The heart has four chambers: two atria or upper small and two large lower chambers or ventricles. Each ventricle has an inlet valve and one outlet through which blood can flow only in one direction. The tricuspid valve opens from the right atrium into the right ventricle and the lung from the right ventricle into the pulmonary arteries. The mitral valve opens from the left atrium into the left ventricle while the aorta is opened from the left ventricle into the aorta.
The malfunction of the heart valves may be due to blood escaping them (valvular regurgitation) or that do not open properly (stenosis). Each disorder can severely disrupt the heart’s pumping ability. Sometimes, a single valve can have both problems.
Mitral valve insufficiency
The mitral valve insufficiency (mitral incompetence) is the backflow of blood through the mitral valve, which does not close properly every time the left ventricle contracts.
When the left ventricle pumps blood from the heart to within the aorta, some blood back into the left atrium, thereby increasing the volume and pressure in this cavity. This situation increases the pressure in the vessels that carry blood from the lungs to the heart and, consequently, fluid (congestion) in the lungs.
Years ago, rheumatic fever used to be the most common cause of mitral regurgitation. But now, rheumatic fever is rare in countries where it has developed a good preventive medicine. For example, in those countries, the use of antibiotics to treat strep throat prevents the disease appears, so currently only rheumatic fever is a common cause of mitral regurgitation in the elderly who could not benefit from appropriate antibiotics during their youth. However, in countries that do not have a sufficiently developed preventive medicine, rheumatic fever is still prevalent and, therefore, is a common cause of mitral regurgitation.
In many developed countries, for example, one of the most common causes of mitral regurgitation is myocardial infarction, which can cause serious injury to the supporting structures of the valve. Another common cause is myxomatous degeneration, a condition in which the valve will gradually weaken until they become too soft.
Symptoms
Moderate mitral regurgitation may be asymptomatic. The disorder can be identified only if the doctor, listening with a stethoscope, you hear a characteristic heart murmur caused by the backflow of blood into the left atrium when the left ventricle contracts.
Because the left ventricle must pump more blood to compensate for the backflow into the left atrium, it expands gradually to increase the strength of each heartbeat. The enlarged ventricle can cause palpitations (awareness of one’s own strong heartbeat), especially when the person is lying on the left side.
The left atrium also tends to expand to accommodate the backflow from the ventricle. A very dilated right atrium often beats rapidly in a disorganized and irregular (atrial fibrillation), which reduces pumping efficiency. In fact, an atrial fibrillation that is not pumping, only shudders, and the lack of proper blood flow causes the formation of blood clots. If a clot breaks can block a smaller artery and cause a stroke or other injury.
Severe mitral regurgitation reduces blood flow to the aorta so as to cause heart failure and, therefore, cough, dyspnea on exertion and swelling in the legs.
Diagnosis
Mitral regurgitation is usually identified by the presence of a distinctive murmur (a sound that is heard with a stethoscope when the left ventricle contracts.)
An electrocardiogram (ECG) and chest radiograph showed left ventricular dilation. The test that provides more information is the echocardiogram, an imaging technique using ultrasound to visualize the defective valve and determine the seriousness of the problem.
Treatment
When the failure is severe, the valve needs to be repaired or replaced before the disorder of the left ventricle can no longer be corrected. It can perform surgery to repair the valve (valvuloplasty) or to replace it with a mechanical or a partially made with a pig valve. The repair of the valve eliminates regurgitation or lowered enough that their symptoms become tolerable and to prevent cardiac injury. Each valve replacement method has its advantages and disadvantages. Although mechanical valves are usually effective, increase the risk of blood clots, so anti-clotting drugs are administered indefinitely to reduce this risk. Valves made in part with pig valves work well and have no risk of causing blood clots, but instead its duration is less. When a replacement valve is defective, it must be replaced immediately.
Atrial fibrillation may also require treatment. Drugs such as beta blockers, digoxin and verapamil slow the heart rate and help control the fibrillation.
The surfaces of the damaged heart valves are prone to serious infections (infectious endocarditis). Anyone with an artificial valve or damaged should take antibiotics before dental or surgical procedure to prevent infection.
Mitral Valve Prolapse
In mitral valve prolapse occurs protrusion of the valve leaflets into the left atrium during ventricular contraction, which may cause reflux (regurgitation) of small amounts of blood into the atrium.
From 2 to 5 percent of the general population has mitral valve prolapse, although this usually does not cause serious heart problems.
Symptoms and Diagnosis
Most people with mitral valve prolapse have no symptoms. Others do have (although they are difficult to explain based only on the mechanical problem), such as chest pain, palpitations, migraine, fatigue and dizziness. In some cases, blood pressure drops below the normal level by joining, in others it may appear slightly irregular heartbeats that cause palpitations (a subjective perception of the heartbeat).
The condition is diagnosed after listening to a typical sound (click) through the stethoscope. Regurgitation is confirmed if during ventricular contraction is heard a murmur. An echocardiogram, an imaging technique using ultrasound, looks prolapse and the severity of heart failure.
Treatment
Most people with mitral valve prolapse do not require treatment. If the heart beats too fast, given a beta blocker to slow the heart rate and reduce the palpitations and other symptoms.
If there is regurgitation, the person should take antibiotics before undergoing dental or surgical procedures because of the risk that bacteria released during such procedures infect the heart valve.
Mitral valve stenosis
The mitral valve stenosis is a narrowing of the mitral valve opening that increases resistance to current flow of blood from the left atrium to left ventricle.
Mitral stenosis is almost always the result of rheumatic fever. In countries with health and care services capable of maintaining adequate preventive measures, mitral stenosis is rare today, except for seniors who suffered rheumatic fever during childhood. In countries with inadequate healthcare infrastructure, rheumatic fever is common and causes stenosis in adults, teenagers and sometimes in children. When rheumatic fever is the cause of mitral valve stenosis, the thin blades (leaflets) that make up the valve is partially fused.
Mitral stenosis can also be congenital. Children born with this disorder rarely live more than two years, unless surgery is practiced. A myxoma (a benign tumor that appears in the left atrium) or a clot can block blood flow in the mitral valve and produce similar effects to the stenosis.
Symptoms and Diagnosis
If the stenosis is severe, the increased pressure in the left atrium and the veins of the lungs causes heart failure and, therefore, fluid accumulates in the lungs (pulmonary edema). If a woman with severe stenosis mitral valve becomes pregnant, heart failure develops rapidly. On the other hand, heart failure is associated with fatigue and shortness of breath. At first, shortness of breath occurs only during physical activity, but gradually the symptoms occur even during rest. In some cases, proper breathing is achieved only when the patient is sitting or lying half on a pair of pillows. A purple shade on the cheeks suggests that a person suffers from mitral valve stenosis. Hypertension in the pulmonary veins can make them or break capillaries and result in bleeding in the lungs, either minor or massive. Finally, the enlargement of the left atrium can cause atrial fibrillation (a rapid, irregular heartbeat).
With a stethoscope you can hear a distinctive murmur when blood passes from the left atrium through the narrowed valve. Unlike a normal valve, which opens quietly, this valve produces a sound similar to a click every time it opens to allow blood flow from the atrium to left ventricle. The diagnosis is confirmed with an electrocardiogram, a chest radiograph showing an enlarged atrium or an echocardiogram (an imaging technique using ultrasound). Sometimes you need a cardiac catheterization to determine the extent and characteristics of the obstruction.
Prevention and treatment
Mitral stenosis can only be prevented by avoiding the occurrence of rheumatic fever, a childhood disease that sometimes occurs after untreated strep throat.
The administration of drugs such as beta blockers, digoxin and verapamil slow the heart rate and controlled atrial fibrillation. If you get heart failure, digoxin also strengthens the heartbeat. Diuretics reduce blood pressure in the lungs by decreasing the volume of blood in circulation.
If drug treatment does not reduce symptoms, it is necessary to repair or replace the valve. You can delay the opening of the valve in a procedure called valvuloplasty. In this procedure, is introduced through an intravenous catheter with a balloon at the tip within the heart. Once located in the valve, the balloon is inflated and the edges are separated in the same place where they merged. The valves can also be separated by an operation, if the valve is too damaged, surgery may be replaced by a mechanical valve or other of porcine origin.
In case of mitral valve stenosis are given antibiotics as a preventive measure before any dental or surgical procedure to reduce the risk of valve infection.
Aortic valve insufficiency
The aortic valve regurgitation (aortic insufficiency, aortic incompetence) is the backflow of blood through the same each time the left ventricle relaxes.
The most frequent causes in general, tended to be rheumatic fever and syphilis, but today, in developed countries that have an appropriate medical facility, these causes are very rare due to the frequent use of antibiotics. In places with inadequate sanitary structure, injuries caused by rheumatic fever are still common. Apart from these infections, the most common cause of aortic valve insufficiency is the weakening of the tissue, usually fibrous and tough, of the valve (myxoid degeneration), a birth defect or other unknown factors. Myxoid degeneration is an inherited disorder of connective tissue weakens the heart valve tissue, causing it to soften and rarely occurs even rupture. Other causes include a bacterial infection or injury. About 2 percent of children and 1 per cent of girls born with two valves instead of three, you may develop mild aortic insufficiency.
Symptoms and Diagnosis
Mild aortic insufficiency does not produce another symptom rather than a characteristic heart murmur that is heard with a stethoscope every time the left ventricle relaxes. When blood is severe regurgitation, the left ventricle receives an increasing blood flow, leading to an increase in size and eventually causes heart failure. It produces dyspnea on exertion or when lying down, especially at night.
By contrast, in the sitting position is favored fluid to drain from the top of the lungs and breathing returns to normal. The person may also feel palpitations (a pounding sensation) due to enlarged ventricular contractions should be stronger. In some cases it appears angina pectoris, especially at night.
The diagnosis is made by auscultation of the characteristic heart murmur, and other signs of aortic valve regurgitation during the physical examination (such as anomalies in the pulse) and the presence of an enlarged heart on chest radiograph. An electrocardiogram may show changes in heart rate and signs of an enlarged left ventricle. The echocardiogram can allow the valve to see injured and highlight the seriousness of the problem.
Treatment
To prevent any infection of the injured valve are given antibiotics before any dental or surgical procedure. This type of precaution should be taken also with mild aortic insufficiency.
A patient who develops symptoms of heart failure should undergo surgery before the left ventricle is damaged irreversibly. In the weeks prior to surgery, heart failure treated with digoxin and inhibitors of angiotensin converting enzyme or other drug that dilates the veins and reduce the heart’s workload. In general, the valve is replaced with a mechanical valve or a pig valve.
Aortic valve stenosis
The aortic valve stenosis is a reduction of the aortic valve opening that increases resistance to the flow of blood from left ventricle to the aorta.
In North America and Western Europe, aortic valve stenosis is a disease that occurs mainly in old age as a result of the development of scarring of the valve and the accumulation of calcium in their shells. When should this cause, aortic stenosis begins after 60 years, but no symptoms until 70 or 80. It can also be caused by rheumatic fever contracted in childhood. In this case, aortic stenosis associated with mitral valve disease, either stenosis, regurgitation or both.
In the youngest, the most common cause is a birth defect. The narrowing of the aortic valve may be asymptomatic in childhood, although disruptive over time. The valve remains the same size, while the heart is enlarged and is pumping large amounts of blood through the small valve. The valve may have two cusps (bicuspid aorta valve) instead of three as is normally or abnormally present a funnel. Over the years, the opening of such valves is difficult because it becomes rigid and narrowed by the buildup of calcium deposits.
Symptoms and Diagnosis
While trying the left ventricle to pump enough blood through the aortic valve narrows, your wall will thicken, resulting in an increased requirement of blood from the coronary arteries. Finally, the blood supply is inadequate and, consequently, angina occurs with exertion. This insufficient supply can injure the heart muscle, so that the amount of blood leaving the heart appears inadequate to the needs of the organism. The resulting heart failure causes fatigue and dyspnea. A person with severe aortic stenosis may faint on exertion because the narrowed valve prevents the ventricle to pump enough blood to the arteries of the muscles, which have been expanded to accept more oxygen-rich blood.
Diagnosis is made after the sounding of a distinctive murmur of the heart through a stethoscope, as well as abnormalities in heart rate and electrocardiogram, and a thickening of the walls of the heart in a chest radiograph. In case of angina, dyspnea, or fainting, performed an echocardiogram (an ultrasound image of the heart) and possibly a cardiac catheterization to identify the cause and the severity of the stenosis.
Treatment
In any adult suffering from fainting, angina pectoris and dyspnea caused by aortic stenosis, this valve must be replaced surgically, preferably before they appear irreparable injury in the left ventricle. The replacement valve may be mechanical or pork. Anyone with a valve replacement should receive antibiotics before undergoing any dental or surgical procedure to prevent possible infection.
In children, if the stenosis is severe operation should be performed even before symptoms appear. It is important to begin treatment early, because sudden death may occur before symptoms appear. For children, are used to repair the valve through surgical intervention and valvuloplasty (valve introduction of a catheter with a balloon on the end, which is then inflated to enlarge the opening) as safe and effective alternative to replacement the valve. Valvuloplasty is also used in frail elderly patients who can not undergo surgery, although the stenosis can develop again. However, valve replacement is usually the treatment of choice for adults of all ages and also the prognosis is excellent.
Tricuspid valve insufficiency
The tricuspid valve regurgitation (tricuspid incompetence) is the blood leaks backward through the tricuspid valve whenever the right ventricle contracts.
In tricuspid regurgitation, when the right ventricle contracts, it not only expels the blood into the lungs, but also pass a certain amount to the right atrium through the valve. This leak through the valve increases the pressure in the right atrium and causes its expansion. This high pressure is transmitted to the veins that drain into the atrium and, as a result, there is a resistance to the arrival of blood from the body and goes to the heart.
The most common cause of tricuspid regurgitation is the resistance to blood flow out of the right ventricle caused by severe lung disease or narrowing of the pulmonary valve (pulmonary valve stenosis). As a compensation mechanism, the right ventricle expands to pump harder and the valve opening is dilated.
Symptoms and Diagnosis
Apart from some specific symptoms such as weakness and fatigue caused by the small amount of blood leaving the heart, the only symptoms are usually present discomfort in the upper right abdomen, due to an enlarged liver and pulsations in the neck, all this is a result of backflow of blood from the heart to the veins. Dilation of the right atrium can cause atrial fibrillation (rapid, irregular heartbeat). Finally, there is a failure and fluid retention occurs, especially in the legs.
The diagnosis is based on the person’s medical history, a physical examination, an electrocardiogram and a chest radiograph. The backflow of blood through the valve causes a murmur that is heard with a stethoscope. An echocardiogram provides a picture of regurgitation and assess the extent of it.
Treatment
Generally, the tricuspid regurgitation requires little or no treatment. But the underlying disease of the lungs or pulmonary valve disease itself in need. Disorders such as arrhythmias and heart failure are usually treated without any surgical practice on the tricuspid valve.
Tricuspid valve stenosis
The tricuspid valve stenosis is a narrowing of the opening of the tricuspid valve that obstructs the flow of blood from the right atrium to right ventricle.
Over the years, tricuspid stenosis causes dilation of the right atrium and right ventricle shrinking. Likewise, it reduces the amount of blood returning to the heart and increases the pressure in the veins carrying the blood.
Most cases are caused by rheumatic fever, increasingly rare in developed countries. Sometimes the cause is a tumor in the right atrium, a connective tissue disease or, in rare cases, a birth defect.
Symptoms, diagnosis and treatment
The symptoms are mild. May be noted palpitations (a sensation of beats) or a throbbing discomfort in the neck and the person may feel tired. There may be a nuisance if the increased abdominal pressure in the veins come to increase the size of the liver.
The murmur caused by tricuspid valve stenosis is heard through a stethoscope. A chest radiograph may reveal an enlarged right atrium, while echo stenosis can see and assess their seriousness. Finally, the electrocardiogram shows changes that indicate an overload of the right atrium.
Tricuspid stenosis is rarely severe enough to require surgery.
Pulmonary valve stenosis
The pulmonary valve stenosis is a narrowing of the pulmonary valve opening that causes a resistance to the passage of blood from right ventricle to the pulmonary arteries.
It occurs rarely in adults and usually is a congenital defect.
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