In the heart are four flaps that act as valves and prevent the blood from being pumped in the wrong direction. The flaps can become too tight or start leaking, which can lead to different types of heart valve diseases. They are often detected when the doctor listens to the heart and hears wheezing. If the failure of the valve causes symptoms or affects the functioning of the heart, surgery may be required to replace the heart valve that does not work with a new one.
Flap diseases can be divided into narrows and leaks of the flaps. In constriction, it becomes difficult for the blood to pass through the narrow valve. In the event of a leak, some of the blood is pumped backwards.
Flea diseases can be congenital or occur later in life. The latter are called acquired.
Flea diseases usually cause no problems at first, but over time you can
- get harder to breathe
- get worse energy
- get tired
- Get dizzy and faint as you exert yourself
- get chest pain
- have a palpitations.
The bigger the flap, the easier you feel the symptoms. Fever, chills and chills can be symptoms of flap disease caused by bacteria. You can also get the symptoms urgently if the cause is, for example, myocardial infarction or infection.
When should I seek care?
- get a strong, pressing or spasmodic pain in the chest that does not disappear within 15 minutes
- gets a diffuse but unpleasant feeling in the chest that lasts for more than 15 minutes
- have chest pains and at the same time feel shortness of breath, are cold sweaty or have a palpitations
- get sudden severe breathing difficulties when you rest
- have fainted without apparent cause when you strained or rested.
- gets a fever in combination with breathing problems
- know that you have a heart disease and suddenly get worse.
If you have mild discomfort, for example, you become more breathless than before when you exert yourself and have had less energy, you can contact a health care center . You can seek care at any healthcare center you want throughout the country. You also have the opportunity to have a regular doctor’s contact at the health center.
Mild flaps are followed up with regular ultrasound examinations. More difficult forks that cause trouble or impact on the heart should be operated. It is important that you can get in touch with your doctor if you have any questions, get worse or get new symptoms. You need to know what symptoms will lead to you contacting the healthcare system and where to turn.
The most common surgical procedure is for the surgeon to remove the non-functioning heart valve. The flap is replaced with a mechanical or biological flap prosthesis. There is no risk of the flap prosthesis being rejected as it does not consist of living tissue.
- A mechanical flap prosthesis consists of metal discs that open and close by the blood stream. The advantage is that the flow will be maximal and that the prosthesis will last a lifetime. The disadvantage is lifelong treatment with blood clot prevention drugs.
- A biological flap prosthesis is made from cardiac tissue from pig or calf and synthetic material. The advantage is that blood clot prevention drugs are not needed. The disadvantage is that this type of flap does not last as long and does not provide as good passage for the blood.
Sometimes tissue around the flap may need to be replaced and some leaking flaps can also be repaired. The narrowing of the mitral valve can usually be dilated with the help of an inflatable balloon.
Recently, new techniques have also been introduced with valve replacement and valve repair via the blood vessels so that the chest does not need to be opened. These treatment methods are only current in some cases.
Having a heart surgery is not risk-free. In all surgeries you can get bleeding and infections, it is also common with rhythm disorders. Everyone also does not survive, and therefore a thorough analysis of the benefit against the risks is made. The older you are and the more diseases you have, the greater the risk. Decisions about surgery are made in consultation with you as a patient and you should then be well informed. It is of great value if relatives are also involved in this process.
After cardiac surgery, it is common to receive care at a cardiac surgery clinic for about a week and then a week at a rehabilitation hospital. It takes about three months to recover. It is important to get treatment for the root cause of the valve and all other diseases in order to get the best long-term results possible. If you have received a mechanical flap prosthesis, life-long Waran treatment applies.
What can I do for myself?
There appears to be an association between constricted aortic valve and high blood pressure, high blood fat and smoking. There is nothing special that you can do yourself if you have had flap disease. However, you can reduce the risk of getting cardiovascular disease by following these tips:
- Stop smoking because it greatly increases the risk of cardiovascular and lung problems. The risks also increase in connection with surgeries, and it takes longer to recover
- Eat healthier. Mediterranean and Nordic foods are good for health. Such diets contain a lot of vegetables, fish, vegetable fats, nuts and fruits but a little less of dairy products and meats where lamb and game are more useful than beef and pork. Elevated blood fats and obesity increase the risk of cardiovascular disease. Also, it often takes longer to recover after surgery if you are overweight because you have reduced lung capacity.
- Move more. At least 30 minutes of physical activity per day has beneficial effects on health. If you have a pronounced flap and become very breathless when you exert yourself, listen to the body’s signals and adjust accordingly. In heavy climbing, you should be a little careful with some forms of strength training. You should consult your doctor
- Measure your blood pressure either at the health center or at home. Blood pressure cuffs for home use are available. Discuss the values with your doctor.
- Keep your teeth clean. Studies are ongoing that show that accurate dental care probably reduces the risk of heart infections and possibly atherosclerosis.
Investigations and investigations
Most flea diseases are detected during routine checks when a doctor listens to the heart and hears wheezing. If the doctor hears acoustic sounds, you will usually receive a referral to a heart specialist for supplementary examination and assessment.
Two heart tones
A healthy person has two heart tones, which are heard when the heart valves are closed. The first tone is heard when the flaps between the atrium and the chamber are closed. Then comes the contraction phase of the heart, systole, when usually nothing is heard. Systole ends with the second heart tone, which is heard when the aortic valve and the flap between the right ventricle and pulmonary artery are closed. The time between the second and the first heart tone is the heart’s resting phase, diastole.
The doctor hears hissing sounds
Usually only the two heart tones are heard. However, when you have a flea disease, the doctor can often hear acoustic sounds from the heart with the help of a stethoscope. The acoustic noise is due to the even flow of blood from the blood due to a constricted or leaking flap.
You can have blisters from the heart without having a flap disease. The error on the flap can also be so small that it does not matter. Small leaks are common.
ECG – electrocardiography
The ECG examination shows the electrical activity of the heart. With the help of the ECG, the doctor can see if you have a regular heart rhythm or an irregular rhythm, which may be due to extra stroke or atrial fibrillation. Some flap diseases cause the left ventricular muscle to become thicker and it can sometimes be seen on the ECG. Scars after major heart attacks and much more are also visible.
With ultrasound , the doctor can assess the heart’s function and movement. It is possible to measure the size of the various heart cavities and the thickness of the walls. The doctor can also assess the appearance of the flaps and record the blood flow, thus assessing whether the flaps are leaking or constricted. In a leaking flap, part of the blood moves in the wrong direction. Through a constricted flap, the blood moves faster.
Ultrasound examination can also be done via the esophagus. The esophagus is closer to the heart than the chest wall and provides better images of especially the mitral valve and sometimes even the aortic valve. The ultrasound transmitter is brought down into the esophagus after stunning the pharynx.
A work test in the form of a bicycle test can sometimes be performed to evaluate work ability and symptoms, detect any angina and rhythm disorders and how blood pressure develops during work. It is particularly useful for those who do not consider themselves to have symptoms but who, in fact, have become accustomed to a lower level of function and do not think that their ability to work is impaired.
Coronary X-rays are always included before flap surgery to find out if the coronary vessels also need surgery. The doctor numbs the groin and introduces catheters, that is, thin tubes, through the groin artery and up to the heart. There, contrast fluid is injected into the coronary vessels to see how the heart’s blood supply works.
In order for the doctor to be able to map blood value, kidney function, salts and blood fats, blood samples are taken before the operation. It is included in the investigation.
If your doctor is unsure how your heart disease affects the heart’s work, in some cases so-called cardiac catheterization can be performed. This means that a thin tube is inserted into a blood vessel via the groin or throat through the right atrium and chamber to the pulmonary artery. With the tube, the doctor can measure the blood pressure in the lungs and how much blood is pumped into each heartbeat.
What happens in the body?
The heart is a muscle that pumps blood around the body so that all the body’s organs get oxygen. In the heart are four flaps, which ensure that the blood is pumped in the right direction through the heart. These flaps can become constricted or begin to leak.
When the blood has left its oxygen in the body, the blood is returned to the right atrium of the heart. When the right atrium contractes, the blood is pumped through a heart valve into the right ventricle. As the chamber contractes, the blood is passed past the next heart valve to the pulmonary artery and into the lungs, where it takes up oxygen.
From the lungs comes the blood to the left atrium of the heart. When the left atrium contractes, the blood is transported to the left ventricle through the so-called mitral valve. In the left ventricle, the oxygen-rich blood is pumped past the aortic valve to the large body pulmonary artery, which transports the blood to all organs of the body.
The heart valves act as valves that prevent the blood from moving in the wrong direction.
The aortic valve and the valve to the pulmonary artery are so-called pocket flaps. They consist of three pockets, usually called cus pairs. When the blood from the chamber is pressed against the flaps, these are pressed against the vessel wall and the blood can pass. During the resting phase of the heart, the blood wants to rush back into the right and left chambers, but this is prevented by filling the pockets with blood and stretching.
The flaps between the atrium and the chamber are called sail flaps. They consist of sail-like tabs, which are attached to the edges of the hole. When the heart contracts, the sling flaps are compressed and prevent the blood from flowing back to the atrium.
Flap diseases can be divided into flap narrowing or flap leaks. Depending on which flap is constricted or leaking, different symptoms and inconveniences arise, which develop differently quickly.
Acquired flap disease usually occurs in adulthood. Congenital heart failure is much more common. In such cases, other parts of the heart are usually damaged than just the heart valves. Congenital heart defects usually cause problems already in childhood and adolescence.
Congenital flap disease occurs both in the flaps that are left in the heart and those in the right side. Flap diseases that are acquired generally occur only in the left-sided heart valves, that is, the aortic valve and the mitral valve. This is because the pressure is much higher on the left side, ie in the large circulation.
There are five types of acquired flap disease:
- constricted aortic valve
- leaking aortic valve
- leaking mitral valve
- constricted mitral valve
- leaking tricuspid valve
Congenital aortic valve – aortic stenosis
Congestion of the aortic valve, aortic stenosis, is the most common valve disease. About two percent of those over 65 and about five percent of those over 80 have constricted aortic valve. The disease is somewhat more common in men than in women.
Usually you have a normal heart valve from the beginning, which is calcified more and more the older you get. It is not entirely clear why this is happening, but there are similarities with atherosclerotic disease.
Leaking aortic valve – aortic insufficiency
There are two types of leaking aortic valve, so-called aortic insufficiency: chronic leakage and acute leakage.
Chronic leaking aortic valve
Chronic aortic leakage is less common than constricted aortic valve. The disease is about as common in men as in women.
In the elderly, the flap leakage is usually part of a calcified and constricted aortic valve. The flap leakage can also occur if the body pulse vein is dilated, causing the part of the heart where the flap is attached to dilate and the flaps to be pulled apart. Leak in the aortic valve can also be a symptom of inflammatory disease.
In younger people, aortic leakage is usually caused by the fact that the aortic valve has two flap pockets instead of three, and that these do not close properly.
Acute leaking aortic valve
Acute aortic leakage is life-threatening and requires treatment very quickly. The leak is usually due to either a bacterial infection that has destroyed the aortic valve or a rupture of the large body pulmonary artery, which also damaged the valve.
In a bacterial infection, heart failure develops rapidly, usually within a day. If the coronary artery ruptures, you get severe chest pain that radiates in the back and it also becomes difficult to breathe. This condition is very serious and life-threatening.
Leaking mitral valve – mitral insufficiency
Leaking mitral valve, so-called mitral insufficiency, is less common than aortic stenosis. It is mainly younger people who can get the disease, which occurs as often in men as in women.
That the mitral valve is leaking can have several causes. One reason is that the left chamber has been enlarged. As a result, the contraction ability has deteriorated and the two mitral valve seals have been pulled apart. Another cause of the leak may be a disease of the flaps themselves, called prolapse. Leaking mitral valve may also be due to an infection that destroyed the flaps or to acute myocardial infarction.
When the left ventricle contracts, not all blood will come out into the large artery arteries, but some will instead be brought back through the leaking flap to the left atrium, which then expands and enlarges. The pressure rises in the lungs with increased breathlessness as a result.
Pressed mitral valve – mitral stenosis
In the middle of the last century, constricted mitral valve, mitral stenosis, caused by rheumatic fever, Rheumatic fever is caused by a bacterial infection with streptococci and when antibiotics began to be used, this flap largely disappeared from many countries. The disease, on the other hand, can be found in people who come from countries where health care has less resources and living conditions are worse. The effects of the rheumatic fever cause the mitral valve to thicken and open up.
Leaking tricuspidis flap – tricuspidis insufficiency
Leaking tricuspid valve can occur as a result of left-sided flap and lung disease due to elevated pressure in the pulmonary circulation and the effect on the right ventricle. Bacteria can also attack the flap and destroy it.
National guidelines for care
The National Board of Health and Welfare has developed national guidelines for how a number of chronic diseases should be investigated and treated. The guidelines contain recommendations to health care about certain examinations and treatments that may be relevant to treating those with heart valve disease.