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HEALTH CONDITIONS
VALVE DISEASE
What is it?
The heart has four valves. The valves act like oneway 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 or from other conditions that affect the structures of the
heart.
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 (allows blood to enter the
left ventricle) or the aortic valve (allows blood to exit the left ventricle). These
heart valves generally develop one of two problems:
• Opening—the valve may not fully open. This is associated with stenosis,
which is the thickening and narrowing of the valve. Stenosis slows blood flow
through the heart and/or to the body.
• Closing—the valve may not fully close, allowing blood to leak back into the
heart chamber it came from. This is called regurgitation. Regurgitation can
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cause less blood than normal to be pumped to your body.
What is the cause?
The causes of valve disease are not always known. But the following are
common causes:
• Congenital heart problem (a defect present from birth)
• Rheumatic fever
• Heart infection called endocarditis
• Prior heart attack
What are the symptoms?
Symptoms of valve disease can include:
• Weakness and fatigue
• Shortness of breath
• Heart palpitations (feeling that the heart is racing or that the heartbeat is
irregular)
• Chest discomfort or tightness
• Dizziness, lightheadedness, or fainting (syncope)
• Chest infections or coughing (sometimes coughing up blood)
• Swollen legs and feet
• Rapid weight loss
You may not have any symptoms of valve disease. Over time, however, as your
heart tries to compensate for valve disease by working harder, 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.
What tests could I have?
Cardiac Catheterization
Chest X-ray
Echocardiogram
Electrocardiogram (ECG or EKG)
Holter Monitoring
MRI
Stethoscope Test
Stress Test
Cardiac Catheterization
What is a cardiac catheterization?
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. A cardiac catheterization is the first step in a number
of heart and blood vessel tests and procedures.
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For instance, a cardiac catheterization is often the first step in an angiogram. In
an angiogram, your doctor injects dye through the catheter into your arteries to
find any blockages. With a catheterization, your doctor can also:
• Measure blood pressure in your heart or lungs
• Take a tiny sample (a biopsy) of your heart muscle
• Determine how much oxygen is in your blood
• Measure the amount of blood flowing through your heart and blood vessels
• Do an electrophysiology (EP) study to check the electrical system in your
heart
During a cardiac catheterization, your doctor may also treat any blocked blood
vessels with one or more of these procedures to improve blood flow:
• An atherectomy—using a catheter with a cutting tool to clear plaque from an
artery
• A balloon angioplasty—using a catheter with a balloon that expands and
presses plaque against the side of an artery
• A stent implant—inserting a tiny mesh tube into an artery to help keep it open
after plaque has been cleared
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.
Chest X-ray
What is a chest x-ray?
A chest x-ray produces an image of your heart, lungs, and nearby blood vessels.
It reveals the:
• Size and shape of your heart
• Presence of fluid around your lungs
• Position and shape of your large arteries
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.
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What can I expect?
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.
Echocardiogram
What is an echocardiogram?
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:
• The shape and size of your heart
• How well the heart valves are working
• How well the heart chambers are contracting
• The ejection fraction (EF), or how much blood your heart pumps with each
beat
What can I expect?
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.
Electrocardiogram (ECG or EKG)
What is an ECG?
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:
You have arrhythmias
Your heart medication is effective
Blocked coronary arteries (in the heart) are cutting off blood and oxygen to your
heart muscle
Your blocked coronary arteries have caused a heart attack
In all, there are three kinds of tests that record your heart's electrical activity,
each for a different period of time:
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Electrocardiogram (ECG)—done in the doctor's office. It records your heart
rhythms for a few seconds.
Holter monitoring—records and stores (in its memory) all of your heart
rhythms for 24-48 hours.
Event recorder—constantly records your heart rhythms. But it stores the
rhythms (in its memory) only when you push a button.
What are the parts of an ECG strip?
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:
• The P-wave shows your heart's upper chambers (atria) contracting
• The QRS complex shows your heart's lower chambers (ventricles) contracting
• The T-wave shows your heart's ventricles relaxing
The P-Q-R-S-T waves in a series reflect one heart beat.
What can I expect?
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
What is Holter monitoring?
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:
• Electrocardiogram (ECG)—done in the doctor's office. It records your heart
rhythms for a few seconds.
• Holter monitoring—records and stores (in its memory) all of your heart
rhythms for 24-48 hours.
• Event recorder—constantly tracks your heart rhythms. But it stores the
rhythms (in its memory) only when you push the button.
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.
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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.
What can I expect?
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, however, your skin may become irritated from the
sticky patches. 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)
What is magnetic resonance imaging (MRI)?
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 threedimensional images of the inside of your body.
The images can reveal:
• Blockages in blood vessels
• The size and thickness of your heart's chambers
• Damaged muscle from a heart attack
• How your heart valves are working
What can I expect?
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
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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.
Stethoscope Test
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.
Stress Test
What is a stress test?
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:
• Heart rate
• Blood pressure
• Your heart's electrical system
The test can show:
If you have coronary artery disease (CAD)
If you might be at risk for a heart attack
The cause of symptoms like chest pain (angina)
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Whether you have irregular heart rhythms (arrhythmias)
Whether treatment—medications or an implanted device—has improved your
heart and blood vessel function
In one of the simpler types of stress tests, you walk on a treadmill or pedal a
stationary bike. You begin at an easy pace. The machine is slowly adjusted to
make you work harder. You continue exercising until you feel symptoms or until
you get too tired. A stress test is also known as an exercise test, a treadmill test,
or an exercise ECG.
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 different color on the image.
What can I expect?
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.
What are the treatment options?
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.
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Medications
Currently there are no medications to treat valve disease. However, medications
may be used to prevent complications of valve disease.
Antibiotics
Anticoagulants
Diuretics
Procedures
Valve Repair
Valve Replacement
MEDICATIONS
Tips for Taking Heart Medications
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 dietary 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 and supplements.
You may also want to discuss these topics with your doctor or nurse each time
you get a new medication:
• The reason you're taking the medication, its expected benefits, and its
possible side effects
• How and when to take your medications
• If you take other medicines, vitamins, supplements, or other over-the-counter
products
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:
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Questions about how your medications work
Unpleasant side effects
Trouble remembering to take your pills
Trouble paying for your medications
Other factors that prevent you from taking your medications as needed
Questions about taking any of your medications
And don't hesitate to ask your pharmacist if you have questions about how and
when to take your medications.
Antibiotics
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.
aspirin
clopidogrel (Plavix)
dabigatran etexilate (Pradaxa)
heparin (Lovenox)
prasugrel (Effient)
ticlopidine (Ticlid)
warfarin (Coumadin)
What They're Used For
To reduce the risk of blood clots that could lead to stroke and other medical
conditions
How They Work
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.
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A blood clot in the coronary arteries (which carry blood to the heart muscle)
can cause angina (chest pain). A clot or blockage in the coronary arteries is
called coronary artery disease (CAD) and could lead to a heart attack.
A blood clot in the carotid arteries (in the neck) can travel to the brain and
cause a stroke.
A blood clot in the vessels in the arms or legs, called peripheral vascular
disease (PVD), can decrease circulation to the limbs and cause pain.
Taking anticoagulant medications can:
Decrease the stickiness of the blood
Reduce the likelihood of blood clots forming
Diuretics (Water Pills)
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
amiloride (Midamor)
bendroflumethiazide (Naturetin)
bumetanide (Bumex)
chlorothiazide (Diuril)
chlorthalidone (Hygroton, Thalitone)
eplerenone (Inspra)
ethacrynic acid (Edecrin)
furosemide (Lasix)
hydrochlorothiazide (Microzide, Oretic)
indapamide (Lozol)
methyclothiazide (Enduron)
metolazone (Zaroxolyn)
polythiazide (Renese)
spironolactone (Aldactone)
torsemide (Demadex)
triamterene (Dyrenium)
What they're used for
To lower blood pressure
To reduce edema (swelling caused by excess fluid in your body—often in the
legs and feet) associated with conditions such as heart failure
How they work
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.
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Diuretics also relieve symptoms like shortness of breath. That's because excess
fluid in your lungs can cause these symptoms.
Valve Repair
Some diseased valves can be repaired:
• Calcium deposits can be removed from the valve, allowing it to close better.
• Part of the valve can be surgically reshaped, allowing it to close better.
• If the valve opening is too wide, it can be tightened with stitches.
Valve repair is a major surgery requiring general anesthesia.
PROCEDURES
Valve Replacement
What is a valve replacement?
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.
How is the surgery done?
Your doctor needs to operate on a completely still heart. During the surgery you
will receive medications to stop your heart. A heart-lung machine then does the
job of both the heart and the lungs:
• It adds oxygen to the blood—as the lungs would do
• It pumps the blood back into, and throughout, the body—as the heart would
do
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.
What can I expect?
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
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certain dental or surgical procedures. Anticoagulant medications may be
prescribed afterward depending on the type of replacement value you received
Important Safety Information
Medications, procedures and tests can have some risks and possible side effects. Results may vary
from patient to patient. This information is not meant to replace advice from your doctor. Be sure to
talk to your doctor about these risks and possible side effects.
Boston Scientific is a trademark and HEARTISTRY is a service mark of Boston Scientific Corporation.
All other brand names mentioned are used for identification purposes only and are trademarks of their respective owners.
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