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A normal heart contains four main valves which regulate the direction of blood flow within the heart. The top two chambers of the heart, the atria, pass blood into the lower two chambers, the ventricles. The valves that separate the atria and the ventricles are the Mitral valve and the Tricuspid Valve. The ventricles then pump blood out of the heart. The left side of the heart pumps blood to the brain and the body through the aortic valve. The right side of the heart pumps bloods to the lungs, through the pulmonary valve.
The heart valves are thin pliable structures that open and close with every heart beat. A number of conditions can affect heart valves. These different conditions generally act on the heart valves by either becoming too ‘sticky’ or too ‘leaky’.
Valves can become ‘sticky’ and open less well (‘stenosed’). In some cases, valves lose the ability to close fully and become ‘leaky’ (‘regurgitant’). Valves can be both stenosed and regurgitant and multiple heart valves can be affected at the same time. The process of heart valve damage involves a progressive calcification of the leaflets. There is also likely to be component of inflammation and lipid deposition.
Over time, a damaged heart valve will put strain on the heart, causing it to become less efficient at pumping blood. Heart failure can occur – where the heart has become swollen and less good at pumping blood. The common symptoms are breathlessness and fatigue on exertion. There may also be chest tightness or swelling of the legs.
Heart valve disease is diagnosed by clinical examination which may reveal a ‘murmur’. A ‘murmur’ simply refers to a sound of blood flow within the heart. Detailed scans of the heart using Echocardiography are required to make a diagnosis of valvular heart disease. In most cases, patients with valvular heart disease will be monitored for many years before intervention is needed. Typically, patients are monitored with a yearly heart scan and clinic review. Cardiologists will observe for a number of different symptoms as well as changes in the heart valve and heart function.
The most common cause of heart valve damage is natural ‘wear and tear’. This occurs slowly over a long time and can affect many older people. In some cases, people are born with valves that are more inclined to suffer wear and tear (this includes those with bicuspid aortic valves and those with severe mitral valve prolapse); this can manifest with valvular heart disease at mid-life. Others are born with more serious congenital heart problems and may require medical attention very early in life.
There are a number of other heart conditions that can affect the valves.
The treatment will depend on the underlying condition.