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Valvular Heart Disease

The valves of the heart exist to keep blood flowing in one direction as the heart squeezes. There are four heart valves: the aortic, mitral, tricuspid and pulmonic.

Valvular stenosis occurs when the valve becomes stiff and is unable to open. This makes the heart work harder and may cause it to fail. The most common valve stenosis is aortic stenosis. Most commonly this occurs from the build up of calcium on the valve over many years. The valve may be congenitally malformed causing it to be stenotic.

The symptoms of aortic stenosis include shortness of breath from heart failure, angina from the build up of pressure on the arteries and dizziness from the inability to get blood out of the heart when the valve is critically stenotic.

Valvular insufficiency or "leaky valve" occurs when the valve does not close tightly. This causes blood flow to go in the wrong direction when the heart squeezes. This makes the heart beat inefficiently and over time causes it to fail. Most commonly this involves the mitral and aortic valves. It is not unusual to have a mild leak of the tricuspid and pulmonic valves as the pressure on the right side of the heart is much lower then the left.

Common causes of mitral regurgitation include mitral valve prolapse, coronary artery disease due to the lack of blood supply to the valve, and endocarditis or infection of the valve.

Causes of aortic insufficiency also include endocarditis, but more commonly it is caused by aging of the valve, where it becomes stiffer and is unable to close completely. Disease of the aorta, such as aneurysms cause the valve to stretch and leak as well.

Most valve disorders initially are asymptomatic but progress to have symptoms of heart failure such as shortness of breath. Weakness or dizziness, chest discomfort(angina), edema(swelling of your legs) and palpitations are other symptoms.

The diagnosis is usually made by history and a good physical exam. The stethoscope allows the doctor to hear the opening and closing of the valves. A murmur is a swishing sound that can be caused by abnormal blood flow through the valves. Most murmurs are benign or "innocent".

Other diagnostic tests may include an echocardiogram, transesophageal echocardiogram, heart catheterization or MRI.

Treatment of the valve disease depends on which valve is involved and whether it is stenotic or leaks. The cause of the disorder is also important. The main goals are to keep further damage from occurring, diminishing symptoms and repair or replacing significantly damaged valves.