Heart Valve Disease

Diagnosis

Symptoms such as shortness of breath or your heart skipping a beat may suggest a heart valve problem to your doctor. Your primary care doctor may discover that you have heart valve disease because you are experiencing these symptoms. Other times, heart valve disease is discovered accidentally during a routine examination. If your disease is serious, you may be referred to a heart specialist (cardiologist) or a surgeon for treatment. However, your primary care doctor will likely be the one monitoring your condition.

Your doctor will take a complete medical history to determine if you have any symptoms—such as fatigue and palpitations—that point to valve disease. Symptoms of valve disease are often vague and appear slowly. Other times, they come on very suddenly. That’s why it’s important to provide your doctor with as much information as possible. Be prepared to explain your exact symptoms, including the mildest (such as fatigue) or most severe (shortness of breath or chest pain while resting). Information about when and how symptoms first appeared is also important.

A physical examination is one of the most important ways to diagnose heart valve disease. Normally, blood flows through the valves without making any noise. When a valve is damaged in any way, bloodflow will make a “whooshing” sound as it is forced through a narrowed opening or leaked backward; this is referred to as a “murmur.” Your doctor can determine if you have a murmur by listening to your heart with a stethoscope. Many types of valve diseases have characteristic sounds that help distinguish them. Your doctor will also consider where in the chest the murmur is the most distinctive, the timing of the murmur in relation to other normal heart sounds, and the presence or absence of symptoms. Remember that heart murmurs don't always indicate disease and can be present in perfectly healthy people.

In addition to listening to your heart, your doctor will take your blood pressure and pulse rate. Both of these help to rule out other forms of heart disease as well as additional reasons for abnormal heart sounds.

At least one of three tests will be done to confirm a valve disease diagnosis: a chest x-ray, an electrocardiogram (ECG), or an echocardiogram.

• Chest x-ray. Valve diseases cause the heart to work harder to keep blood flowing. As a result, the heart thickens and enlarges over time. A chest x-ray can show whether or not any area of your heart has become enlarged. Although an enlarged heart may indicate another form of heart disease, it can point your doctor in the right direction. A chest x-ray can also show signs of calcium or tissue deposits on the valve leaflets.
• Electrocardiogram. An electrocardiogram (ECG) is a test that records the electrical impulses of the heart. It can show any type of heart rhythm disturbances.
• Echocardiogram. The most specific test for confirming heart valve disease is an echocardiogram. This procedure uses sound waves that are transmitted to the heart, and is essentially the same technology used in an ultrasound to observe a fetus in pregnant women. The echoes are produced when the waves are reflected back and turned into images by an instrument called a transducer. An echocardiogram provides very specific information about the size of the heart's chambers, the valve movements (which show whether they are closing and opening properly), and any changes in the blood vessels and other structures in and around the heart. One part of the echocardiogram, known as a “Doppler,” measures the speed and quality of the bloodflow, and can pinpoint stenosis or regurgitation.

Your doctor may want to perform an extra procedure known as cardiac catheterization if other tests haven't provided enough information about your valve disease, or if surgery is being planned as treatment. Cardiac catheterization is a test that involves inserting a thin tube into your heart through a blood vessel. A dye is then injected into the tube so that the heart and bloodflow can be seen on x-ray. Catheterization can also be used to measure blood pressure within your heart, and to determine if blockages exist in the coronary arteries.

Prevention and Screening

Heart valve disease can increase the risk for a serious, life-threatening infection of the heart and valve linings called endocarditis. If you're at risk, your doctor may recommend that you take an antibiotic before certain dental and surgical procedures. Endocarditis is an infection that affects the lining of the heart and valves. It occurs when bacteria that reside normally in other parts of the body, such as the mouth, and upper respiratory and urinary tracts, travel through the bloodstream and settle in the heart. Endocarditis is twice as common in men over the age of 50 than in women, and rarely occurs when the valves are healthy. Certain dental and surgical procedures can stimulate the release of these bacteria. These procedures include:

• Teeth cleaning or extraction
• Examination of the respiratory tract with a bronchoscope (a hollow tube with a lens and eyepiece)
• Gallbladder or prostate surgery
• Examination of the digestive tract with a flexible viewing tube (sigmoidoscopy)

Some people with heart valve disease and a history of rheumatic fever may need to take an antibiotic to prevent future attacks. Although rare in America and other Western countries, rheumatic fever is an important cause of several types of common valve diseases. If you’ve had rheumatic fever as a child and are younger than 35 years of age, your doctor may recommend that you take an antibiotic to prevent future episodes.