Heart Valve Diseases

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What are heart valves?

Heart valves are thin structures (leaflets) that are located within the heart, one between the right upper chamber (right atrium) and the right lower chamber (right ventricle), one between this and the main (pulmonary) lung artery; one between the left upper chamber (left atrium) and the left lower chamber (left ventricle), and one between the left ventricle and the main artery of the body (aorta) that is connected to the heart.

What is the function of these heart valves?

These four valves in our heart separate the various chambers and regulate the flow of blood from one chamber to the other, from the time used blood (unoxygenated) from all over our body goes back to the heart, flows to the lungs for oxygenation, and back out of the heart to the aorta, then circulating to all over our body. Just like valves the plumbers use for our water pumps, these valves regulate the flow and prevent leaks. The valves are like doors between rooms, they open and close according to the flow of traffic.

What are the names of these valves?

They are the tricuspid valve, pulmonary valve, mitral valve, and aortic valve, in the exact sequence of forward flow as described above. These valves are tri-leaflets (with 3 leave-like structures) except the mitral valve which is bi-leaflet (with 2 leaflets). These leaflets are held by cords (chorda tendinae), like a parachute dome held down by the parachute cords. The heart muscles control the cords to open and close the valves rhythmically and sequentially. These motions are timed perfectly to allow easy and efficient traffic of blood from one chamber to the other.

What cause these valves to be diseased?

Some of the commonest causes are Rheumatic Fever (during childhood), valve infection (including syphilis), degenerative, or heart attack (lack of blood causing the cords that hold and control the valve leaflets to weaken and flail, or even break, causing

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a leaky valve). Rheumatic Fever could also cause the opposite, hardened and tight valves.

How common is heart valve diseases?

Diseases of the heart valves, especially involving the aortic and mitral valves, is very common in the Philippines and in the whole of Asia. They are more prevalent in poorer countries for obvious economic, socio-cultural, and techno-medical reasons. They are seen a lot where Rheumatic Fever is common.

What is Rheumatic Fever?

Rheumatic fever is a diffuse inflammatory infection, which is caused by the common Strep throat (Strep A Pharyngitis). This usually affects children (most frequently 5 to 15 years of age, extremely rare in infancy), and sometimes not adequately controlled and recurrent or not treated at all because of economic reason. The Streptococcus A bug is the bacterial culprit. When the Strep throat is accompanied by skin rash, it is called Scarlet Fever, and obviously, this can cause Rheumatic Fever also.

What are the signs and symptoms of Rheumatic fever?

The typical form (following a Strep Throat) presents itself as fever, swelling of the joints, heart, skin and the nervous system. The joint pains travel from one joint to the other. Most of the time, this may be confused with influenza, and only a trained physician could recognize and diagnose it after a thorough medical history and physical examination.

Does Strep infection always cause Rheumatic Fever?

No, only about 3% (three out of 100 patients) of those with acute Strep Pharyngitis that have NOT been treated at all lead to the complication of Rheumatic Fever. Strep throat could lead to Rheumatic fever, but Streptococcus infection of the skin or other organs outside of the throat will not cause Rheumatic fever. Three percent may not sound high, but this incidence is way too high for medical and health comfort.

How does Rheumatic Fever cause valve diseases?

With the generalized inflammation that takes place in those organs mentioned above, especially the heart, the inflammed valves become scarred, shrunken, and form

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hard calcium deposits in the valves, making the leaflets hard like rocks. As a result, the valve leaflets lose their flexibility and normal apposition, causing them not to open well, making it harder for the heart to pump the blood across this tight valve (stensosis). The other form of damage is the opposite, the valve becomes flimsy because of the (myxomatous) degeneration, and the leaflets become weak and flail, and therefore causing a leaky valve, where blood, instead of moving forward with the circulation when the heart pumps, has a tendency to "slide back" into the chamber where it was before ejection (regurgitation). In this case the flail and leaky valve is unable to prevent the blood from "sliding back" so the heart has to try and pump harder to maintain a "forward flow". This is obviously inefficient and an added work for the heart, which later leads to heart failure.

How does one prevent Strep Throat and Rheumatic Fever?

Foremost is to see the physician when sore throat develops, especially in children. The physician can do a throat (swab) culture to find out if the cause is Streptococcus A bacteria. Or, by experience, he/she may simply prescribe Penicillin or an antibiotic that is known to fight the particular bug or infection affecting the patient. The proper and adequate antibiotic treatment will be effective in preventing the onset of Rheumatic Fever. A clean home and environment is essential to prevent the transmission of infectious diseases, and Strep throat is no exception. Washing our hands frequently as needed, making sure the kitchen utensils, silver wares we use, the food we eat and the water we drink, are clean, using a mask (or covering your mouth and nose) when you have a sore throat, not breathing directly and close to another person, especially children, and seeing your physician without delay when a sore throat develops, are effective measures to ward off Rheumatic Fever and its potentially serious, and even deadly, complication of heart valve diseases.

©2003Raoul R. Diez, M.A.O.D.