palpitations or dizziness.
Valve disease symptoms can occur suddenly, depending upon how quickly the disease develops. If it advances slowly, then your heart may adjust and you may not notice the onset of any symptoms easily. Additionally, the severity of the symptoms does not necessarily correlate to the severity of the valve disease. That is, you could have no symptoms at all, but have severe valve disease. Conversely, severe symptoms could arise from even a small valve leak.
Many of the symptoms are similar to those associated with congestive heart failure, such as shortness of breath and wheezing after limited physical exertion and swelling of the feet, ankles, hands or abdomen (edema). Other symptoms include:
There are many different types of valve disease; some types can be present at birth (congenital), while others may be acquired later in life.
Get prompt treatment for a sore throat that lasts longer than 48 hours, especially if accompanied by a fever. Timely administration of antibiotics may prevent the development of rheumatic fever which can cause valvular heart disease.
A heart-healthy lifestyle is also advised to reduce the risks of high blood pressure, atherosclerosis and heart attack.
During your examination, the doctor listens for distinctive heart sounds, known as heart murmurs, which indicate valvular heart disease. As part of your diagnosis, you may undergo one or more of the following tests:
The following provides an overview of the treatment options for valvular heart disease:
A number of minimally-invasive cardiac surgeries are performed at the Heart and Vascular Institute. These include:
Cardiac Surgery (Valve Surgery) at Johns Hopkins
What is it? You may have had an illness or injury or been born with a problem that does not let a heart valve work the way it should. You may need to have heart surgery to repair or replace the heart valve.
Why is it necessary? You have four valves in your heart. Valve surgery is needed when one of the valves in your heart is not working, which means the blood is not flowing through your heart in the right way. Sometimes the valve can be repaired. Other times the valve must be replaced, either with a valve from a pig or one that is manmade.
How is it done? The surgeon opens the chest by cutting through the breastbone. The surgeon then connects the heart-lung machine. The machine “acts” as the heart and lungs so that the doctor can work on the heart. Once the surgery is done, the heart starts beating and the machine is stopped. The breastbone is wired together to let the bone heal, which takes about four to six weeks.
For more information on this procedure, including patient information, please see the full description of Cardiac Surgery (Valve Surgery) at Johns Hopkins.
Cardiovascular Diagnostic and Interventional Laboratory at Johns Hopkins
The Johns Hopkins Hospital Cardiovascular Diagnostic Laboratory (CVDL) is a state-of-the-art imaging facility performing over 24,000 diagnostic and interventional procedures annually. The CVDL operates 11 procedure rooms.
There are three general areas within the CVDL: Cardiology, Radiology and Electrophysiology. The Cardiology section is involved in treating patients with disorders of the heart and vascular tree including coronary artery disease, congestive heart failure, valve disease, congenital heart defects, cardiomyopathy and peripheral vascular disease.
Valvular Heart Disease services included in the CVDL:
The Johns Hopkins Coronary Care Unit
The Coronary Care Unit is a 25-bed unit consisting of 13 critical care beds and 12 intermediate care beds. The CCU cares for patients admitted from the emergency department and floors of the Johns Hopkins Hospital as well as many patients referred from outside institutions. Patient diagnoses include the care and management of acute myocardial infarction and complications including cardiogenic shock, post-infarction angina and congestive heart failure. The CCU staff also cares for many other critically ill patients including those with severe cardiomyopathies, valvular heart disease and life-threatening arrhythmias. We have a large support team including experienced nurses, case managers, house staff, cardiology fellows and an attending who oversees the care and management of all the patients.
Extensive services include cardiac catheterization, right heart catheterization, continuous monitoring, physical therapy, nutritional education, risk factor modification education and exercise rehabilitation.