Heart Valve Disease Causes And Symptoms
Allen Graeve: Heart valve disease is really caused by anything that causes the valve either to leak or to obstruct. These leaflets that form the valves are very, very thin in the mitral position, they are so thin that you can almost see through them, similarly with aortic position. Thick pieces of paper with approximately almost the width -- portions of the leaflets, so anything that causes them to thicken and stiffen and calcify, can produce damage enough to either cause a valve to leak or to obstruct. In the mitral position, the tissue can also thin out, so that it begins to stretch out and then also causes leak predominantly rather than obstruction.
John Puskas: The coronary arteries are those blood vessels that supply blood to the heart, so that the muscle of the heart can do its work. Blockages in those arteries cause heart attacks and we treat them either with medicines or with stents, catheter-based treatments or with surgery.
The valves on the other hand, are inside the heart, they could allow the flow of blood to go in only one direction within the heart and when they're narrowed, pressures build up inside the heart chambers or when they leak, pressures and volumes build up inside the heart chambers and that causes inefficient or poor function of the heart. Those valve problems are treated typically with surgery.
Allen Graeve: Not everyone who has rheumatic fever or even rheumatic heart disease ends up with a bad valve. But as a result of it, the three valves are sometimes affected, the aortic valve, mitral valve and tricuspid valve. They can, all three be affected by that or usually predominantly the aortic valve and then secondarily the mitral valve.
Gary Pederson: When I was nine-years-old, I had rheumatic fever and I understand that was the onset of the disease. Throughout my childhood and early adult life, it didn't have an affect on me, but as I got older, and started to be more active, there was some pain in the area up here.
Allen Graeve: Endocarditis can hit anyone, usually it hits people as a result of dental work or dental procedures. For example, if a patient has a bicuspid aortic valve and has no knowledge of that and then has a dental procedure without receiving prophylactic antibiotics, they are more susceptible than the person who has a trileaflet aortic valve, who has that same dental procedure.
John Puskas: Some forms of heart valve disease have no known cause. They are associated with advanced age, that is to say that we, as we get older, are more likely to have a problem with one of our heart valves. You can think of them as simply wearing out. But high blood pressure, smoking, cholesterol, those things are associated with some higher incidence of some heart valve diseases. But still there are many heart valve diseases that have no obvious, direct cause and therefore preventing them is difficult.
Allen Graeve: There are multiple other causes of valve disease, probably, the second most common and most important problem today would be the bicuspid aortic valve, which is a congenital valve, it's a congenital abnormality of the valve that some people may never know about in their lifetime, but for most people, over the course of a lifetime that valve begins to deteriorate, either it thins out and it begins to leak, or it thickens up more likely and begins to obstruct the aortic valvular position.
Gary Pederson: Medically, they found out that, that I had a heart murmur at very, very young age and we monitored that through all the years and then two-and-a-half years ago, things vigorously got worse, as far as, my shortness of breath and the activities that I could do without any pain, and we knew that was going to be a replacement at that time.
Allen Graeve: If we live long enough, we're going to wear out some of our body parts and one of those parts is the aortic valve. The aortic valve, being subjected to 100,000 movements per day, it's amazing that anything mechanical can last 80 or 90 years. But what we're seeing now in some of the elderly patients is that they've never had rheumatic fever, that they were born with a perfect trileaflet aortic valve, and yet over a period of time, they've thickened and stiffened and calcified that valve.
So that it either leaks or it obstructs their aortic position, and right now, I think, if you live to be 80, your average life expectancy is six years. If you live to be 85, your average life expectancy is something like four years. So, we're seeing a lot of people in their 70s and 80s who have anticipation that they could live 10 or 20 years.
John Puskas: The most common heart valve diseases are those related to the aortic valve and the mitral valve, the two valves on the left side of the heart and usually patients develop these and know that they're developing it, because of symptoms of shortness of breath or fatigue or weakness. That disease progresses to congestive heart failure and limits life; and the quality of life and the length of life.
Gary Pederson: The first one was when I had a shortness of breath and the second one was the pain in the heart area. Those are really the ones, the symptoms that I had.
Allen Graeve: Heart valve disease is usually manifested by either chest pain or shortness of breath or syncope and in some instances sudden death. These are the hallmarks of the disease. It really doesn't matter to some extent, whether it's mitral or aortic position, sometimes even tricuspid position. Shortness of breath is one of the primary symptoms, chest pain, the same exact chest pain as you might get from coronary artery disease, Angina. Then the problems of either light-headedness and syncope or even in some instances, sudden death.
John Puskas: There are no medicines that will actually improve the function of the valve. There are heart medicines that improve the function of the wall of the heart, that supports the mitral valve, for instance, so that many patients with congestive heart failure can be managed with medicines and avoid or at least delay mitral valve surgery. But there are no specific medicines to treat the valves themselves.
Gary Perderson: Well, it prohibited me from actually doing activities that I wanted to do. I was really restricted and it's for the time that I could do the activity, specially we'll say physical activity such as dancing or hiking or even out in the yard moving along.
John Puskas: Eventually if valves, a valve disease progresses and becomes severe, the only present available treatment is surgery.
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