Valvular Insufficiency
What causes valvular insufficiency? All the information about this condition: causes, symptoms, and treatment.
Symptoms and Causes
Valvular insufficiency, also known as valve regurgitation or valve incompetence, is a malfunction of the heart valves that prevents them from closing completely, causing blood to leak backward. This hinders the heart’s ability to pump blood efficiently.
There are four types, depending on the affected valve:
- Mitral insufficiency: The mitral valve allows blood to flow from the left atrium to the left ventricle. Insufficiency causes some of the blood to flow back into the atrium, which enlarges to compensate for the increased blood volume. It is the most common type of valvular insufficiency.
- Aortic insufficiency: The aortic valve allows blood to flow from the left ventricle into the aorta, which carries oxygen-rich blood to the rest of the body. Insufficiency causes blood to leak back into the ventricle, which may dilate over time to compensate for the excess blood.
- Tricuspid insufficiency: The tricuspid valve separates the right atrium and right ventricle. When it doesn’t close properly, some blood flows backward into the atrium, leading to dilation of the right atrium.
- Pulmonary insufficiency: The pulmonary valve allows blood to flow from the right ventricle into the pulmonary artery, which carries blood to the lungs for oxygenation. If the valve fails to close, some of the blood flows back into the ventricle, which may dilate over time due to the excess volume. This type is very rare.
Symptoms
Valvular insufficiency usually develops slowly (chronic insufficiency) and does not show symptoms until the condition becomes severe. However, aortic and mitral insufficiency can present suddenly (acute insufficiency) and cause symptoms from the outset. Acute valvular insufficiency is a medical emergency. Common symptoms of valvular insufficiency include:
- Dyspnea (shortness of breath)
- Chest pain that worsens with physical activity
- Fatigue or weakness
- Swelling in the feet and ankles
- Irregular (arrhythmia) or rapid (tachycardia) heart rate
- Dry cough, in the case of mitral insufficiency
- Lightheadedness or fainting, in cases of severe aortic insufficiency
- Neck pulsations and swelling in the abdomen or neck veins, in tricuspid insufficiency
- Wheezing or heart murmur, in pulmonary insufficiency
Causes
Valvular insufficiency may be caused by anatomical valve problems (primary valvular insufficiency) or result from other conditions (secondary valvular insufficiency). Many causes are common to all forms of insufficiency:
- Dilation of the valve annulus, which prevents closure
- Rheumatic fever
- Autoimmune diseases, such as lupus
- Connective tissue disorders, such as Marfan syndrome
- High blood pressure or pulmonary hypertension
- Congenital valve malformation
- Infective endocarditis
Other causes are specific to each valve:
- Causes of mitral insufficiency:
- Mitral valve prolapse: the valve leaflets bulge into the left atrium during systole
- Rupture or elongation of the valve tissues
- Coronary artery disease
- Cardiomyopathy
- Acute myocardial infarction
- Causes of aortic insufficiency:
- Aortic root dilation occurring along with valve widening
- Aortic stenosis
- Aortic dissection
- Reiter’s syndrome
- Acute aortic dissection
- Causes of tricuspid insufficiency:
- Congenital valve defects, such as Ebstein’s anomaly
- Carcinoid syndrome
- Use of certain medications for migraines or Parkinson’s disease
- Mitral valve disease
- Chest trauma
- Causes of pulmonary insufficiency:
- Idiopathic dilation of the pulmonary artery
- Carcinoid syndrome
Risk Factors
Factors that increase the risk of developing valvular insufficiency include:
- Presence of conditions associated with valvular insufficiency
- Advanced age
- History of valvular heart disease
- Hypertension
- Current or past infections
Complications
Long-term dilation (hypertrophy) of the heart chambers caused by severe valvular insufficiency can lead to:
- Heart failure due to weakening of the heart muscle
- Increased pressure in the pulmonary blood vessels and resulting fluid accumulation in the lungs (pulmonary hypertension)
- Atrial fibrillation, a heart rhythm disorder associated with clot formation that can lead to thromboembolism and cardiovascular events
The acute form of mitral and aortic insufficiency is very serious and may cause acute pulmonary edema, cardiogenic shock with life-threatening multiorgan failure, or sudden death.
Prevention
Some measures can help reduce the risk of developing valvular insufficiency:
- Undergo regular cardiac exams in cases of personal or family history of disorders related to valvular insufficiency, to enable early detection, facilitate treatment, and prevent serious complications
- Control blood pressure levels
- Protect against infections (which can cause endocarditis)
- Follow a heart-healthy lifestyle: avoid alcohol, tobacco, and high-fat or high-cholesterol foods; exercise; maintain a healthy weight; and adopt good sleep habits
What kind of doctor treats valvular insufficiency?
Valvular insufficiencies are diagnosed and treated in cardiology and cardiovascular surgery departments.
Diagnosis
After detecting a heart murmur and checking blood pressure during a physical exam, several tests are used to confirm a diagnosis of valvular insufficiency and determine its underlying cause:
- Electrocardiogram (ECG): measures the heart's electrical activity and detects abnormal heart rhythms. It also provides information about the size and thickness of the heart chambers.
- Chest X-ray: helps visualize pulmonary vascular congestion and an enlarged heart or arteries.
- Doppler echocardiogram: uses ultrasound to generate three-dimensional images of the heart in motion. It can identify regurgitant blood flow, pulmonary hypertension, and chamber dilation.
- Magnetic resonance imaging (MRI): produces highly detailed images using magnetic fields and radio waves. It can confirm the presence and severity of valvular insufficiency when an echocardiogram is inconclusive.
- Cardiac catheterization: involves inserting a catheter into an artery in the groin and guiding it to the heart using X-ray imaging. A special dye is then injected to visualize blood flow through the heart. This test allows for precise measurement of heart chamber and pulmonary pressures.
Treatment
Treatment depends on the affected valve, the severity of the insufficiency, and whether symptoms are present.
- Drug treatment: helps relieve symptoms and prevent complications but does not correct the malfunctioning valve. It may be used in mild or asymptomatic cases.
- Diuretics: help eliminate excess fluid
- Anticoagulants: prevent blood clots
- Antihypertensives: relax blood vessels and lower blood pressure
- Surgical treatment: in advanced cases, it may be necessary to repair or replace the damaged valve.
- Valve repair: involves removing, trimming, or reshaping dysfunctional leaflet sections so the valve can close properly. Tendinous cords or supporting structures may also be trimmed or replaced.
- Annuloplasty: the valve annulus is repaired, and a synthetic ring may be sewn around it.
- Valve replacement: required when the valve is severely damaged and cannot be repaired.
- Mechanical prosthetic valves: made of artificial materials such as plastic, carbon, or metal. These are durable and long-lasting but increase the risk of blood clots, requiring lifelong anticoagulant therapy.
- Biological prosthetic valves: made from animal tissue, donor human tissue, or the patient’s own tissue. These do not pose a clotting risk but are less durable and need to be replaced after several years.
