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Heart Valve Disease in the Elderly

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Blood flows through the heart in a single direction: from the upper chambers (atria) to the lower chambers (ventricles) and then out of the heart. This unidirectional flow of blood is regulated by four valves present in the human heart:

  • two atrioventricular valves between the atria and the ventricles, and
  • two semi-lunar valves in the arteries leaving the heart

Dysfunction of these valves prevents proper blood flow through the heart and results in heart valve disease. The condition often starts earlier in life, sometimes as early as childhood, but more common types only pose a major problem in the later years of life. Seniors therefore may have to consider heart valve replacement surgery despite having had the condition for decades.

Types of Heart Valve Disease

For a valve to function optimally, it has to open wide to allow blood to flow through. When it shuts, it has to ensure there is a tight seal to prevent the backward flow of blood. Therefore, heart valve dysfunction can be one of two types:

  • Stenosis: narrowing of the valves resulting in inefficient pumping of blood by the heart
  • Insufficiency: incomplete closure of the valves (leaky valves) resulting in regurgitation or backflow of the blood

Both valve stenosis and valve insufficiency make the heart work harder than normal to pump blood. This could ultimately lead to heart failure and death. Heart valve diseases could involve defects in either a single valve or in multiple valves.

Heart Valve Disease Symptoms

Mild valve defects may not show any symptoms. The following are some of the symptoms seen when valve dysfunctions lead to serious impairment of blood flow and heart functions:

  • Chest pain
  • Shortness of breath and fatigue
  • Swelling in the lower part of the body (especially in the abdomen, ankles, and feet)
  • Fast and irregular heartbeats (palpitations)
  • Coughing
  • Bluish lips and skin
  • Dizziness and fainting
  • Stroke

Heart murmurs heard through a stethoscope may be the first sign of a valve dysfunction. Electrocardiography (ECG), echocardiography, and chest X-rays are then used to arrive at a diagnosis.

Causes and Risk Factors

Heart valve disease can either be congenital (present at birth) or acquired later on in life.

Congenital heart valve diseases mostly affect the aortic and pulmonary valves (the valves that regulate blood flow from ventricles to the main arteries leaving the heart). These valves may have deformed structures due to abnormal fetal development in the womb.

Acquired heart valve disease develops during the course of life for various possible reasons. The following are some of the risk factors that can lead to acquired heart valve diseases:

  • Rheumatic fever
  • Endocarditis
  • Coronary artery disease
  • Heart attack due to failure of blood supply to the heart muscles
  • Syphilis
  • High blood pressure
  • Diseases of the connective tissue that affect the fibrous tissue in the valves
  • Bulging of the aorta (aortic aneurysm), the main blood vessel leaving the heart
  • Tumors
  • Certain drugs and radiation

Treatment of Heart Valve Disease

The treatment of heart valve diseases depends on many factors including the age of the patient, the medical history of the patient, severity of disease and type of valve dysfunction. Some of the treatment options include :

  • Medications to manage the symptoms of valve disease, such as diuretics, anti-arrythmic drugs, vasodilators, beta-blockers and anti-coagulants. The aim is to prevent heart failure by decreasing the workload of the heart.
  • Surgical options include catheter-based vulvoplasty (to widen narrow valves),  the repair of defective valves, and complete replacement of the defective heart valves. Replacement of heart valves (either by pig heart valves or mechanical artificial valves) is the last option and requires life-long medications to prevent infection and other complications.

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