Heart Valves

Heart Valves

Have you ever asked the question what are heart valves? Well, if so you are probably not alone. For those of us who have spent some time on the internet doing research on heart disease the term heart calves comes up often. In short, the heart valves open close when the heart beats in order to ensure that blood flows in only one direction. Without the aid of heart valves, it would be impossible for blood to pump through all four of the hearts chambers. As you could imagine, this is why the heart valves are so important. If you have symptoms of a condition that has to do with heart valves it would be a wise idea to see your doctor as soon as possible. If the heart valves are not functioning properly then there is a chance that you could have a heart attack.

Heart Valve Overview

Each heart valve has a set of flaps that open and close in full when they are functioning properly. The valves can be defective at birth or there are things that can happen in order to make them become defective.

* There are four heart valves located in the heart.
* The tricuspid valve is located between the right atrium and the right ventricle.
* The pulmonary valve can be found between the pulmonary artery and the right ventricle.
* Between the left atrium and the left ventricle is the mitral valve.
* The aortic valve is between the aorta and left ventricle.
* An infection can cause any one of the heart valves to malfunction.
* As you become older, the valve structure can change for the worse.

Defective Heart Valves

* A defective heart valve could be one that does not open fully which means that enough blood is not getting through to the heart.
* A defective valve may also not close completely which can lead to a backup of blood in the heart and surrounding areas.
* Defective heart valves can either be treated with medication or surgery. The severity of the malfunction with the valve determines the course of treatment.

Exactly what are heart valves is a question that everyone should know the answer to. Since properly functioning heart valves are essential to one’s health is really important to know what the warning signs are for this condition. Having a faulty heart valve diagnosed early will give you a better chance of living comfortably with the condition.

Normal heart sounds

Normal heart sounds are produced by heart valves movements during cardiac cycle (events that take place during a heartbeat). There are two  normal heart sounds which are usually heard during heart auscultation: sound 1 and 2. Before we go farther with explanations, it is better to clarify a few elementary terms in order to understand the rest of the description.
Our heart has four chambers called ventricle and atrium, atrium are the heart chambers located in the upper part, while ventricles are located in the lower part:

• there is a right atrium connected to the right ventricle, in this part of the heart there is blood with carbon dioxide, brought by cava veins from tissues; then blood from right atrium flows through tricuspid valve ( it is like a door between the right chambers of the heart, which is open only in specific moments of the cardiac cycle) into right ventricle,
• the left part of the heart has also two chambers-atrium and ventricle, they are separated by mitral valve and contain blood with oxygen, brought from lungs.

So-called right and left heart are separated by a wall called septum, in abnormal situation this wall can be interrupted letting blood to flow from one part of the heart to the other and this situation can also generate ab normal heart sounds, a murmur that we hear during auscultations.
When we listen heartbeats with a stethoscope we can hear the two normal heart sounds 1 and 2, followed by a pause. Next, we will explain a few terms about cardiac cycle: every cardiac cycle has two phases-the contraction called systole and a pause caused diastole. Why are these two phases of the cardiac cycle so important? The atrium contraction will make blood to flow into the ventricle, while ventricle contraction will „throw” the blood into the main arteries, aorta (this artery with its branches supplies with blood and oxygen all the tissues of the body) and pulmonary artery (the blood with carbon dioxide resulted from cell metabolism is brought to lungs to be oxygenated). The pause we hear is nothing else but the time that hearts needs to relax in order to fill the chambers with blood; in this pause heart muscle also receives blood, because as any organ its function depends on the oxygen supply. All these „events” happen very fast and the indirect prove for these are  the normal heart sounds we hear in the auscultation.

Normal heart sounds description

Finally, we get to the point where we can define the meaning of the normal heart sounds 1 and 2. Sound 1 is a low frequency sound heard at the beginning of the ventricular contraction (also called heart systole), and results from mitral and tricuspid valve closure. Once these valves are closed, the ventricle contraction starts, also the pressure in this chamber increases and the blood will flow into the main arteries. Another normal heart sound is sound 2, a high frequency sound, resulted from aortic and pulmonary arteries valve closure, and signifies the beginning of the heart diastole (the pause that follows heart contraction).
Other sounds we may detect in heart auscultation are sound 3 and 4; these are not considered normal heart sounds, with a few exceptions. Sound 3 is heard in the first part of the diastole (heart pause) and may be the result of tachycardia, heart failure etc. Sound 4 appears in the last part of the heart relaxation, in patients with hypertension, myocarditis (heart muscle dysfunction) or mitral valve narrowing
Normal heart sounds are heard in specific areas of the chest called auscultation areas. Another aspect we have to mention is that normal heart sounds can be more intense in younger persons, due to a thinner thoracic wall or in conditions of stress or in effort, because the blood speed increases.
Normal heart sounds indicate a healthy heart?
 Normal heart sounds are not necessary associated with a normal heart function, that’s why, beside this basic examination, doctors look for other signs, investigations, medical history and symptoms.

Please let the doctor decide if you have normal heart sounds, and never try to treat yourself.

Left sided heart failure

Left sided heart failure is the term used to describe the incapacity of the left heart to supply tissues with blood. Left heart has two chambers known as left atrium and ventricle, which communicate thorough the mitral valve. The left atrium (the left upper chamber of the heart) receives oxygenated blood from the lungs, through pulmonary veins and this blood will be delivered to left ventricle (the lower left chamber). The whole amount of blood is pumped by left ventricle in the aorta (which is the main artery of the body) and then into the less large arteries that supply all the tissues and organs (kidney, liver, digestive organs, brain, limbs). Imagine blood flowing in the arteries as a liquid passing through a tube (pipe) and all the factors and interactions between them, which have great influence on the amount of blood that in the end each tissue will get and also the influence on the whole organism: e.g. blood consistency (a viscous blood will allow clots to appear), pressure that blood develops on arterial wall, the influence of arterial walls pressure on blood flow etc.

What is the cause for left sided heart failure?

Left sided heart failure is caused by different pathologies:

• congenital heart diseases,
• heart attack (the ischemia determines cardiac cells to die and a part of the heart is no longer functional),
• coronary heart disease (a chronic ischemia of the heart tissue, a chronic deprivation of oxygen will determine tissues changes in order to adapt to the new condition and in the end cardiomyopathy and left sided heart failure)
• high blood pressure forces the left heart to increase its labor and force, and the only way this can be possible is to increase number of muscle fibers (but the numbers of vessels will remain unchanged, so the same number of vessels will supply a larger number of muscle fibers, which will determine heart ischemia with all the consequences that result from this condition) and increase inside pressure (this pressure will act on heart walls to and will press the vessels which won’t be able to fill enough and this will lead to ischemia)
• another cause of left sided heart failure is heart valves pathology: leaking valves (an amount of blood remains in the heart chambers creating a blood deficit in the tissues and forcing heart, at the next contraction, to throw in the aorta a larger amount of blood, this means a greater labor, which in time will lead to left sided heart failure) or narrow valves (the heart muscle must defeat the obstacle represented by the narrow valves),
• heart muscle infection will determine cardiomyopathy and left sided heart failure,
• excessive alcohol consumption will determine dilated cardiomyopathy and left sided heart failure,
• thyroid dysfunctions,
• heart muscle disorders,
• major cardiac arrhythmia (irregular heart beats).

What happens in the systemic blood circulation, when there is a left sided heart failure?

Left sided heart failure

Compromise of left ventricular function will result in poor systemic circulation: muscle weakness, cool extremities, fatigue, low tolerance to effort, fainting, chest pain, palpitations, rapid heart beats, dizziness, confusion, memory impairment. Backward failure of left ventricle results in pulmonary congestion (blood will remain in the pulmonary veins creating a great pressure and determining shortness of breath, first on exertion and then at rest), hypoxemia (low level of oxygen in the blood), cyanosis (blue coloring of the extremities, because of the hypoxemia), tachypnea (increased rate of breathing), pulmonary edema (because of the great pressure in the pulmonary veins, the fluid from the blood will go through veins walls into the lung). Valvular heart disease may occur due to the increased pressures in heart chambers and pulmonary veins. Another symptom of left sided heart failure is paroxysmal nocturnal dyspnea (sudden and severe breathlessness attack during night, several hours after going to sleep).
If you have signs of left sided heart failure please call an MD for medical advice.