Valve Leakage In The Heart - By Dr Harold Gunatillake Health Writer

Heart disease, the commonest disease today, was unknown 75 years ago. It has become a "lifestyle" disease, no too words about it. We survived on home cooked nutritious foods cooked by our mothers, and enjoying each meal sitting with family, chit chatting and laughing, a daily phenomenon that has disappeared. We have become more self-centered and independent, eating from food outlets, working till late hours, coming home late, and the relaxed pattern of lifestyles have changed to a stressful one. Families now meet on special days like mother's day or father's day and during the festive seasons.

Heart disease came about with the evolution of change of human behaviour patterns and was unknown during World War 2, in spite of the stress people suffered. Today, we are trapped in a society inevitably associated with chronic illnesses we cannot escape.

In addition to coronary artery blockage disease, more and more valvular heart disease with its complications seems prevalent today.

Most of the readers may have been told by their cardiologist on routine echo-cardiograms that there is a leak from one of the valves, the doctors call them 'murmurs' The common valves that tend to leak are aortic and mitral valves.

From the grading of the murmur and ejection leaks visible on echoes, your cardiologist will measure and monitor such leakages. Early soft murmur leakages are only observed and with worsening situation surgery will be the option.

Your heart valves lie at the exit of each of your four heart chambers and maintain one-way blood flow through your heart. The four heart valves make sure that blood always flows freely in a forward direction and that there is no backward leakage.

Blood flows from your right and left atria into your ventricles through the open mitral and tricuspid valves.

When the ventricles are full, the mitral and tricuspid valves shut. This prevents blood from flowing backward into the atria while the ventricles contract.

As the ventricles begin to contract, the pulmonic and aortic valves are forced open and blood is pumped out of the ventricles through the open valves into the pulmonary artery toward the lungs, the aorta, and the body.

When the ventricles finish contracting and begin to relax, the aortic and pulmonic valves snap shut. These valves prevent blood from flowing back into the ventricles. This pattern is repeated over and over, causing blood to flow continuously to the heart, lungs and body.

When these valves are defective, the "Valvular Heart Disease" is commonly used. Early stages of valvular defects are asymptomatic. But, as a secondary phenomenon, the lung can get congested due to back pressure from left mitral valve insufficiency.

Call an ambulance if you experience severe chest pain. Call your physician if you develop persistent shortness of breath, palpitations or dizziness.

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:
Palpitations, chest pain (may be mild).
Fatigue.
Dizziness or fainting (with aortic stenosis).
Fever (with bacterial endocarditis).
Rapid weight gain.

Some heart valvular disease is congenital and many others are acquired. Rheumatic fever may cause valvular heart disease. Bacterial endocarditis caused by infections of the inner lining of the heart muscle may cause valve disease. Atherosclerosis and high blood pressure may also cause valvular problems.

Prevention
Always get antibiotic treatment for a sore throat that lasts longer than 48 hours. A heart healthy lifestyle is important to prevent heart disease.

One of the worst complications of heart valvular disease is blood clot formation within the chambers due to disturbed blood flow and minute clots can disseminate to distant sites. To prevent such clot formations, your cardiologist will start you on anticoagulant therapy.

Antithrombotic (clot-preventing) medications such as aspirin or ticlopidine may be prescribed for those with valvular heart disease who have experienced unexplained transient ischemic attacks, also known as TIAs Transient Ischaemic Attacks. A transient ischemic attack (TIA) is a stroke that comes and goes quickly. It happens when the blood supply to part of the brain stops briefly.

Symptoms of a TIA are like other stroke symptoms, but do not last as long.

They happen suddenly, and include
•Numbness or weakness, especially on one side of the body
•Confusion or trouble speaking or understanding speech
•Trouble seeing in one or both eyes
•Loss of balance or coordination

Most symptoms of a TIA disappear within an hour, although they may last for up to 24 hours. Because you cannot tell if these symptoms are from a TIA or a stroke, you should get to the hospital quickly.

TIAs are often a warning sign for future strokes. Taking medicine, such as blood thinners, may reduce your risk of a stroke. Your doctor might also recommend surgery.
There are many causes for TIA. Atherosclerotic plaques may get dislodged from the carotid arteries in the neck or a clot from an ulcerating plaque may cause an attack. Blood clots can dislodge from the left chambers of the heart and cause a stroke.

As a precautionary measure your cardiologist will commence anticoagulant therapy.

Until surgery is considered, you may be put on a stronger and more potent anticoagulaneloke warfarin. This may be prescribed if there is atrial fibrillation, a common cause for clot formation.

TIAs Despite Initial Treatment
Long-term administration of anticoagulants may be necessary following valve replacement surgery, because prosthetic valves are associated with a higher risk of blood clots.
If the valves are stenosed and restrict blood flow, your cardiologist may suggest balloon dilatation (a surgical technique involving insertion into a blood vessel of a small balloon that is led via catheter to the narrowed site and then inflated) may be done to widen a stenotic valve.

Valve Surgery to repair or replace a damaged valve may be necessary. Replacement valves may be artificial (prosthetic valves) or made from animal tissue (bioprosthetic valves). The type of replacement valve selected depends on the patient's age, condition and the specific valve affected

The writer is a one time Senior Registrar in the Cardiac Unit in Tan Tok Seng Hospital, Singapore.

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