The heart has four valves. The valves act like one- way doors. One set of valves opens to allow blood to flow into the heart’s lower chambers (ventricles). Another set of valves opens to allow blood to be pumped out of the ventricles.
Valves need to open fully to allow all of the available blood to enter the chamber. They also need to close tightly, so that blood doesn’t seep back into the emptied chamber.
Valve disease occurs when the valves do not work as they should. Sometimes the problem is present from birth (congenital). Other times the valves become diseased from an infection or an illness like rheumatic fever.
Although you have four heart valves, they fall into two categories:
Atrioventricular valves- control blood flow from the upper chambers (atria) to the lower chambers (ventricles). The valve between the right atrium and the right ventricle is the tricuspid valve. The valve between the left atrium and the left ventricle is the mitral valve.
Semilunar valves- control blood flow from the ventricles to the rest of your body. Blood flows out of the right ventricle to the lungs through the pulmonary valve. Blood flows out of the left ventricle to your body through the aortic valve.
The left ventricle is the heart’s main pumping chamber. Thus symptoms of valve disease are especially noticeable with the mitral valve (entering the left ventricle) or the aortic valve (exiting the left ventricle). These heart valves generally develop one of two problems:
The causes of valve disease are not always known. But the following are common causes:
Symptoms of valve disease can include:
You may not have any symptoms of valve disease. Over time, however, your heart muscle can become weakened. You may even develop heart failure or arrhythmias such as atrial fibrillation. If your heart muscle is damaged from valve disease, you will likely notice symptoms. But whenever possible, your doctor will identify valve disease before your heart muscle is damaged.
A cardiac catheterization is a procedure in which a small, flexible tube called a catheter is inserted into a blood vessel. The catheter is usually put into a blood vessel in your groin (or sometimes in your arm). Your doctor gently “steers” the catheter toward your heart, or toward a blood vessel that might be blocked. A cardiac catheterization is the first step in a number of heart and blood vessel tests and procedures.
For instance, a cardiac catheterization is often the first step in anangiogram. In an angiogram, your doctor injects dye through the catheter into your arteries to find any blockages. With a catheterization, your doctor can also:
During a cardiac catheterization, your doctor may also treat any blocked blood vessels with one or more of these procedures to improve blood flow:
Your procedure will be performed in a “cath lab.” When you have a cardiac catheterization you undress and put on a hospital gown or sheet. You lie on an exam table and an intravenous (IV) line is put into your arm. The IV delivers fluids and medications during the procedure. The medication makes you groggy, but not unconscious. Electrodes on your chest monitor your heart’s activity during the procedure. A blood pressure cuff on your arm also regularly takes your blood pressure. The doctor makes a small incision (usually in the groin) for the catheter. The area will be numbed so you shouldn’t feel pain, but you may feel some pressure as the catheter is inserted. You won’t be fully asleep, so during the test your doctor or nurse might ask you questions to make sure you are not feeling pain, for instance. Afterwards you might be in the hospital overnight. Most people have a fairly rapid recovery.
What can I expect?
Your procedure will be performed in a “cath lab.” When you have a cardiac catheterization you undress and put on a hospital gown or sheet. You lie on an exam table and an intravenous (IV) line is put into your arm. The IV delivers fluids and medications during the procedure. The medication makes you groggy, but not unconscious. Electrodes on your chest monitor your heart’s activity during the procedure. A blood pressure cuff on your arm also regularly takes your blood pressure. The doctor makes a small incision (usually in the groin) for the catheter. The area will be numbed so you shouldn’t feel pain, but you may feel some pressure as the catheter is inserted. You won’t be fully asleep, so during the test your doctor or nurse might ask you questions to make sure you are not feeling pain, for instance. Afterwards you might be in the hospital overnight. Most people have a fairly rapid recovery.
A chest x-ray produces an image of your heart, lungs, and nearby blood vessels. It reveals the:
An x-ray can help diagnose many different conditions, including heart diseases. And if you have a cardiac device like a pacemaker, the x-ray also shows the device and the coated wires (leads) that carry the energy to your heart.
When you have a chest x-ray you undress from the waist up and put on a hospital gown. You are partly covered by a shield-a heavy apron made of flexible lead-to protect you from any excess radiation. (X-rays use only a small amount of radiation to create the image.) You stand in front of the x-ray machine and hold your breath while the image is taken. Your doctor usually orders two views: one from the back and one from the side.
An echocardiogram (also called an echo) is a three-dimensional, moving image of your heart. An echo uses Doppler ultrasound technology. It is similar to the ultrasound test done on pregnant women. The echo machine emits sound waves at a frequency that people can’t hear. The waves pass over the chest and through the heart. The waves reflect or “echo” off of the heart, showing:
When you have an echocardiogram, you undress from the waist up, put on a hospital gown, and lie on an exam table. The technician spreads gel on your chest and side to help transmit the sound waves. The technician then moves a pen-like instrument (called a transducer) around on your chest or side. The transducer records the echoes of the sound waves. At the same time, a moving picture of your heart is shown on a special monitor. You may be asked to lie on your back or your side during different parts of the test. You may also be asked to hold your breath briefly so that the technician can get a good image of your heart. An echo is a painless test. You feel only light pressure on your skin as the transducer moves back and forth.
An electrocardiogram (ECG or EKG) reveals how your heart’s electrical system is working. The ECG senses and records your heartbeats, or heart rhythms. The results are printed on a strip of paper. An ECG can also help your doctor
diagnose whether:
In all, there are three kinds of tests that record your heart’s electrical activity, each for a different period of time:
The peaks on an electrocardiogram (ECG) strip are called waves. Together, all the peaks and valleys give your doctor important information about how your heart is working:
When you have an electrocardiogram (ECG) you undress from the waist up, put on a hospital gown, and lie on an exam table. As many as 12 small patches called electrodes are placed on your chest, neck, arms, and legs. The electrodes, which connect to wires on the ECG machine, sense the heart’s electrical signals. The machine then traces your heart’s rhythm on a strip of graph paper.
Holter monitoring uses a small recording device called a Holter monitor. The monitor tracks and records your heart’s electrical activity, usually for 24-48 hours.
Holter monitoring can help your doctor find out if you have abnormal heart rhythms, or arrhythmias. Arrhythmias might happen rarely, yet it is still important for your doctor to know about them and to treat them.
In all, there are three kinds of tests that record your heart’s electrical activity, each for a different period of time:
When the heart rhythms from any of these three tests are printed out, they all look the same: the electrical signals look like peaks and valleys. A doctor may suggest Holter monitoring when you have symptoms at least once every day or two.
Your doctor may ask you to write down any symptoms you have during the test. Symptoms might include faintness, dizziness, or fluttering in the chest. You should note the time and how long the symptoms last. Your doctor might also ask you to write down when you exercise, take medications, or get upset. This can help your doctor see if there is a connection between your heart rhythms and your symptoms or activities.
As many as seven 4-7 sticky patches called electrodes are placed on your chest.
The electrodes connect to wires on the Holter monitor. The electrodes sense your heart rhythms, while the monitor records and stores the rhythms. Since the electrodes cannot get wet, you should shower or bathe before you begin the Holter monitoring, and not at all during the testing. The Holter monitor device itself is the size of a small portable tape recorder. It fits easily on a belt or can be worn on a shoulder strap.
You should be able to do most or all of your daily activities at home and work while using the Holter monitor. You won’t feel anything while the Holter monitor is tracking your heart rhythms. After 24-48 hours, you return the monitor. A technician examines the recordings, notes whether you had any arrhythmias, and prepares a report for your doctor.
Magnetic resonance imaging (MRI) uses magnets, radio waves, and computer technology to create images of different parts of your body. MRI is especially useful in creating clear images of soft tissues. For instance, many people have an MRI to check their heart and/or blood vessels.
MRI is done in a large, tube-shaped machine. Coils inside the machine’s walls produce a strong magnetic field. Other coils inside the machine’s walls send and receive radio waves. In response to the radio waves, your body produces faint signals. As the machine senses the faint signals, a computer creates three dimensional images of the inside of your body.
The images can reveal:
Before your magnetic resonance imaging (MRI) you undress and put on a hospital gown or sheet. Before entering the MRI room, it’s important to remove any jewelry, hearing aids, or anything else with metal in it. The magnets in the MRI machine are very strong, and if you have metal on your body you could possibly be injured. Most people with a cardiac device-a pacemaker, implantable defibrillator, or heart failure device-should typically avoid an MRI. All cardiac device patients should check with their doctor before scheduling an MRI.
Once in the MRI room, you lie on a moveable table and an intravenous (IV) line is put into your arm. The IV delivers fluids and medications during the procedure. For instance, the technician may put contrast dye into the IV.
Patches called electrodes are put on your chest. The electrodes connect to wires on an electrocardiogram (ECG). The electrodes and ECG monitor your heart’s activity during the procedure. Often a blood pressure cuff on your arm also regularly takes your blood pressure. The table you are lying on slides into the MRI scanner, but there are no moving parts inside the machine. You wear headphones or earplugs to muffle some of the noises from the machine, which makes thumping sounds. The technician might ask you to lie very still or hold your breath for parts of the test. However, you may feel muscles twitching in your fingers or toes.
Often a very simple test can reveal valve disease: your doctor can listen to your blood flow with a stethoscope. A swishing sound (called a murmur) as the blood passes through your heart can signal a valve problem. Some murmurs are harmless-they are called innocent murmurs. Your doctor may just monitor the sound of the murmur at your annual physical. Some heart murmurs are more serious. In this case your doctor may recommend one or more follow-up tests as well.
A stress test is a type of electrocardiogram (ECG or EKG). Regular ECGs examine how your heart beats at rest. Stress tests examine your heart’s response to exercise, or stress. There are many variations of stress tests. But the purpose of most stress tests is to find out if your heart is getting enough blood and oxygen.
Stress tests are often done to reproduce symptoms like chest pain or shortness of breath. The test looks at:
The test can show:
During a nuclear stress test, the technician or nurse inserts an intravenous (IV) line-usually in your arm. A small amount of a radioactive substance called thallium is injected through the IV into your bloodstream. Usually a nuclear stress test is done as part of a regular stress test, since the thallium can give your doctor more information about whether your heart gets enough blood and oxygen. But a nuclear stress test can be done even if you are unable to exercise, since another medication can also be given to make your heart work harder.
After the thallium is injected, you lie on a table underneath a special camera. The camera then takes images of your heart. Any part your heart that doesn’t receive enough blood and oxygen also receives less thallium. Therefore that part of your heart shows up as a lighter color on the image.
When you have a stress test you undress from the waist up and put on a hospital gown. As many as 12 small patches called electrodes are placed on your chest, neck, arms, and legs. The electrodes connect to wires on the electrocardiogram (ECG). The machine then records the electrical activity in your heart from each of the electrodes. A blood pressure cuff is also put on your arm, and your blood pressure is checked often. If you have a nuclear stress test, you will also have an IV inserted (usually into your arm).
A stress test itself does not usually cause any pain, although sometimes it reproduces painful symptoms. However the test gives you a workout, since you exercise until you’re very tired. Usually a nurse talks to you and gives you instructions throughout the test. The nurse continues to monitor your symptoms, your blood pressure, and your heart rate for about 10-15 minutes after you stop exercising.
The earlier valve disease is diagnosed and treated, the better. Early treatment is important because valve disease can weaken the heart muscle. For a while your doctor may simply monitor your valve disease to see if it is stable or is getting worse. Eventually your doctor might recommend surgery, such as valve repair or replacement. Even if you feel fine, it’s best to have surgery before valve disease causes any heart muscle damage.
Currently there are no medications to treat valve disease. However, medications like antibiotics may be used to prevent complications of valve disease.
If you have a heart or blood vessel condition, you might want to know more about some of the medications you take. The information in this section describes some medications commonly prescribed for heart or blood vessel conditions. It also includes some tips to help you take your medications as ordered.
Make sure you tell your doctor-or any new doctor who prescribes medication for you-about all the medications and supplements you take. Your doctor can then help make sure you get the most benefit from your medications. Telling your doctor this information also helps avoid harmful interactions between medications.
You may also want to discuss these topics with your doctor or nurse each time you get a new medication:
In some cases, your heart needs several months to adjust to new medications. So you may not notice any improvement right away. It also may take time for your doctor to determine the correct dosage.
Blood tests are sometimes necessary for people who take heart medications. The blood tests help your doctor determine the correct dosage- and therefore help avoid harmful side effects.
Never stop taking your medication or change the dosage on your own because you don’t believe you need it anymore, don’t think it’s working properly, or feel fine without it.
Be sure to talk to your doctor or nurse if you have:
And don’t hesitate to ask your pharmacist if you have questions about how and when to take your medications.
If you have mitral valve regurgitation, you are at risk for a heart infection (endocarditis). Endocarditis is an infection of the inner lining of the heart and its valves. To help prevent endocarditis, your doctor may ask you to take antibiotics before having surgery or before going to the dentist. Always follow your doctor’s instructions about when and how to take the antibiotics.
In other cases, medications may be used to treat the symptoms of valve disease rather than the disease itself.
Anticoagulants (Blood Thinners)
You can understand the purpose of anticoagulants by looking at the root words of the term. Anti = counter or against; coagulant = thicken or clot.
Some Generic (and Brand) Names
All medications are approved by the Food and Drug Administration (FDA) for a specific patient group or condition. Only your doctor knows which medications are appropriate for you.
To reduce the risk of blood clots that could lead to stroke and other medical conditions
Anticoagulants are often called blood thinners, although they don’t actually thin the blood. Rather, they help prevent clots from forming in your blood.
These medications treat conditions related to atherosclerosis, or arteries blocked by plaque. Plaque buildup can lead to a blood clot.
Taking anticoagulant medications can: Decrease the stickiness of the blood
Reduce the likelihood of blood clots forming
Diuretics remove excess water from your body.
All medications are approved by the Food and Drug Administration (FDA) for a specific patient group or condition. Only your doctor knows which medications are appropriate for you.
Some generic (and brand) names
Some diuretics work by causing the kidneys to release more sodium (salt) into urine. Sodium helps draw water out of the blood. With less fluid in your blood, your blood pressure decreases.
Diuretics also relieve symptoms like shortness of breath. That’s because excess fluid in your lungs can cause these symptoms.
Some diseased valves can be repaired:
If you have a damaged heart valve, sometimes your doctor might simply monitor it for a while. But over time a faulty valve could start to affect the left ventricle (lower chamber of your heart). So your doctor may recommend a valve replacement. During surgery, your doctor removes the damaged valve and replaces it with a new valve. The heart valve should be replaced before damage is done to the left ventricle.
A valve replacement is a major surgery that requires general anesthesia.
Your doctor needs to operate on a completely still heart. So you will receive medications to stop your heart. A heart-lung machine then does the job of both the heart and the lungs:
Your doctor takes out the damaged valve and sews a new valve into place. The healthy valve for this surgery sometimes comes from an organ donor. More often a doctor will implant a mechanical valve, made of plastic and metal.
Usually you are told not to eat or drink anything for a number of hours before your surgery. You lie on an exam table and an intravenous (IV) line is put into your arm. The IV delivers fluids and medications during the surgery. You are then wheeled into the operating room, where you receive medication that makes you unconscious during the surgery. After surgery you need to spend a few days in the hospital. You may have pain at the incision site for several weeks, but medication is provided for pain. At home, recovery may take 6-8 weeks.
Once you have had valve replacement surgery, you are at higher risk for a valve infection (endocarditis). So your doctor will order antibiotics for you to take before certain dental or surgical procedures.
Our knowledgeable and courteous staff will help set up a consultation for you, schedule surgical procedures, discuss your insurance, and answer any questions you may have.
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