Valvulopathies

What are they

Valvular diseases, or valvulopathies, are diseases of the heart that involve the four heart valves: tricuspid, pulmonary, mitral and aortic.

They can be congenital, that is, present from birth, or acquired, when they appear later.

The alterations can be of two types:

• valve stenosis
• Valve insufficiency.

Let’s see what are causes and consequences in the two different forms.

The most frequent valvular pathologies are aortic stenosis and mitral regurgitation.

Diseases of the valves of the right sector of the heart (tricuspid and pulmonary), where blood pressure is lower, are rare and usually due to congenital problems.

Causes

Congenital valvulopathies are due to alterations in embryonic development and are often associated with other abnormalities.

Acquired valvulopathies, on the other hand, may be due to:

• degeneration of valve structures (age-related)
• infections (endocarditis)
• rheumatic fever
• Ischemia or pathologies of the heart muscle with dilation of the heart or impairment of its contractile function.

Once rheumatic disease was the most frequent cause of acquired valve alterations, but today they are mainly due to degenerative diseases.

The most common symptoms

The most frequent disorders caused by a valve malfunction are:

• easy fatigability (tendency to rapid depletion of energy)
• difficulty breathing, initially during physical activity, then also at rest
• shortness of breath at night
• weakness
• anginal pain
• Fainting
• arrhythmias (up to atrial fibrillation)
• edema or swelling of the lower limbs
• abdominal swelling

In most cases, however, valvulopathies remain completely asymptomatic even for years.

The suspicion of the presence of a valve defect is usually placed during a normal medical examination due to the presence of a “murmur” at cardiac auscultation.

Although the murmur is not always a sign of pathology: the so-called innocent murmurs are physiological sounds, common in children and some adults, and have no clinical significance.

Pathological murmurs, on the other hand, are due to the passage of blood through valves that do not open or close well. The presence of valvulopathy is then confirmed by echocardiography.

Complications

Except in rare acute cases (trauma, valve rupture, infection with perforation of the valves or heart attack), the evolution of valvulopathies is slow.

It is important to regularly check its progress because it can happen that it suddenly worsens, with consequences that depend on the type of defect (stenosis or insufficiency) and its severity.

The final complication of all untreated valvulopathies is, however, heart failure.

Regularly performing an echocardiogram to assess the function of the ventricles allows you to intervene before they are excessively dilated: this limits the risk of surgery and facilitates post-operative recovery.

Treatment

Treatment of valvulopathies is usually surgical. Current techniques often allow the valve to be repaired without having to replace it.

When this is not possible, the replacement is carried out with mechanical valves or with biological valves.

In case of acute valvulopathy, drugs are administered in order to stabilize the disease to arrive at the surgery in the best conditions.

In slow-progressing defects, medications may be used to slow the progression of valvular disease and/or control symptoms.

Sometimes anticoagulant therapy is prescribed to prevent thromboembolic events.

When to consult your doctor

You should seek medical attention whenever you appear:

• difficulty breathing, especially after physical activity or when lying in bed
• tightness in the chest, especially when it’s cold
• unusual tiredness in carrying out normal activities
• palpitations, swelling in the ankles, feet or abdomen

In addition, those who know they have a valve defect must warn the doctor in case of surgical, dental, gynecological procedures, etc., in order to implement adequate antibiotic prophylaxis to avoid the danger of bacterial endocarditis.

Remember that in case of tonsillitis or bacterial pharyngitis, early and adequate antibiotic treatment, prescribed by the doctor, can protect the heart from complications.