The chances of developing heart valve disease increase with age. Yet if it is diagnosed and treated with valve replacement or repair promptly, people can return to a good quality of life and enjoy the Power of Positive Ageing.
Heart Valve Disease
Heart valve disease is a condition caused by either wear or disease of the heart valve(s), affecting the flow of blood through the heart.
When diseased or defective, heart valves may not open or close properly and can interfere with the flow of blood. The most common valve problems involve the mitral and aortic valves, which are located on the left side of the heart.
Many over 65s mistakenly believe the symptoms of breathlessness, fatigue and chest pains are due to ageing, and by not being aware and seeking diagnosis, they are putting their health at risk when heart valve replacement can restore them to good health.
The primary types of heart valve disease are:
- Valve Stenosis: As a result of certain medical conditions or anatomical abnormalities, a valve can be exceptionally narrow (therefore having a “stenosis”) which can limit the blood flow through the valve. This may result in a “back-up” of blood behind the valve, causing the heart to pump inefficiently
- Valve Regurgitation: When a valve’s leaflets fail to close completely, the valve itself can become “leaky,” allowing blood to backwash down through the valve (called “regurgitation”). In addition, the valve may not ever completely move the volume of blood to the next appropriate chamber
Causes and Symptoms of Heart Valve Disease
Stenosis is most often due to age-related degeneration or hardening (calcification) of the aortic valve, leading to progressive narrowing (stenosis) or leakage – changes that compromise valve function and impair normal blood flow through the heart.
- Shortness of breath
- Light-headedness or dizzy
- Fainting and difficulty exercising
Heart Valve Disease Diagnosis
Heart valve disease is almost always detected during a medical visit. A heart “murmur” or “click-murmur” heard through a physician’s stethoscope is usually the first indication of a valve disorder. There are further tests that aid in detecting the origin of heart valve problems and determining the best treatment approach such as electrocardiography
However, there are many challenges faced at all stages of care around the diagnosis and management of patients with heart valve disease. Some of the challenges include:
- Infrequency of presentation: It is a challenge for primary care to identify patients for treatment and refer them. This is due to the relative infrequency with which they see heart valve disease cases, meaning this is not necessarily at the forefront of their diagnostic skills set
- Difficult symptoms to identify: Some patients are asymptomatic – but many patients, who say they have no symptoms, do have symptoms on objective testing – it is difficult for physicians in both primary and secondary care to detect and correctly diagnose heart valve disease
- Infrequent use of stethoscopes: Surveys suggest that stethoscopes are infrequently used by physicians in primary care to listen to a patient’s heart when they present with potential symptoms of heart valve disease – the one key action that could potentially detect heart valve disease
- Late diagnosis: Patients are not being diagnosed early enough – they are ‘slipping through the net’ at all stages of the treatment pathway; in primary care and within secondary care due to lack of education, awareness and incorrect referrals
Heart Valve Disease Treatment Approaches
Without treatment, patients with severe disease face reduced longevity and impairments in physical and social functioning and emotional well-being that contribute to poor quality of life. There are a number of potential treatments:
- Valve Repair: The valve can be repaired by surgery and the patient’s original tissue maintained
- Aortic Valve Replacement (AVR): Surgery to replace the aortic valve. In recent years, minimally invasive techniques have been introduced
- Transcatheter Aortic Valve Replacement (TAVI): Transcatheter Aortic Valve Implantation (TAVI) offers a less invasive treatment option than surgical replacement and provides a way of implanting valves in patients who previously would have been considered too risky for surgical valve replacement