agulants to reduce the risk for blood clots and beta
blockers or calcium channel blockers to lower
BLOOD PRESSUREand slow the HEART RATE. When
heart failure or cardiomyopathy is also present,
the cardiologist may prescribe digoxin to
strengthen the heart’s contractions and diuretic
medications to reduce or prevent excessive fluid
accumulation in the body tissues. Lifestyle efforts,
such as nutritious EATING HABITSand daily physical
exercise, are important to improve overall cardio-
vascular status. SMOKING CESSATIONand weight loss,
if appropriate, are essential to reduce the risk for
further CARDIOVASCULAR DISEASE(CVD).
Surgery becomes a treatment option when
medical efforts are unsuccessful or valve damage is
significant. Surgical options include repair (valvu-
loplasty) or replacement (prosthetic valve).
Valvuloplasty Balloon valvuloplasty is a proce-
dure to treat stenosis in which the cardiologist
uses cardiac catheterization to thread a catheter
with a tiny balloon on the tip through a blood ves-
sel and into the heart. When the catheter tip is in
position in the valve’s opening, the cardiologist
inflates the balloon to gently expand the opening.
Operative valvuloplasty involves OPEN HEART SUR-
GERYto gain access to the diseased valve. The sur-
geon may use various methods to repair the valve,
depending on the valve and the nature of the
damage.
Valve replacement The surgeon may replace a
damaged valve that is beyond repair. Prosthetic
heart valves fall into two general categories, tissue
and mechanical. Tissue valves come from human
cadaver donors or animal tissues. Animal valves
are typically porcine (pig) or bovine (cow) and are
sterilized and processed before use. The advantage
to tissue valves is that they function in the same
manner as the native valve. The disadvantage is
that they wear out. Mechanical valves are made of
materials such as stainless steel and high-tech
plastics. Their main advantage is that they are
completely inert and last a very long time. After
receiving a prosthetic heart valve the person must
take ANTICOAGULATION THERAPYfor life and take pro-
phylactic antibiotics before invasive dental, surgi-
cal, or diagnostic procedures. Prosthetic valves,
whether tissue or mechanical, are prone to col-
lecting blood clots. A valve replacement OPERATION
is also open heart surgery.
Risk Factors and Preventive Measures
Adults who are over the age of 40 may have had
rheumatic FEVER or rheumatic heart disease as
children and may be vulnerable to valvular heart
disease as a result. Most people under the age of
40 receive antibiotic medications as the standard
course of treatment for strep throat, which has
greatly reduced the spread of the infection to the
heart. Despite these advances, however, nearly
20,000 Americans a year die from valvular heart
disease. It remains essential to receive prompt and
appropriate treatment for strep infections as well
as for early indications of valvular heart disease.
People who know or believe they had rheumatic
fever in childhood should make sure their doctors
are aware of this when having routine medical
examinations or receiving treatment for other car-
diovascular conditions.
See alsoCARDIOPULMONARY BYPASS; CARDIOVASCU-
LAR DISEASE PREVENTION; CONGENITAL HEART DISEASE;
LIVING WITH CARDIOVASCULAR DISEASE; OBESITY AND
CARDIOVASCULAR DISEASE; WEIGHT LOSS AND WEIGHT
MANAGEMENT.varicose veins Distended and distorted veins,
typically occurring in the legs. Varicose veins indi-
cate dysfunctional venous valves, which allow
BLOODto backflow or to pool in the VEINwhen
standing or sitting (VENOUS INSUFFICIENCY). There
appears to be a GENETIC PREDISPOSITIONfor varicose
veins, in that they seem to run in families. Vari-
cose veins become more common with increasing
age, as the blood vessels lose elasticity and other
health conditions become contributing factors.
Women are more likely than men to develop vari-
cose veins, though men and women who spend a
lot of time standing are at increased risk for vari-
cose veins.
Varicose veins appear enlarged and twisted
beneath the skin’s surface, most noticeably on the
lower legs. For many people, varicose veins are
more of a cosmetic than a health concern. Some
people experience leg cramps, soreness, and itch-
ing. Severe varicose veins result in extensive blood
pooling that can cause changes in SKINcolor or
skin ulcers (venous stasis ulcers) to develop. Most
varicose veins respond to conservative treatment
such as frequent elevation to relieve the pressure
gravity exerts on blood flow. Regular walking114 The Cardiovascular System