Conditions and Treatments

 

Coronary Artery Disease 

 
Build up of cholesterol laden plaques in the wall of the coronary artery can cause narrowing , leading to restriction of blood supply to the heart muscle. This usually results in development of Angina.

Angina is a type of pain which comes on when you exercise and subsides when you rest. The pain or discomfort is usually like a crushing pain in the center of the chest and can radiate to the shoulder, jaw or arms. Sometimes it is like a tight band around the chest and in some it can cause a choking sensation in the throat. This pain can be helped by using nitroglycerine tablet or spray and if it does not settle rapidly, hospital admission should be sought.

Occasionally, the cholesterol plaque can rupture and clots forming at the site can block the coronary artery completely. This results in oxygen  deprivation in the related heart muscle and death of the cells. This is called a Heart Attack and variable amount of heart muscle will die. This requires an emergency admission into a hospital so that the blocked vessel can be opened as quickly as possible ( using clot-busting drugs or Angioplasty with a balloon and stent) to minimise the size of the heart damage.

If the heart becomes significantly damaged, breathlessness can develop. Some patients never feel pain of angina (especially diabetics) and can present with breathlessness or dyspepsia.
 

Aortic Valve Disease

 
Aortic Stenosis  (narrowing)

This is the commonest form of heart valve disease in the UK. The aortic valve can be damaged by rheumatic fever in childhood and can present in adult life with narrowing.  Deposition of calcium causes the leaflets to stiffen and act as an obstruction to the forward blood flow. More commonly, the aortic valve degenerates with age and heavy calcification causes obstruction.

When a patient complaints of breathlessness or angina and has a significant pressure drop across the valve, the surgeon will recommend a valve replacement.
 
Aortic Valve regurgitation (Leak)

When the heart beats and pushes blood into the main artery (Aorta), the Aortic valve closes and stops the blood from falling back and acts as a one-way valve. If the aortic valve is leaking,, a lot of the blood will fall back into the cavity of the heart and increase the workload. Patients tolerate this well for a long time but if they should become symptomatic or show dilatation of the heart on echocardiography, the surgeon will recommend  repair or replacement of the valve.
 

Mitral valve disease

 
Mitral Valve Stenosis
 
This is the end result of rheumatic heart valve disease. The valve is narrowed by fibrosis and fusion of leaflets and often calcification. Blood is having difficulty going from the left atrium to the left ventricle and consequently the pressures in the atrium are raised. This causes the atrium to dilate and may induce atrial fibrillation (irregular heart beat). Some patients may also get back pressure on the circulation in the lungs.  When the valve opening is significantly compromised and there are symptoms, your surgeon will recommend  repair or replacement of the valve.
 
Mitral Valve Regurgitation (Leak)
 
This can occur if the chords (strings) holding the valve snap and lead to part of the valve becoming flail. If the leakage is severe, surgery will be indicated to repair the valve. This can be achieved by cutting out the flail segment and using a tightening ring or by creating new chords. Sometimes, the valve leaks as an end result of heart attacks. Repair can often be achieved but sometimes the valve will have to be changed. Infection (Endocardits) can also cause severe damage to the valve leaflets requiring repair or replacement.

 

Pulmonary Valve

 
It is rare for this valve to go wrong in adult life
 

Tricuspid Valve

 

This valve is on the right side of the heart. It can be affected by rheumatic disease and by infections. If the valve is infected it will be changed. Sometimes the back pressure from mitral valve disease can cause dilatation of the ring and leakage . this type of problem can be dealt with by repair.