Are You Feeling Breathless? It Could Be A Sign Of Structural Heart Disease

Do you feel breathless when you have been active (e.g. climbed a set of stairs)? Do you spend nights upright in a chair since you cannot breathe properly if you lie down? Do you feel as though your heart is fluttering in your chest? Are your feet swollen or do you feel tired all the time? These could be signs of heart disease and could also be due to changes in the structure of your heart.

Structural heart disease (SDH) is the name given to any disease/defect that affects any part of the heart’s structure i.e. its walls, chambers or valves. SDH can exist from birth (congenital) or can be acquired (due to infections, high blood pressure, etc.). The heart is a muscular pump that works tirelessly all your life to ensure efficient blood circulation. Within the heart, your blood moves through four chambers (two upper atria and two lower ventricles) in a single direction with the help of four gated openings called valves (tricuspid, mitral, pulmonary and aortic).

In developing countries like India, the most common reason for damage to the valves is rheumatic heart disease (RHD) which is caused due to inadequate treatment of bacterial sore throat (also called rheumatic fever). RHD affects nearly 3.6 million Indians with 44,000 new patients affected every year.[1] Indian studies show that in 6 out of 10 cases with RHD, the mitral valve (which lies between the left atrium and left ventricle) is affected.

Mitral regurgitation

The commonest forms of heart valve disease are aortic stenosis and mitral regurgitation (MR). Aortic stenosis occurs when the aortic valve (which controls the supply of blood from the heart to the rest of the body) becomes narrow whereas MR refers to a ‘leaky’ mitral valve due to which blood flows back into the heart. MR occurs in up to 10 oer cent of the general population. In addition to RHD, other causes of MR include increasing age, trauma (e.g. car accident), endocarditis (infection of the lining of the heart), previous heart attack or abnormality of the heart muscle (cardiomyopathy) and certain drugs.

Symptoms of mitral regurgitation

MR develops gradually and as it progresses the heart has to pump much harder to supply blood. However, most patients with MR do not show any symptoms for years together. As the severity increases over time, the left ventricle weakens and this may ultimately lead to heart failure or heart rhythm problems. If not treated, up to 57 percent of such patients may not survive beyond a year.

Symptoms of MR to watch out for include an abnormal heart sound (or heart murmur) which can be heard by your doctor through a stethoscope, shortness of breath (especially after exertion or while lying down), the sensation of a rapid or fluttering heartbeat (palpitation) and swelling in the feet or ankles. Pregnant women with MR should be especially careful about not missing their regular doctor visits since pregnancy causes the heart to work harder than normal.

Some lifestyle changes that can help you handle your condition better include maintaining your blood pressure and weight at normal levels, consuming a heart-friendly diet (eating plenty of fresh fruit/vegetables, nuts and lean meats, avoiding saturated/trans fats, sugar, excessive salt and refined grains), avoiding excessive smoking and alcohol consumption and regularly consulting your doctor to keep him/her aware of your condition and changes if any.

Mitral valve repair or replacement

Though some medicines can help in reducing the accompanying symptoms, open-heart surgery is the only option for treating MR. However, older patients with a history of comorbidities that involve the brain, kidney or lungs or those who are transplant recipients may not suitable candidates for open-heart surgery. For such patients, technologically advanced and minimally invasive surgical solutions are now available.

Depending on the severity of MR, your doctor may suggest either mitral valve repair or replacement. In the case of mitral valve repair, the surgeon may repair the damaged mitral valve to stop it from leaking or tighten it by placing an artificial ring around the valve (annuloplasty band). In mitral valve replacement, the entire valve is replaced with a mechanical or tissue valve.

Minimally invasive mitral repair with a mitral valve clip (MitraClip ) decreases the risk of death by 33 per cent and hospitalisation by 51 per cent. In this beating-heart procedure, the chest is not opened and a thin tube called a catheter along with a clip is guided towards the mitral valve via a vein in the patient’s leg. The implant seals the two leaflets of the mitral valve and reduces the leakage, thereby restoring normal blood flow through the heart. Patients treated with this technology spend less time in the ICU, recover quickly and obtain symptomatic relief.

Such minimally invasive technologies offer a ray of hope for patients with MR who are not eligible for traditional open-heart surgery along with a reduced risk of hospitalisation and symptoms, ultimately improving the patient’s survival and quality of life.

The author of this article is Dr Ravindra Rao- Chairman, RHL Heart Centre, Head- Complex Angioplasty, TAVI Program, Jaipur.

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