Heart valve defects

If you know that your heart valves are not working optimally, you can also look out for non-specific symptoms such as shortness of breath. If the first symptoms occur, treatment is advisable. The classic treatment for heart valve defects is an operation in which the patient receives a new heart valve.

Overview: What are heart valve defects?

Healthy heart valves are important so that the heart can do its job and pump blood through the circulatory system. Like a kind of valve, they ensure that the blood only flows in one direction. If a heart valve is leaking or narrowed, those affected may not notice it at first, but over time they will experience symptoms. Patients sometimes suffer from cardiac insufficiency, which can cause shortness of breath, reduced performance and an urge to cough, for example. In advanced stages, cardiac arrhythmias can also develop. If symptoms increase, those affected should start treatment.

There are various heart valve defects

A narrowing of the heart valve is called stenosis, while experts use the term insufficiency to describe heart valves that no longer close properly. This means that when the valve closes, the blood flows either from the artery into the ventricle or from the ventricle back into the atrium – depending on where the defective heart valve is located. This means that the blood does not reach where it is needed, so that a backlog can occur and the heart has to intensify its pumping action.

Heart valve defects: causes and risk factors

Heart valve defects can have various causes. Some are innate, others have developed over time. Heart valve insufficiency is often the result of a previous heart attack in which muscle fibers were damaged. This causes tears in the heart muscle, which also affect the heart valves.

Causes of stenosis

There are several possible causes of stenosis. Around ten percent of heart valve stenoses are congenital. The valve between the pulmonary circulation and the right ventricle is usually affected. Bacteria rarely trigger a narrowing of the heart valves, for example as part of an inflammation of the inner lining of the heart. The resulting scars can lead to the heart valves no longer adequately fulfilling their valve function. However, the most common cause of stenosis is calcification.

In many people, the heart valves calcify over time and become increasingly narrow and inflexible as a result. They lose size and grow together with their surroundings, making it increasingly difficult for them to regulate the blood flow. Possible reasons for calcification of the heart valves are natural ageing processes on the one hand, but also an unhealthy lifestyle on the other. People who do not get enough exercise and have an unhealthy diet therefore have an increased risk of heart valve defects.

Symptoms: Shortness of breath and high blood pressure

Heart valve defects are insidious because they initially cause no symptoms. Over time, however, the performance of the heart decreases significantly, which can sometimes have serious consequences. Sometimes only one heart valve is affected, sometimes several. If several heart valves cannot fulfill their function properly and the defect is very pronounced, noticeable symptoms occur more quickly.

The most common heart valve defect in western industrialized nations is aortic valve stenosis. The aortic valve is the “valve” on the aorta. Defects in other valves are rarer, for example in the mitral valve between the left atrium and left ventricle. There are a total of four heart valves that can be affected. All can trigger the same symptoms.

Why there are no symptoms at first

Over time, the disease puts a strain on the heart. This is because the constantly returning blood must reach its destination in the heart or body with renewed effort. The next time the heart pumps blood, it must therefore set an even larger amount of blood in motion. And not just once, but anew with every pumping process. Constantly pumping so much blood overloads the heart, which has to increase in volume over time in order to cope with its task. In this way, cardiac function can be ensured for a while.

Because the body can compensate for the weakened performance of the heart valves, there are no symptoms in the early stages. But over time, even the enlarged heart can no longer compensate for the heart valve defect. Then the first symptoms appear.

Complications of a heart valve defect

A heart valve defect not only changes the heart, but also the adjacent vessels and the lungs. This is because the backlog of blood and the altered flow pressure have an effect on the nearby lungs. A change in the anatomical structures can make itself felt through shortness of breath and high blood pressure. Hypertension is often only recognized during a health check-up, as it shows no or only unspecific symptoms for many years. Possible signs of high blood pressure include headaches, nosebleeds, dizziness and ringing in the ears.

Heart valve defects can also lead to heart failure : The heart becomes weaker and weaker and performs its tasks increasingly poorly. It can no longer pump enough blood through the circulatory system, which may lead to other heart conditions such as coronary heart disease (CHD). In the worst case scenario, a heart attack occurs.

Typical symptoms of heart failure are

• Shortness of breath
• Cough
• Reduced performance
• nocturnal urination
• sudden weight gain

Not all symptoms necessarily occur – they depend, for example, on which part of the heart is affected.

If the heart valve defect remains untreated despite significant symptoms and the heart valve increasingly loses control of the blood flow to be regulated, cardiac arrhythmia can occur. In this case, the heart beats very irregularly, begins to race or palpitate strongly. Sometimes there are also dropouts or extra beats. Depending on the severity, those affected may feel dizzy, weak or light-headed, and sometimes nervous.

Despite the non-specific symptoms, we can reliably diagnose heart valve defects. Modern imaging techniques are used to visualize possible structural changes.

Heart valve defects: Diagnosis with us

To begin with, we will ask you about your symptoms and possible underlying illnesses to get an idea of the situation. If we suspect a heart valve defect, we will listen to you with a stethoscope. We then feel the movements of the heart to find out which heart valve is affected. But we also use imaging techniques to make a solid diagnosis.

• ECG: An ECG shows exactly where the heart valve defect is located. The electrocardiogram shows the electrical excitation process in the heart. It is important to classify it in order to check the heart function. If the affected person is already suffering from cardiac arrhythmia, it will be clearly visible on the recorded image.
• Echocardiogram: However, the most important diagnostic procedure for clarifying heart valve defects is echocardiography. Cardiac ultrasound allows us to assess the structure and shape of the heart. It is painless and harmless. Transesophageal color Doppler echocardiography can be used to visualize processes in the heart in color. We see how the ventricles fill with blood, how the heart valves move and how the heart works. To obtain the corresponding images, we push an ultrasound probe through the esophagus to the heart.
• X-ray: We can also take X-ray images to assess the size of the heart. This also allows us to see possible water accumulation. They form, for example, if the heart valve defect has already led to heart failure.

Heart valve defects: prevention, early detection, prognosis

A healthy lifestyle reduces the risk of developing a heart valve defect. Although this does not protect you one hundred percent from a defective valve, it does at least eliminate one risk factor.

How to prevent

So make sure you eat a balanced diet with plenty of fruit and vegetables. You should be cautious with meat, sausage and desserts, and make sure you drink enough. It is also important to exercise regularly. If you find this difficult, you can try out several types of sport to find out what you enjoy. If you enjoy exercise, you will stick with it in the long term.

As heart valve defects often do not cause any symptoms at first, early detection is particularly difficult for laypeople. You should therefore have regular health check-ups so that we can detect any changes to your heart at an early stage.

If rheumatic or bacterial inflammation of the inner lining of the heart has already been diagnosed, it must be treated quickly. You should also do something about high blood pressure, even if there are no symptoms. This prevents the heart from constantly having to pump against a higher resistance. High blood pressure appears to be harmless, but can cause lasting damage to the heart.

Heart valve defects: progression and prognosis

Heart valve defects that do not cause any symptoms are usually harmless. In the case of a narrowed aorta, for example, the risk of sudden cardiac death is less than one percent. An early diagnosis is nevertheless advisable in order to strengthen the heart with a healthy diet and sufficient exercise. It is also important to state that you have a heart valve defect before undergoing medical procedures. We may prescribe antibiotics to prevent inflammation of the inner lining of the heart.

People with heart valve defects are more likely than others to contract such a disease. And not only that: the inflammation is often more severe in them. It spreads to surrounding areas, sometimes forming fistulas and abscesses. If blood clots form, this can lead to an embolism. A blood vessel becomes blocked, which can either remain asymptomatic or cause pain, shortness of breath, heart attacks or strokes.

Heart valve stenosis usually increases over time. The flaps become narrower and narrower and can no longer fulfill their valve function well. This ultimately leads to symptoms that significantly worsen the prognosis. Now it is important to intervene and improve heart function. The most important treatment option is surgical intervention.

Self-help groups

The exchange with people who are affected by the same disease can be a great support in coping with the disease. Advice on finding a suitable self-help group is available from Selbsthilfe Zürich. Self-Help Zurich and the University Hospital Zurich are cooperation partners in the national project “Health literacy thanks to self-help-friendly hospitals”.