Heart murmurs and heart valve disease

The heart has valves called the aortic, mitral, tricuspid and pulmonary. These valves work to ensure that blood circulates normally within the heart. Valves can become too tight and impede blood flow. This is known as valvular stenosis, or they may fail to close normally leading to backflow or regurgitation of blood.

Some people are born with heart valve disease, while others acquire it later in life.

Heart valve disease that develops from birth is called congenital heart valve disease and is due to heart valves not forming properly. These valves may not have enough tissue flaps, they may be the wrong size or shape, or they may lack an opening through which blood can flow properly.

Heart valve diseases that occur later in life(acquired heart valve disease) involve heart valves that are healthy and normal but develop problems over time.

Examples include degenerative valve disease, valve infections, and valvular inflammation. Other diseases of the heart may also affect the valves, such as coronary heart disease and cardiac muscle diseases which may lead to enlargement of the heart chambers and subsequent valve failure.

Some people with heart valve disease have no symptoms. For others, they may have the condition throughout their lives without any cause for concern. However, the condition may worsen for some individuals until symptoms develop.

Symptoms include breathlessness, especially on exertion, fatigue, irregular, fast or strong heartbeats, chest tightness or pain. It may even cause dizziness and when severe, fainting. In these cases, if left untreated, advanced heart valve disease can lead to heart failure, stroke or death from cardiac arrest.

Currently, there are no medications that cure heart valve disease. It’s known that living a healthy lifestyle with medication may relieve many of the symptoms and reduce complications. Eventually, the faulty heart valve may need to be surgically repaired or replaced.

A cardiologist is the best person to assess the heart valves. This can be done with cardiac ultrasound also known as echocardiogram to visualise the valve function in real time. Further specialised ultrasound techniques such as 3-dimensional (3D) ultrasound, trans-oesophageal and stress echo can allow more precise evaluation of the valve.

With a complete and precise evaluation, the cardiologist can determine the safety of exercise and if there is any need for surgery. The surgery(open heart surgery) aims to repair the valve or replace it with a metallic valve, or a prosthetic one made of animal tissue.

Recently, minimally invasive techniques may be an option for selected patients. In these cases, instead of open-heart surgery, the valve may be treated percutaneously through the insertion of small catheters into the heart via the blood vessels. As no open-heart surgery is involved, there is no surgical scar, lesser post-operative pain, faster recovery, and the risk of the procedure is generally lower.