Heart Valve Disease Treatment

  • Treatment

    Heart valve disease can sometimes disrupt heart rhythms or lead to blood clots. When this occurs, immediate hospitalization is necessary.

    Sudden onset of palpitations, chest pain, fatigue, extreme shortness of breath even when resting, wheezing, and sweating can indicate a serious heart complication and require immediate medical attention.When valve disease becomes very severe, it can disrupt the regular beating of your heart. This can lead to a condition known as atrial fibrillation, where the heart’s upper chambers (atria) quiver erratically and rapidly instead of beating effectively. This allows the blood to gather in the atria instead of flowing forward, and increases the risk for a blood clot. If the clot dislodges itself, it can travel through the bloodstream and get stuck in a small blood vessel, blocking the flow of oxygen and blood. If the clot lodges in the brain, it can cause a stroke; elsewhere it can cause tissue to die. Atrial fibrillation can also lead to congestive heart failure, a condition where the heart cannot keep up its workload and fails to pump ample amounts of blood.

    Lifestyle changes can often be helpful for managing mitral valve prolapse. Most people with mitral valve prolapse have no symptoms. When symptoms do appear, they are often mild, and can be managed with lifestyle changes.

    • Avoid caffeine-containing foods and beverages (such as coffee, teas, colas, and chocolate), alcohol, and cigarettes
    • Avoid high-calorie foods, such as simple carbohydrates (sugar) and fats
    • Participate in regular aerobic exercise, such as walking, cycling, or swimming
    • Avoid medications containing epinephrine or ephedrine
    • Avoid extreme heat and humidity
    • Drink plenty of fluids (at least 64 oz daily, excluding those with caffeine or high sugar content) before, during, and after strenuous activities

    If you have mitral stenosis and shortness of breath during any sort of activity that requires effort, you might want to avoid extremely strenuous physical activity. Many people with confirmed mitral stenosis become winded with any sort of physical activity. Therefore, it’s wise to avoid strenuous physical activity or emotional upset wherever possible. Both can increase heart rate, and aggravate already slowed bloodflow as the result of the valve narrowing. Your doctor may also recommend that you follow a no-salt diet to avoid fluid overload, since extra fluid that flows backward to the lungs can worsen breathing problems.

    Your doctor is the best source of information on the drug treatment choices available to you.

    Cognitive behavioral therapy (CBT) may be helpful for some people with mitral valve prolapse. Stressful events can raise heart rate and blood pressure, and cause stress hormones to be released into the bloodstream. These hormones can exaggerate mitral valve prolapse symptoms such as chest pain, increased heart rate, and shortness of breath. Cognitive behavioral therapy is a form of psychotherapy that focuses on emotions raised by especially distressing symptoms as well as what they can mean to a person. Learning to recognize these feelings (and their triggers) can often lead to new ways of thinking and better ways of coping.

    Surgery is usually needed when symptoms of heart valve disease become severe, or when complications such as heart failure, stroke, or significant interruptions in heart rhythm occur. Occasionally, surgery may be performed when symptoms are mild, so as to prevent further weakening of the heart. Many people with heart valve disease can be effectively managed with drug therapy for many years before requiring any sort of surgery. Your doctor may refer you to a cardiologist and heart surgeon when symptoms suggest that the disease has progressed beyond the point where drug therapy is effective (for example, when severe aortic or mitral stenosis narrows the valve opening to less than a quarter of its normal size). A referral is also likely if tests indicate that you are heading for a serious complication, such as a stroke.

    Three primary types of surgery are conducted for severe valve disease: percutaneous balloon valvuloplasty, valve repair, and valve replacement Table 02.

    • Percutaneous balloon valvuloplasty is an operation that uses a miniature inflated balloon to open a narrowed or clogged valve. The cardiologist will pass a narrow tube (catheter) with a deflated ballon through the skin into a blood vessel, and then through the blood vessel to the heart valve. Once it reaches the heart valve, the balloon is inflated to separate fused or thickened leaflets, and push calcium and other deposits away from the valve. This procedure is often used in mitral stenosis.
    • Valve repair is the most common procedure used for mitral regurgitation. This procedure involves opening up the chest through the breastbone and stopping the heart. A heart-lung machine takes over the function of your heart and lungs during the operation. The left atrium is then opened, and the surgeon will reconstruct or repair the valve leaflets by cutting or reshaping them so that they close properly. Recovery time varies, but it usually takes several weeks before the results of surgery are fully realized.
    • Valve replacement surgery is the most common procedure for aortic valve problems, although it may also be used for mitral valve stenosis and regurgitation. Damaged valves are replaced during a procedure similar to the one used for repair. Artificial valves, which are made from metal, plastic, or carbon; or biological valves, which are usually made from animal tissue, are used. The new valves are sewn into place onto the ring that surrounds the valve opening.

    Table 2.  Surgical Procedures for Heart Valve Disease

    Procedure Valve Disease Advantages Disadvantages
    Percutaneous balloon valvuloplasty Mitral stenosis Only requires local anesthesia (injected directly into area being worked on). May not completely rid of obstruction. Shorter recovery time than surgery (only 2 to 3 day hospital stay) Low death rate from complications (<1%) May not completely rid of obstruction.
    Valve repair Mitral regurgitation Occasionally mitral stenosis Since the valve is not ?replaced,? it can't wear out. Does not normally require blood thinners following the procedure. May not completely get rid of an obstruction, but can lessen symptoms. May eventually need replacement. Recovery time is about one week in the hospital and several more weeks at home.
    Valve replacement: artificial valve Aortic stenosis Aortic regurgitation (if medical therapy does not prevent disease from worsening) Mitral stenosis and mitral regurgitation (if valvuloplasty and repair are not options) Often lasts a lifetime. About 80% of people can return to normal activities within the first year. Small but increased likelihood for a blood clot around the mechanical parts and therefore, a stroke. Increased risk for infection. Recovery time is up to two weeks in hospital and several more weeks at home. Lifetime blood thinners are required, and contact sports and other activities with high risk of injury must be avoided. Not an option if you have any type of bleeding disorder, such as an ulcer.
    Valve replacement: biological valves Aortic stenosis Aortic regurgitation (if medical therapy does not prevent disease from worsening) Mitral stenosis Mitral regurgitation Only requires 8 to 10 weeks of blood thinners following surgery Usually wear out and need to be replaced every 10 years. Recovery time is up to two weeks in hospital and several more weeks at home.

    Herbal medicines containing ephedrine are particularly dangerous in anyone with heart disease, and should be avoided.

    Pregnancy can cause symptoms that are similar to heart valve disease, and can aggravate already existing valve disease. Pregnancy naturally causes symptoms that are similar to those of heart valve disease, such as fatigue, shortness of breath after activity or when lying down, heartbeats that appear to be premature, and swollen feet and ankles. Pregnancy can also worsen symptoms of already existing heart valve disease, and possibly pose a risk to the fetus. If you are pregnant and have heart valve disease, your condition must be managed by a team that includes a primary care doctor, an obstetrician, and a cardiologist.

    In many cases, labor and delivery will be normal and the risk to the fetus is low, especially with modern advances in medical and surgical treatment. However, pregnant women with heart valve disease may need to avoid vigorous activity and omit salt from their diets. If you are pregnant and have an artificial heart valve, blood thinner therapy (which is required with artificial valves) can pose a risk to the fetus. Your team of doctors will recommend that you either continue warfarin up to week 35 of your pregnancy and then switch to another blood thinner call heparin, or switch to heparin earlier in the pregnancy. Close monitoring is required, because heparin poses a greater risk to both the mother and fetus than warfarin, and may lead to blood clot and bleeding.

    Many people with confirmed heart valve disease continue to lead full and active lives. In many cases, symptoms of heart valve disease can take 10 to 20 years to appear. By the time they do appear, the disease may be severe, and survival may be limited to two to ten years after diagnosis. However, advances in medical and surgical therapy have increased the likelihood for a symptom-free and normal lifespan if the disease is diagnosed early enough. Other factors that can influence survival include age at diagnosis, the type of valve disease, and whether or not you have other forms of heart disease. While valve replacement surgery used to be considered risky for older patients, statistics on survival rates, (both immediate and long term) and on quality of life have improved a great deal and continue to do so. The risk of operating on an older patient is often acceptable and results are often considered excellent.

    It’s also important to keep in mind that many people with damaged heart valves never experience any problems whatsoever.

    The number and type of follow-up visits to your doctor after your valve disease is diagnosed depends on the type of disease you have, its severity, and your specific treatment. If you have confirmed heart valve disease and no symptoms, you doctor will likely ask you to return for follow-up tests such as echocardiography. If you’ve had surgery to repair or replace your heart valve, the surgeon will likely ask you to return within one to two weeks to make sure that there are no complications. After this visit, you may be asked to return every six months to a year. Follow-up visits during drug therapy will depend on the medications your doctor has prescribed. Regardless, you should seek immediate medical attention if your symptoms suddenly worsen, if you notice any unusual symptoms, or if you have sudden and severe chest pain, heart palpitations, or breathlessness.

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