VALVULAR HEART DISEASE
Abnormalities of heart valves may predispose patients to cardiac disease and cardiac infections. While bacteria is found all around us, those with structural heart problems can develop infections of the heart if bacteria enters the bloodstream and attaches to damaged tissue. Infections of the heart valves are known as endocarditis and require treatment to prevent the development of secondary complications such as valvular heart disease which affects the valves (mitral, aortic, tricuspid or pulmonary valve) and thus the blood flow to and from the heart.
A history of rheumatic fever in the past may lead to valvular heart disease over time. If the following symptoms appear, it may be time to see a cardiologist.
- shortness of breath
- symptoms similar to the flu – fever, chills, night sweats and aching muscles
- bumps or spots on the skin of your hands and feet
- pain in the left side of the chest
- blood in the urine
- swelling of the abdomen, legs and feet
- nausea and vomiting
- heart palpitations or murmur
When left untreated, the valves of the heart can become affected by the infection. While the heart valves ensure that blood flows in the correct direction, at the proper time, in cases of valvular heart disease the valves may either become too narrow and hardened, or cause leakage of blood into the preceding chamber. This means they are unable to open or close properly causing blood flow problems.
Infections may also involve heart muscle, known as myocarditis or the outer lining of the heart, known as pericarditis.
Diagnosis & Treatment
In order to make a diagnosis, Dr Ho may do a physical exam followed by a range of tests. These diagnostic tests may include a blood test to look for anaemia, inflammation or bacteria in the bloodstream. An electrocardiogram (ECG) or exercise stress test will be done to evaluate the electrical activity generated by the heart when it is at rest and when exercising. This will measure the rhythm and length of heartbeats. Echocardiography will be performed to detect structural heart disease. Dr Ho may also do this using a transoesophageal echocardiogram (TEE). This method is done by passing a transducer device into the oesophagus to provide more precise images of the heart. An x-ray may also be done to see if endocarditis has damaged the heart and lungs. A CT scan or MRI may also be done to show if the infection has spread to another area of your body like your brain or chest.
In some cases where Dr Ho suspects that valvular heart disease may be present, he may also perform right and left heart catheterisation studies incorporating coronary angiography. This involves internal pressure measurements of the right and left heart using catheters under x-ray imaging. Valve screening for assessing prosthetic heart valves can also be performed under x-ray imaging.
Because infections of the heart are caused by bacterial infections, your treatment will be focused on prescribing antibiotics to fight the infection. Antibiotic treatment may be given in hospital on an IV so that you can be monitored by your cardiologist, Dr Ho, and the hospital staff.
In severe cases where the endocarditis has led to valvular heart disease, and a particular valve has become damaged, the blood flow may be compromised. In severe cases, surgery may be required to replace a damaged heart valve with a prosthetic or bio-prosthetic valve.