The heart has four valves, namely the tricuspid, aortic, mitral, and pulmonary, all of which play an important role in controlling the flow of blood forward and preventing backflow. Each of the valves has leaflets that open and close with each heartbeat. Heart valve disease in the elderly is not uncommon.  Sometimes these valves can get damaged and either become too narrow or too loose. When they become narrowed, the heart is unable to pump the blood out and when they become too loose, the blood keeps on flowing back into the heart. In both cases, if the heart valves are not fixed, the individual can develop a wide range of symptoms.

Causes of Valve Disease

Valves can be damaged for a variety of reasons that include the following:

• Wear and tear due to advancing age
• Infections
• Trauma
• Congenital (born with a defective valve)
• Linked to other disorders, like coronary artery disease

What are the Symptoms of Heart Valve Problems?

The symptoms of heart valve problems depend on the cause and usually include the following:

• Shortness of breath, which progressively gets worse
• Palpitations
• Irregular heartbeats
• Chest discomfort
• Lightheadedness
• Fainting spells or dizziness
• No exercise endurance

In most cases, once symptoms of heart valve problems appear, they tend to get worse over time. If the valve damage is not recognized, it is possible for it to lead to death.

What are the Common Valve Disorders in the Elderly?

1. Aortic stenosis is a common heart valve disease in the elderly and can be due to stiffness and narrowing of the valve. The heart is unable to pump blood out into the circulation and, consequently, you will feel light-headed, develop chest pain, and shortness of breath. If the aortic stenosis is causing symptoms, the valve needs to be replaced.
2. Aortic regurgitation is another common heart valve disease in the elderly that may be caused by an infection or degeneration of the tissues. It causes blood to leak backward into the heart and, usually, the condition is progressive. The valve will need to be replaced or the heart can be permanently damaged.
3. Mitral stenosis is caused by rheumatic fever in childhood, but the symptoms may present 2-3 decades later. The condition is not that common in North America, but with recent immigration, cases are being reported in many U.S. states. In all cases, the mitral valve needs to be replaced.
4. Mitral regurgitation can be caused by an infection, degeneration of the tissues, or coronary artery disease. It results in blood accumulating in the lungs and usually causes symptoms, such as palpitations, heart murmur, rapid heartbeat, shortness of breath, swollen ankles or feet, lightheadedness, or fatigue. The valve can be repaired or replaced in many instances.

Risk Factors for Valve Disease

Factors that increase the risk of valvular heart disease include the following:

• Advancing age
• Injection of illicit drugs
• Coronary artery disease
• Infections
• High blood pressure
• Elevated levels of cholesterol
• Trauma to the heart
• Born with a heart defect

Complications of Valvular Heart Disease

• Stroke
• Heart failure
• Blood clots that can migrate to the brain
• Changes in the heart rate and rhythm
• Death

Diagnosis

Once symptoms appear, it is important to see your healthcare provider. In the majority of cases, the healthcare provider can detect the presence of a murmur when a valve has been damaged. Tests that are usually done to confirm the presence of valvular heart disease include:

1. ECG will reveal the heart rate and rhythm. It can also reveal the presence of enlargement of the heart chambers and prior heart attacks.
2. A chest X-ray is commonly done to look for fluid in the lungs and the size of the heart.
3. Because the chest X-ray is not very sensitive, more advanced imaging studies, like an MRI, are also done to determine which valve is damaged and the heart function.
4. An echocardiogram is always done when valvular heart disease is suspected. This simple test can be done at the bedside and is noninvasive. It can reveal the status of the valves, heart function, and the size of the different chambers of the heart.
5. The doctor may perform a stress test to assess your exercise tolerance. Those who can exercise may not need immediate surgery.
6. Since people over the age of 65 often have coronary artery disease, the doctor may also order a cardiac angiogram. In many cases, in elderly patients, valve replacement and coronary artery bypass are done at the same time.

Treatment

The treatment of valvular heart disease depends on the severity of symptoms and the degree of valve damage. In most cases of mild symptoms, the treatment is medical and include the following:

• Change in lifestyle
• Use of prescription medications to control blood pressure and heart rate
• If blood clots have been identified, then blood thinners are prescribed, especially if you have atrial fibrillation

All cases of medically managed valvular heart disease are closely followed up with serial echocardiograms to assess the function of the valves. 

Severe Valvular Disease

If the individual has severe valvular heart disease and symptoms that do not respond to medications, surgery is recommended.

Surgery

1. In general, when the aortic valve is diseased, it cannot be repaired and needs to be replaced. On the other hand, the mitral valve can be replaced or repaired. Repair is preferable because the patient gets to keep his/her own natural valve.
2. When it comes to valve replacement, the patient may get a mechanical or a tissue valve. Mechanical valves last much longer and also function better, but the patient needs to be on a blood thinner for the rest of his or her life; as well, blood thinners need constant monitoring. On the other hand, tissue valves do not require blood thinners, but they are fragile and most last less than 15 years. In elderly people, the decision on which valve to use is made on life expectancy. In seniors, over the age of 75, a tissue valve is usually used because it will last about 15 years and there is no need for blood thinners. 
3. Today several types of minimally invasive procedures can be done to repair and replace the valve. In addition, in elderly individuals too frail to undergo the prolonged heart surgery procedure, there are now percutaneous procedures where the diseased valve can be replaced by a procedure done from the groin. 

Conclusion

There are different types of heart valve disease in the elderly.  Know the symptoms of heart valve problems.  If you have been diagnosed with valvular heart disease, it is important to follow up closely with a heart doctor(cardiologist) because timely intervention can improve the outcome.  Cano Health is a leader in senior care, and they accept both Medicare and Medicaid payments.  

Personalized patient care is what sets Cano Health apart from other healthcare providers.  Recently, Cano Health has implemented a new cardiovascular disease prevention program: Healthy Heart by Dr. Juan. Dr. Juan Rivera brings his experience and expertise to help patients understand their cardiovascular disease risk. Call Cano Health at 1-855-447-6059 today to learn more.