Heart valve disease & artificial valves

With an artificial valve the card belongs in the wallet: it tells the dentist, the emergency room and the pharmacy which valve is in place and which blood thinning goes with it.

With artificial valves, after a past infection of the heart lining and with certain congenital defects, a single dose of antibiotic is recommended before bleeding procedures in the mouth. Who belongs to that group is on the card — asking is half the protection.

Bleeding gums wash bacteria into the blood with every brushing. Regular dental hygiene lowers exactly that route — more than any single measure shortly before the appointment.

Mechanical valves need blood thinning within a narrow range that differs by valve and position. Self-measuring devices exist; more important than the device is knowing one’s own target value.

Two kilos in a few days, new breathlessness on stairs, sleeping only with the head raised: these three signs come earlier than any check-up in the calendar.

How often an ultrasound of the heart is needed depends on the severity — from yearly to every few years. The next appointment should be set at the current one.

No medicine opens a narrowed valve and none seals a leaking one — drugs treat only the consequences for pressure and rhythm. What helps is replacement. After that the choice matters: a mechanical valve usually lasts a lifetime but requires lifelong anticoagulation and regular checks; a biological valve needs no permanent blood thinning and lasts ten to twenty years depending on age.

A narrowing of the aortic valve counts as severe from an opening area under one square centimetre. Once symptoms appear — breathlessness, tightness in the chest, fainting — the course changes markedly; so that moment decides the replacement. A mechanical valve usually lasts a lifetime, a biological one ten to twenty years, less in younger people. Checks are every six to twenty-four months depending on severity.

At first only with heavy exertion, then on stairs, then walking on the flat. The comparison with last year says more than the state today.

Going black before the eyes or a brief loss of consciousness during or right after exertion is, with a narrowed aortic valve, a warning sign and belongs investigated quickly.

Needing more pillows, waking at night from breathlessness, swollen ankles towards evening and two kilos more in a few days. That is water backing up.

Unexplained fever, night sweats and weariness for more than a week with an artificial or diseased valve belongs investigated before an antibiotic is given on suspicion — blood cultures first.

Rises when the heart is strained or overloaded by significant valve disease.

With a mechanical valve, blood must be thinned lifelong and the INR kept in target range (usually ~2–3.5).

With fever and a murmur, a high value raises suspicion of valve infection (endocarditis) — blood cultures are then needed.

They lower the blood fats and act on the excitability of the heart muscle. Oily sea fish twice a week is the best-supported route; very high doses from capsules are not a harmless more.

Keeps the rhythm steady and lowers blood pressure. Water tablets drive it down, certain blood pressure drugs and a weak kidney drive it up — which is why it is checked under treatment.

A lack favours extra beats and at the same time keeps a potassium deficiency going. Anyone replacing only the potassium sees no success while the magnesium is missing.

Less salt lowers blood pressure measurably, and most of it is not in the salt cellar but in bread, cheese, cured meat and ready meals. With very low blood pressure the opposite applies.

With a mechanical valve blood thinning with warfarin-type medicines is lifelong, and vitamin K is their counterpart. The rule is not “avoid” but “steady”: someone who eats about the same amount of green vegetables every week has more stable values than someone who leaves it out entirely and then eats a lot once.

One of the few plant remedies that can really become dangerous here: it speeds the liver breakdown of the blood thinner, the protection falls — and at a mechanical valve that is exactly the situation in which a clot forms. Anyone starting or stopping it says so beforehand.

From about 3 g EPA+DHA daily the bleeding time lengthens measurably. Together with a blood thinner that adds up — it does not strengthen the protection against clots but the bleeding risk. Two portions of fish a week are something other than a high-dose capsule.

Effective when deficient; effects on sleep and stress plausible but moderate. Too much causes loose stool.

The atria release this hormone when they are stretched. With a leaking valve exactly that happens — which is why the natriuretic values often rise before complaints appear and serve for follow-up.

With an artificial valve on warfarin-type blood thinners, vitamin K is the medicine’s counterpart. Not forbidden, but steady — the swing in amount tips the value, not the amount itself.

Do not avoid it, keep it steady: eating roughly the same amount of green vegetables daily gives more stable values than cutting them out and then eating a lot. Swings are the problem, not the amount.

With artificial valves oral hygiene counts for more than any diet — bacteria from the gums can settle on the valve. Sugar frequency works here through the teeth.

After valve replacement movement belongs to rehabilitation. With mechanical valves and blood thinning, sports with a risk of falling are judged more cautiously.