Valvular heart disease

 

Heart valve disorders can affect any of the valves in your heart. Your heart valves have flaps that open and close with each heartbeat, allowing blood to flow through the heart’s upper and lower chambers and to the rest of your body. The upper chambers of the heart are the atria, and the lower chambers of the heart are the ventricles.

Our heart has these four valves:

• The tricuspid valve, which is located between the right atrium and the right ventricle
• The pulmonary valve, which is located between the right ventricle and the pulmonary artery
• The mitral valve, which is located between the left atrium and the left ventricle
• The aortic valve, which is located between the left ventricle and the aorta 

Blood flows from the right and left atria through the tricuspid and mitral valves, which open to allow blood to flow into the right and left ventricles. These valves then close to prevent blood from flowing back into the atria.

 

Once the ventricles have filled with blood, they begin to contract, forcing the pulmonary and aortic valves to open. Blood then flows to the pulmonary artery and aorta. The pulmonary artery carries deoxygenated blood from the heart to the lungs. The aorta, which is the body’s largest artery, carries oxygen-rich blood to the rest of your body.

 

The heart valves work by ensuring that blood flows in a forward direction and doesn’t back up or cause leakage. If you have a heart valve disorder, the valve is not able to do this job properly. This can be caused by a leakage of blood, which is called regurgitation, a narrowing of the valve opening, which is called stenosis, or a combination of regurgitation and stenosis.

 

Some people with a heart valve disorder may not have any symptoms, while others may experience conditions like strokes, heart attacks, and blood clots if the heart valve disorder goes untreated. 

 

Types of heart valve disorders

 

Mitral valve prolapse

A mitral valve prolapse is also called:

• floppy valve syndrome
• click-murmur syndrome
• balloon mitral valve
• Barlow’s syndrome 

It occurs when the mitral valve doesn’t close properly, sometimes causing blood to flow back into the left atrium.

 

Most people with mitral valve prolapse don’t have symptoms and don’t require treatment as a result. However, symptoms that indicate that treatment is necessary include:

• heart palpitations
• shortness of breath
• chest pain
• fatigue
• a cough 

Treatment involves surgery to repair or replace the mitral valve.

Bicuspid aortic valve disease

Bicuspid aortic valve disease occurs when a person is born with an aortic valve that has two flaps instead of the usual three. In very severe cases, the symptoms of this type of disorder are present at birth. However, some people may go decades without knowing they have this type of disorder. The valve is usually able to function for years without causing symptoms, so most people with bicuspid aortic valve disease aren’t diagnosed until adulthood.

 

The symptoms may include:

• shortness of breath with exertion
• chest pain
• dizziness
• fainting 

Most people are able to have their aortic valve repaired successfully with surgery. According to the Clinical study, 80 percent of people with this type of heart valve disorder will require surgery to repair or replace the valve. This typically happens when they’re in their 30s or 40s.

Valvular stenosis

Valvular stenosis occurs when a valve isn’t able to open completely, which means that not enough blood can flow through the valve. This can occur in any of the heart valves and may be caused by the heart valve thickening or stiffening.

 

The symptoms may include:

• chest pain
• shortness of breath
• fatigue
• dizziness
• fainting 

Some people don’t need treatment for valvular stenosis. Other people may need surgery to replace or repair the valve. Depending on the severity of your stenosis and your age, valvuloplasty, which uses a balloon to dilate the valve, may be an option.

Valvular regurgitation

Valvular regurgitation may be also called “leaky valve”. It occurs when any of the heart valves doesn’t close properly, causing blood to flow backward. The symptoms can include:

 

• Shortness of breath
• A cough
• Fatigue
• Heart palpitations
• Light-headedness
• Swelling of the feet and ankles 

The effects of valvular regurgitation vary depending on the person. Some people simply need to have their condition monitored. Others may need to have medication to prevent fluid buildup, while others require valve repair or replacement.

 

Symptoms of heart valve disorders

Symptoms of heart valve disorders vary depending on the severity of the disorder. Usually the presence of symptoms indicates that the disorder is affecting blood flow. Many individuals with mild or moderate heart valve disorders don’t experience any symptoms. However, signs and symptoms may include:

 

• shortness of breath
• heart palpitations
• fatigue
• chest pain
• dizziness
• fainting
• headaches
• a cough
• water retention, which can cause swelling in the lower extremities and abdomen
• pulmonary edema, which is caused by excess fluid in the lungs

CARDIOMYOPATHY

Cardiomyopathy is a progressive disease of the myocardium, or heart muscle. In most cases, the heart muscle weakens and is unable to pump blood to the rest of the body as well as it should. There are many different types of cardiomyopathy caused by a range of factors, from coronary heart disease to certain drugs. These can all lead to an irregular heartbeat, heart failure, a heart valve problem, or other complications.

 

Medical treatment and follow-up care are important. They can help prevent heart failure or other complications. Cardiomyopathy generally has four types.

 

Dilated cardiomyopathy

The most common form, dilated cardiomyopathy (DCM), occurs when your heart muscle is too weak to pump blood efficiently. The muscles stretch and become thinner. This allows the chambers of your heart to expand. This is also known as enlarged heart. You can inherit it, or it can be due to coronary artery disease.

 

Hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy is believed to be genetic. It occurs when your heart walls thicken and prevent blood from flowing through your heart. It is a fairly common type of cardiomyopathy. It can also be caused by long-term high blood pressure or aging. Diabetes or thyroid disease can also cause hypertrophic cardiomyopathy. There are other instances that the cause is unknown.

 

Arrhythmogenic right ventricular dysplasia (ARVD)

Arrhythmogenic right ventricular dysplasia (ARVD) is a very rare form of cardiomyopathy, but it’s the leading cause of sudden death in young athletes. In this type of genetic cardiomyopathy, fat and extra fibrous tissue replace the muscle of the right ventricle. This causes abnormal heart rhythms.

 

Restrictive cardiomyopathy

Restrictive cardiomyopathy is the least common form. It occurs when the ventricles stiffen and cannot relax enough to fill up with blood. Scarring of the heart, which frequently occurs after a heart transplant, may be a cause. It can also occur as a result of heart disease.

 

Other types of Cardiomyopathy

Most of the following types of cardiomyopathy belong to one of the previous four classifications, but each has unique causes or complications.

 

Peripartum cardiomyopathy occurs during or after pregnancy. This rare type occurs when the heart weakens within five months of delivery or within the final month of pregnancy. When it occurs after delivery, it’s sometimes called postpartum cardiomyopathy. This is a form of dilated cardiomyopathy, and it’s a life-threatening condition. There’s no cause.

 

Alcoholic cardiomyopathy is due to drinking too much alcohol over a long period of time, which can weaken your heart so it can no longer pump blood efficiently. Your heart then becomes enlarged. This is a form of dilated cardiomyopathy.

Ischemic cardiomyopathy occurs when your heart can no longer pump blood to the rest of your body due to coronary artery disease. Blood vessels to the heart muscle narrow and become blocked. This deprives the heart muscle of oxygen. Ischemic cardiomyopathy is a common cause of heart failure. Alternatively, nonischemic cardiomyopathy is any form that isn’t related to coronary artery disease.

 

Noncompaction cardiomyopathy, also called spongiform cardiomyopathy, is a rare disease present at birth. It results from abnormal development of the heart muscle in the womb. Diagnosis may occur at any stage of life.

 

When cardiomyopathy affects a child, it’s called pediatric cardiomyopathy. If you have idiopathic cardiomyopathy, it means there’s no known cause.

 

Risk factors of Cardiomyopathy

Cardiomyopathy can affect people of all ages. Major risk factors include the following:

• a family history of cardiomyopathy, sudden cardiac arrest, or heart failure
• coronary heart disease
• diabetes
• severe obesity
• sarcoidosis
• hemochromatosis
• amyloidosis
• heart attack
• long-term high blood pressure
• alcoholism

According to research, HIV, HIV treatments, and dietary and lifestyle factors can also increase your risk of cardiomyopathy. HIV can increase your risk of heart failure and dilated cardiomyopathy, in particular. If you have HIV, talk to your doctor about regular tests to check the health of your heart. You should also follow a heart-healthy diet and exercise program.

 

Symptoms of cardiomyopathy

The symptoms of all types of cardiomyopathy tend to be similar. In all cases, the heart cannot adequately pump blood to the tissues and organs of the body. It can result in symptoms such as:

• general weakness and fatigue
• shortness of breath, particularly during exertion or exercise
• light-headedness and dizziness
• chest pain
• heart palpitations
• fainting attacks
• high blood pressure
• edema, or swelling, of your feet, ankles, and legs

 

Heart failure

 

Heart failure, sometimes known as congestive heart failure, occurs when your heart muscle doesn't pump blood as well as it should. Certain conditions, such as narrowed arteries in your heart (coronary artery disease) or high blood pressure, gradually leave your heart too weak or stiff to fill and pump efficiently.

 

Not all conditions that lead to heart failure can be reversed, but treatments can improve the signs and symptoms of heart failure and help you live longer. Lifestyle changes — such as exercising, reducing sodium in your diet, managing stress and losing weight — can improve your quality of life.

One way to prevent heart failure is to prevent and control conditions that cause heart failure, such as coronary artery disease, high blood pressure, diabetes or obesity.

 

Sign and Symptoms

• Shortness of breath (dyspnea) when you exert yourself or when you lie down
• Fatigue and weakness
• Swelling (edema) in your legs, ankles and feet
• Rapid or irregular heartbeat
• Reduced ability to exercise
• Persistent cough or wheezing with white or pink blood-tinged phlegm
• Increased need to urinate at night
• Swelling of your abdomen (ascites)
• Very rapid weight gain from fluid retention
• Lack of appetite and nausea
• Difficulty concentrating or decreased alertness
• Sudden, severe shortness of breath and coughing up pink, foamy mucus
• Chest pain if your heart failure is caused by a heart attack

When to see a doctor

See your doctor if you think you might be experiencing signs or symptoms of heart failure. Seek emergency treatment if you experience any of the following:

·        Chest pain

·        Fainting or severe weakness

·        Rapid or irregular heartbeat associated with shortness of breath, chest pain or fainting

·        Sudden, severe shortness of breath and coughing up pink, foamy mucus

Cause of Heart failure

Heart failure often develops after other conditions have damaged or weakened your heart. However, the heart doesn't need to be weakened to cause heart failure. It can also occur if the heart becomes too stiff.

In heart failure, the main pumping chambers of your heart (the ventricles) may become stiff and not fill properly between beats. In some cases of heart failure, your heart muscle may become damaged and weakened, and the ventricles stretch (dilate) to the point that the heart can't pump blood efficiently throughout your body.

 

Over time, the heart can no longer keep up with the normal demands placed on it to pump blood to the rest of your body. An ejection fraction is an important measurement of how well your heart is pumping and is used to help classify heart failure and guide treatment. In a healthy heart, the ejection fraction is 50 percent or higher — meaning that more than half of the blood that fills the ventricle is pumped out with each beat.

 

But heart failure can occur even with a normal ejection fraction. This happens if the heart muscle becomes stiff from conditions such as high blood pressure.

Heart failure can involve the left side (left ventricle), right side (right ventricle) or both sides of your heart. Generally, heart failure begins with the left side, specifically the left ventricle — your heart's main pumping chamber.

Any of the following conditions can damage or weaken your heart and can cause heart failure. Some of these can be present without your knowing it:

 

·    Coronary artery disease and heart attack. Coronary artery disease is the most common form of heart disease and the most common cause of heart failure. The disease results from the buildup of fatty deposits (plaque) in your arteries, which reduce blood flow and can lead to heart attack.

·   High blood pressure (hypertension). If your blood pressure is high, your heart has to work harder than it should to circulate blood throughout your body. Over time, this extra exertion can make your heart muscle too stiff or too weak to effectively pump blood.

·   Faulty heart valves. The valves of your heart keep blood flowing in the proper direction through the heart. A damaged valve — due to a heart defect, coronary artery disease or heart infection — forces your heart to work harder, which can weaken it over time.

·   Damage to the heart muscle (cardiomyopathy). Heart muscle damage (cardiomyopathy) can have many causes, including several diseases, infections, alcohol abuse and the toxic effect of drugs, such as cocaine or some drugs used for chemotherapy. Genetic factors also can play a role.

·   Myocarditis. Myocarditis is an inflammation of the heart muscle. Its most commonly caused by a virus, including COVID-19, and can lead to left-sided heart failure.

·  Heart defects you're born with (congenital heart defects). If your heart and its chambers or valves haven't formed correctly, the healthy parts of your heart have to work harder to pump blood through your heart, which, in turn, may lead to heart failure.

·    Abnormal heart rhythms (heart arrhythmias). Abnormal heart rhythms may cause your heart to beat too fast, creating extra work for your heart. A slow heartbeat also may lead to heart failure.

· Other diseases. Chronic diseases — such as diabetes, HIV, hyperthyroidism, hypothyroidism, or a buildup of iron (hemochromatosis) or protein (amyloidosis) — also may contribute to heart failure.

 

Causes of acute heart failure include viruses that attack the heart muscle, severe infections, allergic reactions, blood clots in the lungs, the use of certain medications or any illness that affects the whole body.

 

Risk factors

A single risk factor may be enough to cause heart failure, but a combination of factors also increases your risk.

 

Risk factors include:

 

• High blood pressure. Your heart works harder than it has to if your blood pressure is high.
• Coronary artery disease. Narrowed arteries may limit your heart's supply of oxygen-rich blood, resulting in weakened heart muscle.
• Heart attack. A heart attack is a form of coronary disease that occurs suddenly. Damage to your heart muscle from a heart attack may mean your heart can no longer pump as well as it should.
• Diabetes. Having diabetes increases your risk of high blood pressure and coronary artery disease.
• Some diabetes medications. The diabetes drugs rosiglitazone (Avandia) and pioglitazone (Actos) have been found to increase the risk of heart failure in some people. Don't stop taking these medications on your own, though. If you're taking them, discuss with your doctor whether you need to make any changes.
• Certain medications. Some medications may lead to heart failure or heart problems. Medications that may increase the risk of heart problems include nonsteroidal anti-inflammatory drugs (NSAIDs); certain anesthesia medications; some anti-arrhythmic medications; certain medications used to treat high blood pressure, cancer, blood conditions, neurological conditions, psychiatric conditions, lung conditions, urological conditions, inflammatory conditions and infections; and other prescription and over-the-counter medications.

Don't stop taking any medications on your own. If you have questions about medications you're taking, discuss with your doctor whether he or she recommends any changes.

• Sleep apnea. The inability to breathe properly while you sleep at night results in low blood oxygen levels and increased risk of abnormal heart rhythms. Both of these problems can weaken the heart. 
• Congenital heart defects. Some people who develop heart failure were born with structural heart defects.
• Valvular heart disease. People with valvular heart disease have a higher risk of heart failure.
• Viruses. A viral infection may have damaged your heart muscle.
• Alcohol use. Drinking too much alcohol can weaken heart muscle and lead to heart failure.
• Tobacco use. Using tobacco can increase your risk of heart failure.
• Obesity. People who are obese have a higher risk of developing heart failure.
• Irregular heartbeats. These abnormal rhythms, especially if they are very frequent and fast, can weaken the heart muscle and cause heart failure.

Complications

If you have heart failure, your outlook depends on the cause and the severity, your overall health, and other factors such as your age. Complications can include:

Kidney damage or failure. Heart failure can reduce the blood flow to your kidneys, which can eventually cause kidney failure if left untreated. Kidney damage from heart failure can require dialysis for treatment.

Heart valve problems. The valves of your heart, which keep blood flowing in the proper direction through your heart, may not function properly if your heart is enlarged or if the pressure in your heart is very high due to heart failure.

Heart rhythm problems. Heart rhythm problems (arrhythmias) can be a potential complication of heart failure.

Liver damage. Heart failure can lead to a buildup of fluid that puts too much pressure on the liver. This fluid backup can lead to scarring, which makes it more difficult for your liver to function properly.

 

Some people's symptoms and heart function will improve with proper treatment. However, heart failure can be life-threatening. People with heart failure may have severe symptoms, and some may require heart transplantation or support with a ventricular assist device.

 

Prevention

The key to preventing heart failure is to reduce your risk factors. You can control or eliminate many of the risk factors for heart disease — high blood pressure and coronary artery disease, for example — by making lifestyle changes along with the help of any needed medications.

 

Lifestyle changes you can make to help prevent heart failure include:

·        Not smoking

·        Controlling certain conditions, such as high blood pressure and diabetes

·        Staying physically active

·        Eating healthy foods

·        Maintaining a healthy weight

·        Reducing and managing stress

 

Coronary Artery Disease

Atherosclerosis is the narrowing of arteries due to plaque buildup on the artery walls. It is also called Coronary Artery Disease (CAD). Arteries carry blood from the heart to the rest of the body. A thin layer of cells forms a lining that keeps them smooth and allows blood to flow easily. This is called the endothelium.

Atherosclerosis happens when the endothelium becomes damaged, due to factors such as smoking, high blood pressure, or high levels of glucose, fat, and cholesterol in the blood. This damage allows a collection of substances, known as plaque, to build up in the artery wall. These substances include fat and cholesterol. Over time, plaque can build up and become hard. If plaque continues to collect, it can block the artery and disrupt the flow of blood around the body.

Sometimes, pieces of plaque break open. If this happens, particles from blood cells, known as platelets, gather in the affected area. These can stick together, forming blood clots. A clot can block the artery, leading to life threatening complications, such as stroke and heart attack.

 

Atherosclerosis can affect any artery, but it mainly occurs in the larger, high pressure arteries. Carotid arteries provide blood to the brain. Restricted blood supply can lead to a stroke. Coronary arteries provide blood to the heart. When the blood supply to the heart falls, it can cause angina and heart attack. Renal arteries supply blood to the kidneys. If the blood supply becomes limited, chronic kidney disease may develop.

 

Symptoms

Atherosclerosis usually affects older people, but it can start to develop during adolescence. Inside the artery, streaks of white blood cells will appear on the artery wall. Often, there are no symptoms until a bit of plaque ruptures, or the blood flow becomes restricted. This may take many years to occur. The symptoms of atherosclerosis depend on which arteries are affected.

A build-up of fatty plaques in your arteries, or atherosclerosis can damage your blood vessels and heart. Plaque build-up causes narrowed or blocked blood vessels that can lead to a heart attack, chest pain (angina) or stroke. 

Coronary artery disease symptoms may be different for men and women. For instance, men are more likely to have chest pain. Women are more likely to have other signs and symptoms along with chest discomfort, such as shortness of breath, nausea and extreme fatigue.

Signs and symptoms can include:

• Chest pain, chest tightness, chest pressure and chest discomfort (angina)
• Shortness of breath
• Pain, numbness, weakness or coldness in your legs or arms if the blood vessels in those  parts of your body are narrowed
• Pain in the neck, jaw, throat, upper abdomen or back 

You might not be diagnosed with coronary artery disease until you have a heart attack, angina, stroke or heart failure. It's important to watch for cardiovascular symptoms and discuss concerns with your doctor. Cardiovascular disease can sometimes be found early with regular evaluations.

 

Heart disease & Heart attack

 

WHAT IS HEART DISEASE?

Heart disease encompasses a wide range of cardiovascular problems. Several diseases and conditions fall under the umbrella of heart disease. Heart disease also refers to conditions that involve the heart, its vessels, muscles, valves, or internal electric pathways responsible for muscular contraction. Common heart disease conditions include:

• Coronary artery disease
• Heart failure
• Cardiomyopathy
• Heart valve disease
• Arrhythmias
• Heart infections: caused by bacteria, viruses, or parasites.

Coronary artery disease is the main cause of heart attacks. It is the most common kind of heart disease.

WHAT IS A HEART ATTACK?

When a coronary artery becomes blocked (usually by a blood clot), an area of heart tissue loses its blood supply. This reduction of blood can quickly damage and/or kill heart tissue, so quick treatments in an emergency department and/or catheterization suite are necessary to reduce the loss of heart tissue. Loss of heart tissue due to a blockage can cause symptoms such as chest pain, shortness of breath, weakness, and even death. Quick treatments have reduced the number of deaths from heart attacks in recent years. About 790,000 people suffer from heart attacks in the U.S. each year.

HEART ATTACK SYMPTOMS

The following are warning signs of a heart attack:

• Chest pain (may spread to the back, neck, arms and/or jaw)
• Dizziness
• Nausea, vomiting
• Rapid or irregular heartbeats
• Shortness of breath
• Some people may exhibit anxiety, indigestion and/or heartburn (some women may present with these as their predominant symptoms instead of chest pain)
• Weakness
• Light-headedness
• Breaking out in a cold sweat

Women may experience different heart attack signs and symptoms than men. Jaw pain, shortness of breath, and nausea and vomiting may be more common in women who have heart attacks than men.