Heart valve disease

- congenital abnormality
- degeneration through atherosclerosis (aortic stenosis only)
- damage from rheumatic fever
- excessive calcification in old age (aortic stenosis only).

Leaking valves

These may be due to:

- bacterial infection or inflammation of a valve
- excessive floppiness of the leaflets (mitral valve prolapse)
- enlargement of the heart or aorta - the main blood vessel into which the left ventricle pumps.

What does a malformation of the heart valve feel like?

In mild cases there are no symptoms and generally no cause for worry, although antibiotic treatment to prevent the risk of a valve infection is recommended, for example to cover a dental procedure when there is a chance that there will be some bacteria introduced into the bloodstream temporarily.

Serious cases may not be evident for a long time either. There may be no symptoms, even though the heart is already under strain. In cases of stenosis of the aortic valve, it is important to be aware of the following possible symptoms, since this condition may result in sudden death:

- dizziness or a faint brought on by physical effort
- shortness of breath
- angina (chest pain) on exertion.

How does the doctor make the diagnosis?

The diagnosis is based on the patient's case history, examining the heart and by using a stethoscope to listen for any abnormal sounds or murmurs coming from the heart valves or heart muscle.

To find out if the malformation is serious, the doctor can refer the patient to a hospital for further examinations, such as echocardiography and cardiac catheterisation.

Echocardiography This is an ultrasound scan of the heart. It gives an accurate measure of the degree of the leak and/or stenosis, whether the heart's pumping ability is impaired and can often give the exact cause of the valve disease.

The resolution and accuracy of echocardiography is enhanced by performing 'transoesophageal echocardiography' in these patients. This involves the patient swallowing a fibre-optic tube under sedation. Much clearer pictures may be obtained from behind the heart with this technique.

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