Cardiovascular diseases are the main cause of mortality worldwide.
Dr. Antonio Orraca, member of the board of directors of the Puerto Rican Society of Cardiology. Photo: Medicine and Public Health Magazine. Fabiola Plaza.
In accordance with Dr. Antonio Orraca, member of the board of directors of the Puerto Rican Society of Cardiologycardiovascular diseases are the most common in patients and their time with the main cause of mortality in Puerto Rico and worldwide, among them are valvular problems, the most frequent being aortic stenosis, which occurs when the heart’s aortic valve narrows.
According to the Mayo Clinic portal, in aortic stenosis, the valve does not open completely and this reduces or blocks blood flow from the heart to the aorta and the rest of the body, causing heart failure, stroke, blood clots, bleeding, heart rhythm problems (arrhythmias), infections that affect the heart, such as endocarditis, and even death.
For the specialist, as the population ages, the valve degenerates and calcifies, showing poor opening. In turn, he explains that another valvular condition is mitral regurgitation, which occurs in the mitral valve, this problem is also known as mitral regurgitation.
“As we get older, structural changes appear throughout the body and the heart is not spared, the valves change,” he added.
Nevertheless, What are the factors to take into account to classify valve disease as mild, moderate or severe?about it, Dr. Orraca affirms that the blood flow rate through the valves, “when we have a valve that is restricted, that does not open as it should, the blood passes through it with a certain pressure, we can measure it, classify it and quantify it with an electrocardiogram and other diagnostic tools”.
In Mayo Clinic they refer that an electrocardiogram consists of using cables (electrodes) connected to patches attached to the skin, to measure the electrical impulses of the heart. The electrocardiogram is used to detect dilated heart chambers, heart disease and heart rhythm abnormalities.
“Basically, by quantitative and qualitative parameters, in addition to the characteristics of the valve and hemodynamic measurements, we establish the severity of that valve and that in turn gives us an idea of the screening of the intervention that we are going to give that patient” explained the specialist.
In this regard, he states that it is essential to identify the patient’s problem and therefore, the physical examination, in addition to diagnostic tests and medical history, are key to the evaluation. “We also have to listen to the patient, evaluate him and dedicate time to this intervention. That often leads us to know what kind of tests we are going to do to reach a diagnosis,” he added.
Regarding the electrocardiogram, it indicates that it is an important test to identify structural changes associated with this valve problem. In turn, he expresses that many times specialists go to perform a sonogram, because it is a tool that helps to classify the severity of valve failure.
In addition to aging, there are other long-term conditions that alter the structure of the heart and consequently affect the valves, some of them are: hypertension, diabetes, obesity and alcohol consumption.
In the case of a severe valve problem already diagnosed by specialists, Dr. Orraca states that the indicated treatment depends on the valve and the patient. “Today with the modalities that are emerging, we are able to provide our patients with alternatives ranging from medical therapy, to percutaneous intervention, and we also still use open heart surgery if necessary,” he said.
In his extensive experience, he adds that when they do not have a patient with a severely diseased valve, they usually give him medical therapy, however, when it is a very severe valve problem, in addition to pharmacology, they implement the intervention.
“Sometimes the valve must be replaced, but on other occasions it is possible to repair it. This is decided by a multidisciplinary team and we integrate the patient’s relatives,” he explained.
What is the long-term prognosis of patients with valvular diseases if they do not receive treatment?
On this, he highlights the advances in medical treatments for valve problems, “many times when patients with severe valve disease come to us, the expectation can be less than 3 or 2 years without treatment. If the patient does nothing have an expectation of less than 1 year, but with the treatment we extend their survival and they can live much better” he pointed out.
See the full program here.