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Dr Diana R Holdright

Consultant Cardiologist

Dr Diana Holdright

Cardiac Conditions - Valve Disease

The four chambers of the heart are separated by one-way valves to ensure efficient forward flow of blood from chamber to chamber and into the main blood vessels, the aorta and pulmonary artery. There are four main valves (see figure), two on the left side, the aortic valve and mitral valve, and two on the right side, the pulmonary valve and tricuspid valve.

the heart

There are two main types of valve disease: narrowing, which makes it harder for the heart to propel blood through the valve; and leakage, such that the blood expelled leaks back across the valve making the heart pump inefficiently. Some patients will have a mixture of the two. Valve disease can be congenital, meaning that a patient is born with an abnormal valve, or acquired, developing in later life. In the past the most common cause of valve disease was rheumatic fever, but this is now rarely seen in the Western world. As life expectancy has gradually increased the most common cause of valve disease is degenerative, due to wear and tear over the years; this is not surprising when you consider that the heart beats 90,000 to 100,000 times every day and all four valves open and close with every beat. Valves are extremely fine structures, less than 4 mm thick, and are subjected to tremendous pressure gradients across them, averaging more than 100 mmHg on the left side of the heart with every beat.

In the early stages of valve disease there are no symptoms, although the noise generated by a narrowed or leaking heart valve may be detectable as a heart murmur using a stethoscope. As the valve disease progresses, the heart begins to feel the strain and symptoms such as breathlessness, reduced exercise capacity, fatigue, palpitations and fluid retention begin to develop. It is important that valve problems are picked up early, before the heart muscle becomes strained, since effective and timely treatment with medicines, and valve replacement or repair if necessary, minimise the risk of permanent damage to the heart.

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