Valvular heart disease

The valves that separate the different chambers of the heart can become stiff and difficult to open or liable to leak. This reduces the efficiency of the heart as a pump and is known as valvular heart disease. When valves don't open well it is known as stenosis and when they leak it is called valve incompetence or regurgitation. Both can lead to heart failure and problems with arrhythmias.

Most cases of valvular heart disease can be detected with a stethoscope because the abnormal blood flow often produces a sound called a heart 'murmur'. Not all murmurs are abnormal or the result of heart disease.

Causes

• Congenital heart disease: some people have malformed heart valves when they are born, but only start to notice problems as they get older (because their heart has to work harder). Abnormal valves are more likely to become infected, this is known as endocarditis and, unfortunately, infections can also make leaks more likely.
• Rheumatic fever: most sore throats are caused by viruses, but some are caused by a bacteria called 'streptococcus', which in turn can cause rheumatic fever. This is an inflammation of connective tissues throughout the body such as those in our joints, skin and also our hearts. Rheumatic fever can damage the delicate structure of heart valves.
• Due to the discovery and use of antibiotics, rheumatic fever is far less common now in the UK than it was in the past. However older people and people who grew up in developing countries may have been affected by it. If you know that you have had rheumatic fever you will need regular examinations to ensure that your heart valves are undamaged.
• Weakening of the heart: heart attacks, infections and disease of the muscle itself can weaken the heart muscle. As we get older, our heart valves can become less supple and therefore more likely to leak.

Treatment

Medications are often quite effective in treating cases of valvular regurgitation, however stenotic valves generally require surgical procedures. Control of high blood pressure can be particularly important in people with valvular heart disease. Additionally drugs that thin the blood may be prescribed to reduce the likelihood of clots forming.

Arrhythmias and atrial fibrillation

Irregular heartbeats or arrhythmias cause the heart to pump less effectively. Atrial fibrillation is a particular kind of irregular heartbeat that becomes more common as we get older; it affects 3-5 per cent of people over 70 and can increase the risk of stroke.

There may not be any symptoms, but you may be aware of an irregular or rapid heartbeat for several minutes or possibly hours. These palpitations can become permanent.

Treatment

Treatments vary, but can include aspirin or anti-coagulation medication such as warfarin. An electrical current can be used to help the heart return to a normal rhythm and surgery might be appropriate for severe cases.

Cardiomyopathy

This is a disease of the heart muscle itself, which can lead to heart failure. The heart loses its ability to pump blood and, in some instances, heart rhythm is disturbed, leading to irregular heartbeats, or arrhythmias. Cardiomyopathy can be caused by viral infections. Sometimes the exact cause of the muscle disease is never found.

Congenital heart disease (heart defects from birth)

Some people's hearts or the veins and arteries around the heart, do not develop normally before birth; this is what is known as a congenital heart defect. Most defects either obstruct how blood flows in and around the heart (known as stenoses) or cause blood to flow though the heart in an abnormal pattern.

Heart failure

Heart failure is a general term used when the heart muscle is weak and unable to pump blood efficiently. The heart is still working, but it isn't doing its job of supplying oxygen to the rest of the body properly. Symptoms include feeling tired all of the time, becoming breathless very easily and swollen ankles.

Heart failure affects about one in ten of people aged over 65 years. It usually results from a heart attack or years of high blood pressure and coronary heart disease.

Current treatments for heart failure can relieve symptoms and slow the progression of the condition. Medication may include diuretics, beta blockers and ACE (angiotensin converting enzyme) inhibitors.