Prevention of Heart Valve Disease
Age-related or congenital heart valve disease may not lend themselves to prevention but, otherwise, prevention hinges on preventing the conditions which cause intrinsic defect in valvular leaflet structural integrity or flow dynamic abnormalities in their function.
Endocarditis is a common cause of valvular disease and treatment of it is preventative:
- In the very young, rheumatic fever can have long-term consequences on the mitral and aortic valves, called rheumatic heart disease. Its progression is prevented by early identification and antibiotic treatment when it is suspected.
- Intravenous drug abusers who cease this particular type of drug abuse protect themselves from the endocarditis that typically involves the heart valves, caused by seeding the bloodstream with infectious agents or the inadvertent injection of talc with drug preparation.
- Better dental hygiene can guard against the endocarditis from increased risk due to the intravascular seeding of bacteria seen in dental abscesses.
- Renal dialysis patients should have scrupulous interval evaluations of their implanted shunts or their iatrogenic fistulas that render dialysis access, and when inflammation indicates possible infection, blood cultures and appropriate antibiotic treatment based on them should be started immediately; shunt removal/replacement may be necessary.
Rheumatic arthritis, an immunological disease, can result in valve compromise. The conventional treatment of this and other medical illnesses can impact favorably upon the valvular dysfunction that sometimes arises from them:
- Systemic lupus erythematosus
- Aortic dissection
- Connective tissue disorders
This requires control of diabetes, blood pressure, lipid abnormalities, sedentary lifestyle, and even genetic studies when indicated.
Prevention of conditions that arise from valvular disease is also important. Such complications are often life-threatening and include the following:
- Cardiac arrhythmia
- Heart failure
- Pulmonary hypertension
- Atrial enlargement
- Ventricular enlargement
Prevention of complications from the treatment of valvular disease is another necessary component in the larger picture of prevention:
- Thrombosis on mechanical replacement valves is prevented (or treated) with anticoagulation therapy
- Recurrent endocarditis can be prevented by prophylactic antibiotics, continuously, in those at risk, along with periodic imaging via ultrasound or CT
- Mechanical failure of mechanical replacement valves, can be assessed using transesophageal echocardiography
In pregnancy, any patient with valvular heart disease is at increased risk of cardiac decompensation due to the pregnancy-related hemodynamic changes to heart rate, stroke volume, and cardiac output. Prior to a planned pregnancy, or immediately after diagnosis of an unplanned pregnancy, women with valvular disease should have echocardiography, exercise testing, as well as discontinuation of some of the medications they are on for their cardiac condition which may prove harmful to the gestating baby. Thrombosis due to the thrombogenic influence of estrogen in pregnancy is a serious threat to mechanical valves. In general, other risks are based on the presence of left heart obstruction, arrhythmias, pulmonary or atrioventricular regurgitation, and/or symptomatic heart failure. Referral to a maternal-fetal specialist is essential for a combined approach to such patients.