Steven J. Weiss, MD
Chief of Cardiac Surgery
Chester County Hospital; West Chester, PA

Published: February 22, 2016

Steven Weiss, MD - Cardiothoracic SurgeryHeart valve disease is completely different than coronary artery disease in which we know things like smoking, diabetes, high cholesterol and family history can cause the disease. Heart valve disease is most commonly a result of normal wear-and-tear on the valve as we age. A few causes like childhood rheumatic fever, bloodstream infections and certain medication combinations can cause valve damage and therefore can be prevented. Some heart valve diseases, like bicuspid aortic valves, are congenital and run in families. But most valve disease in America happens in adulthood and is a result of humans living longer lives than our ancestors.

Aortic stenosis is the most common disease that requires a valve replacement. As we get older, the valve that lets the blood out of the heart stiffens and hardens with calcium and begins to narrow. Almost 1 in 10 people over age 70 get aortic stenosis. If you have it, you must have your doctor follow it with you to see if it progresses or causes symptoms. The symptoms are shortness of breath with activity, chest pain, dizziness or passing out. You need a doctor because people can live safely for years with asymptomatic aortic stenosis, but once the symptoms develop, the heart is saying it can no longer keep up with the demands of the narrowed valve.

A doctor can help you figure out that point. About one-third of patients within the first year of that point and half of patients within two years of that point die without heart valve replacement. If the valve is replaced, the symptoms go away and they live as long as people who never had the disease. Symptoms are often hard to notice in older people, with other issues like arthritis limiting activity or lung disease also causing breathing problems, and you need your doctor to help you sort that out. Our goal is to have no one die unnecessarily from having something as relatively easy to fix as aortic valve disease go unnoticed and untreated.

There is also a valve that lets blood into the heart. Mitral regurgitation, or a leaking valve that lets the blood in, is the most common heart valve problem in America, with almost 2 million sufferers. The symptoms are also shortness of breath with activity, and heart "fluttering" or palpitations. As the leak progresses it causes enlargement of the heart which can make the leak worse in a vicious cycle. The valve only needs to be fixed surgically in the most severe cases. The heart can compensate for the leak initially, and medications can help symptoms, so having a doctor giving you these medications and following you from the beginning may help prevent the progression to surgery.

If you need heart valve surgery, the risk is usually less than 1% and the probability of repairing your own heart valve instead of replacing with an artificial one can be more than 90%.

So, how can you tell if it's heart valve disease or something else?

That is the most important question, because heart valve disease often masquerades as something else. A good doctor's exam will often detect it, as one of the findings is a heart murmur. Not all murmurs are from heart valve disease, and unfortunately not all heart valve disease has an obvious murmur. So the best way to tell is with an echocardiogram. This is a safe painless test using sound waves to take moving pictures of the heart. Occasionally even that test can be fooled, especially in overweight patients, so if there is a suspicion after the echocardiogram, a second echocardiogram called a Transesophageal echo can be done. It is also safe and painless but requires light sedation.



Published with permission of the Daily Local News.


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