Surgeon Q&A: Heart Failure & Heart Valve Disease

It is critical for heart valve disease patients to learn the facts about heart failure and its relationship to valvular defects including aortic stenosis and mitral regurgitation. Once symptoms of heart failure become apparent, surgery to replace the problem valve is likely. The further heart failure progresses, the greater the chance of permanent heart damage and poor outcomes.

To learn more about heart failure and its association to heart valve disease, we interviewed Dr. Joanna Chikwe, Chair of Cardiac Surgery at Cedars-Sinai Medical Center.  Dr. Chikwe provided several critical insights about what patients should know about heart failure and heart valve disease.

Key Learnings About Heart Valve Disease and Heart Failure

Here are important points for patient to consider from Dr. Chikwe:

• What is heart failure? Chikwe said, “Simply put, it is when the heart doesn’t pump well enough to deliver enough blood to the body to do what it needs to do.” She explained that sometimes people have heart failure because their valves don’t work, sometimes the coronary arteries don’t supply the heart muscle with enough energy to do its work, or sometimes there are problems inside the muscle.
• What are the symptoms of heart failure? “Heart failure can happen suddenly, or it can happen gradually, and people don’t even notice that they start to feel fatigued. The classic symptom that we ask everybody is about breathing problems,” said Dr. Chikwe. “You might feel breathless when doing something different, or even low energy, like just walking around your house.”

• How to know if you have heart failure? Chikwe explained, “There are many things that can make you feel breathless or fatigued. So, the first stop will be your primary doctor or cardiologist. They will ask you about your history and do a physical exam. Then, they’ll start thinking about tests that can help them evaluate your heart. One of those tests will probably be an echocardiogram, that lets us look at your heart function in more detail.
• Is it common for patients with heart valve disease to also have heart failure? Chikwe explained that, as a surgeon, it is uncommon for her to see patients with heart failure. She said, “Usually, those patients are sent to me to help avoid the risk of heart failure. We have a specialist team of heart failure cardiologists who see a lot of heart failure patients.”
• If a patient has both heart valve disease and heart failure, are there therapies and treatments to help manage both diseases? “Absolutely,” said Dr. Chikwe. “One of the most important things we do as surgeons is to operate on people to prevent heart failure. We’re trying to preserve the heart function by fixing the underlying problem, which may be valve disease. About one-fifth to one-quarter of patients that we see are already in heart failure, so then we’re operating to stop that from getting worse.”

• Is it more common to have a valve repair or a replacement for patients with valve disease and heart failure? “That’s a great question,” said Dr. Chikwe. “Let’s work through each valve because each one is different. If the mitral valve leaks, a repair is usually the gold standard, particularly if the valve is floppy or prolapsing. The aortic valve is different. Generally, we replace that valve if it’s too tight. If the valve leaks, sometimes we can repair it. We’ve talked about the left-sided heart valves, and we used to gloss over the right-sided heart valves. But we’ve become much more aware of their importance, and the tricuspid valve can be a significant driver of heart failure on the right side of the heart. The tricuspid valve, which is also repairable, can often leak because of heart failure on the left side of the heart.”
• What is your advice for patients who hear they have heart failure and heart valve disease? “First of all, don’t panic,” she said. “Those sound like really big, ugly, scary words, but there is amazing medical therapy now that helps people get out of heart failure. Also, if you have severe valve disease, there’s almost always an option to treat that to help your heart work as efficiently as it can for as long as possible.”

Thanks Dr. Chikwe and the Cedars-Sinai Team!

Thank you, Dr. Joanna Chikwe, for sharing all this great information about heart failure with our community. On behalf of all the patients, thanks also to your entire team at Cedars-Sinai Medical Center.

Related Links:

• Top 5 Complications After Heart Valve Surgery
• Early Surgery for Aortic Stenosis?
• Surgical Mitral Valve Repair: The Gold Standard for Mitral Regurgitation

Keep on tickin!
Adam

P.S. For the deaf and hard-of-hearing members of our community, I have provided a written transcript to this video below.

Reference: Gillinov AM, Mihaljevic T, Blackstone EH, et al. Should Patients With Severe Degenerative Mitral Regurgitation Delay Surgery Until Symptoms Develop? Ann Thorac Surg. 2010;90(2):481-488. doi:10.1016/j.athoracsur.2010.03.101