Heart valve problems (general)

Endocarditis

 

Heart valve problems

Heart valve disease is a condition in which one or more of the four heart valves (tricuspid, pulmonary, mitral, and aortic) don't work properly. Heart valves can have three basic kinds of problems:

 

• Regurgitation or backflow. Occurs when a valve doesn’t close tightly. Blood leaks back into the chamber rather than flowing forward through the heart or into an artery. Backflow is most often due to prolapse. "Prolapse" is when the flaps of the valve flop or bulge back into an upper heart chamber during a heartbeat. Prolapse mainly affects the mitral valve, but it can affect the other valves as well.
• Stenosis. Occurs when the flaps of a valve thicken, stiffen, or fuse together preventing the heart valve from fully opening so an inadequate amount of blood flows through the valve. Some valves can have both stenosis and backflow problems.
• Atresia. Occurs when a heart valve lacks an opening for blood to pass through.

 

You can be born with heart valve disease or you can acquire it later in life. Heart valve disease that develops before birth is called a congenital valve disease.

 

Signs & Symptoms

The main sign of heart valve disease is an unusual heart sound called a heart murmur. Your doctor can hear a heart murmur with a stethoscope. However, many people have heart murmurs without having heart valve disease or any other heart problems. Others may have heart murmurs due to heart valve disease, but have no other signs or symptoms. Other common signs and symptoms of heart valve disease relate to heart failure, which heart valve disease can eventually cause. These symptoms include:

 

• Unusual fatigue (tiredness)
• Shortness of breath, especially when you exert yourself or when you're lying down
• Swelling of your ankles, feet, or sometimes the abdomen

 

Outlook

Currently, no medicines can cure heart valve disease. However, lifestyle changes and medicines often can successfully treat symptoms and delay complications for many years. Eventually, you may need to have your faulty valve repaired or replaced with a man-made or biological valve. When possible, heart valve repair is preferred over heart valve replacement. Valve repair preserves the strength and function of the heart muscle. People who have valve repair also have a lower risk for endocarditis after the surgery, and they don't need to take blood-thinning medicines for the rest of their lives.

 

To prevent heart valve disease caused by rheumatic fever, see your doctor if you have signs of a strep infection. This infection can cause rheumatic fever, which can damage the heart valves. If you do have a strep infection, take all medicines as prescribed.

 

Mild to moderate heart valve disease during pregnancy usually can be managed with medicines or bed rest without posing heightened risks to the mother or fetus. Your doctor can advise on which medicines are appropriate during pregnancy.

Severe heart valve disease can make pregnancy or labor and delivery riskier. If you have severe valve disease and/or its symptoms, consider having your heart valves repaired or replaced before getting pregnant. Such repair or replacement also can be done during pregnancy, if needed. But this surgery poses danger to both the mother and fetus.

 

Source: "Heart Valve Disease." Diseases and Conditions Index. The National Heart, Lung, and Blood Institute. The National Institutes of Health.

Endocarditis

Endocarditis is inflammation of the inside lining of the heart chambers and valves. Risk factors for developing endocarditis include:

 

• Injection drug use
• Permanent central venous access lines
• Prior valve surgery
• Recent dental surgery
• Weakened valves

 

Bacterial infection is the most common source of endocarditis. However, it can also be caused by fungi. In some cases, no cause can be identified.

 

Signs & Symptoms

 

• Abnormal urine color or blood in the urine
• Chills or excessive sweating
• Fatigue
• Fever and/or night sweats
• Heart murmur
• Joint pain, muscle aches and pains
• Nail abnormalities (splinter hemorrhages under the nails)
• Paleness
• Red, painless skin spots on the palms and soles (Janeway lesions) and/or red, painful nodes in the pads of the fingers and toes (Osler's nodes)
• Shortness of breath with activity
• Swelling of feet, legs, abdomen
• Weakness
• Weight loss

 

Outlook

People with endocarditis will often need to be hospitalized at first to receive intravenous antibiotics, as the majority of cases are caused by bacterial infection.  Long-term antibiotic therapy (6 weeks) is needed to get the bacteria out of the heart chambers and valves. The antibiotic must be specific for the organism causing the condition. This is determined by the blood culture and the sensitivity tests.

 

Surgery to replace the heart valve is usually needed when:

• The infection is breaking off in little pieces, resulting in a series of strokes
• The person develops heart failure as a result of damaged heart valves
• There is evidence of organ damage

 

Early treatment of endocarditis improves the chances of a good outcome. However, valve destruction or strokes can result in death.

 

Source: "Endocarditis." Medline Plus Medical Encyclopedia.