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How healthy are your heart valves? New guidelines emphasize early detection and prompt treatment to protect yourself from a potentially serious condition.

Water from a faucet typically flows in one direction. If the faucet leaks or becomes clogged, you could have a big problem on your hands. A similar concept applies to blood traveling through the heart. The blood flows one way. Four valves--little flap-like doors--open to let blood move forward, and then quickly close so the blood doesn't go backwards. If a valve leaks or becomes damaged, serious illness may result.

Your risk of developing heart valve disease significantly increases as you grow older, according to a report published in the September 16 issue of The Lancet. Approximately 5 million American adults have moderate-to-severe age-related heart valve disease.

"The diagnosis of valve disease is increasing because the age of the population is increasing," says Mary Ann McLaughlin, MD, MPH, assistant professor of Medicine, Health Policy, and Geriatrics and Adult development at the Mount Sinai School of Medicine.

Heart murmurs

Your doctor can detect a heart valve problem by listening to your heart with a stethoscope. Abnormal blood flow causes a distinct sound, called a murmur.

"When I listen to a healthy heart, I hear 'boom, boom, boom.' When I hear a heart murmur, it sounds like 'boom, ssh, boom, ssh.' The 'ssh' is the murmur part," Dr. McLaughlin says.

There is a big difference between innocent heart murmurs, found mostly in young people, and harmful murmurs, more often found in older people. Once a person is 65 or older, any heart murmur should be checked out using an ultrasound of the heart (echocardiogram).

Blood flow problems

Two types of problems can interrupt blood flow through the heart valves and cause a murmur:

* Stenosis is the narrowing of the heart valve. It is commonly due to the build-up of calcium in the area. When the valve narrows, only a small amount of blood can pass through.

* Regurgitation means you have a leaky heart valve. This occurs when the flaps do not close all the way and blood goes back the way it came.

These problems may occur alone or together. In older adults, the aortic and mitral heart valves in the left ventricle are most commonly affected.

Heart valve disease may lead to breathing problems, irregular heartbeat, and congestive heart failure. Your symptoms will depend on the type and severity of your heart valve problem. However, heart valve disease can be a silent killer--some people with severe disease may have no symptoms at all.

Detection and treatment

But there is good news. The American College of Cardiology and the American Heart Association recently released updated guidelines for diagnosing and treating heart valve disease. The new recommendations emphasize early detection and encourage doctors to use tests, such as echocardiograms and exercise testing, to evaluate a heart murmur, even when a patient has no symptoms. Such testing could help determine if you have mild, moderate, or severe disease, which will enable your doctor to make a better decision regarding your treatment.

Those with mild disease may not need any treatment. Others may be given medicines to reduce pain, control the heartbeat, and help the heart pump more effectively. Surgery may be needed to repair or replace faulty heart valves if the disease worsens. According to a study in the July 25 issue of Circulation, surgery is a feasible option for elderly patients with mitral valve disease.

"If a valve can be repaired, all attempts should be made to repair it," Dr. McLaughlin emphasizes. If a person is too ill to undergo surgery, a procedure called balloon valvuloplasty may be used to open the narrowed valve. The effects of mitral valvuloplasty can last for a few years.

The definitive treatment for aortic stenosis is valve replacement. However, if you have severe disease that makes surgery unsafe, the balloon procedure may be done to relieve symptoms. In this case, the results last between six months and a year.


* Talk to your doctor if you have shortness of breath, faintness, chest pain, or overwhelming fatigue. These could be signs of heart valve disease.

* If you have a heart murmur, you should take antibiotics before having dental work, a colonoscopy with a biopsy, or any other invasive procedure. This helps prevent infections from getting into the bloodstream and settling on the heart valves.

* Treat throat infections promptly to prevent rheumatic fever, which can damage the heart valves. Make sure you always finish all of your medicine.
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Title Annotation:diagnosis of heart problems
Publication:Focus on Healthy Aging
Geographic Code:1USA
Date:Feb 1, 2007
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