I have realized that having a chronic condition like congestive heart failure means that I will never be bored. I get to learn a lot of new stuff. But learning about heart failures has both advantages and disadvantages So the good side - throughout my life and career, I have been a very curious person. So I always have and always will try to learn more about the things that impact me in an effort to challenge the unknown. Seriously - Just ask my heart failure team. I ask a lot of questions!
So the bad side – now that I am retired, I would like to pick and choose what I can learn about. Learning about things that involve fashion - awesome! Learning about things that involve how my blood flows through my body – ewww!!!! Learning about things that involve other cultures and the history of their nations is fascinating! Learning about things that involve how mechanical, electrical or parts in our bodies work is sometimes boring (like watching paint dry), and again, sometimes a bit gross!
However, I didn’t really get a choice in whether or not I had heart failure. By some twist of fate, it is a fact of my everyday life. So I have to face the heart failure learning curve even if I don’t like it, and it is sensible to study up on whatever it is that is causing my heart to work less efficiently.
One of the things that has worsened over time is my mitral valve. When I started to have echocardiograms a few years ago, the test reflected that there was a leak in my mitral valve that was mild to moderate. Since that time, the leak has become moderate to severe.
As I have said before in this blog, my level of heart knowledge was pretty much limited to candy hearts and valentines in the middle of February. But now the heart no longer signifies happy holiday times and love. It signifies shortness of breath, retention of water, pills and devices, and at some point, perhaps death at an earlier date than I had planned.
In the mechanical and plumbing world, a valve is a device that regulates, directs or controls the flow of some type of liquid or gas by opening, closing or obstructing various passageways. For example, there are valves in your kitchen sink that you can shut off when you need to fix your faucets. Valves are used everywhere – the industrial sector, the commercial sector, the residential sector, the military sector and the transportation sector.
Music is more melodious because of valves. Trumpet and trombone players have a device called a water valve on their instruments. Condensation forms in the valve and players have to periodically empty it to drain the accumulated fluid from the instrument. While it is sometimes referred to in the lay world by the rather gross term of “spit valve”, it is actually condensed breath moisture that is being drained from the instrument.
But that ends my knowledge of valves. I was not well versed in what a heart valve did, or how many valves there are in the heart. In my defense, the hearts created by Hallmark, Godiva, Whitman and others do not display valves pumping blood through the heart.
So what does a valve do anyway? This is the point where I always start to ask questions that I know can drive the docs nuts – like, what is the category beyond severe???? Am I anywhere close to that?????? If there are leaks, can I have a spit valve type device where I can empty out the excess fluid when I get an alert? And what is the function of the freaking mitral valve anyway????
But in reality, I knew that I would not be able to present these these simplistic (and possibly annoying) questions to my doctor. True, I needed to make up for my lack of knowledge of the parts that made up the heart, and how they worked together. But as much as it would have been great to play “stump the band”, and hit my doctors with an endless stream of questions, I knew this was not possible. Not because I didn’t want to, but because I only see them once every 4 months or so, and my brain keeps creating endless questions that I want to know the answer to now.
So I decided instead to do some research to gain more knowledge about what a heart valve did. The web is of course the logical place to start looking. There are a number of good and reputable websites out there sponsored by organizations such as the American Heart Association, the Cleveland Clinic, or the Mayo Clinic (and others out there sponsored by medical organizations). Websites like these contain accurate information and it is presented in a way that a lay person can understand.
I learned from the American Heart Association’s website that the heart actually has four valves: the aortic valve, the pulmonary valve, the triscupid valve, and the mitral valve. So on the happy side – at least the other three valves seem to be working fairly well. On the gloomy side, the leak in my mitral valve has been getting more pronounced.
The function of the mitral valve is to close off the upper left chamber (left atrium) of the heart, so that the oxygen rich blood can be collected as it comes into the chamber. Then the mitral valve opens to allow the blood to flow from the upper left side to the lower left side (or from the left atrium to the left ventricle).
As is the case with the other three valves, the key to properly working heart valves is that they: are properly formed and flexible, they open all the way so that the right amount of blood can pass through, and they close tightly so that no blood leaks back into the chamber.
Here is what the report on my mitral valve said after the January 2016 echocardiogram: “Mitral valve morphology is normal. Leaflet excursion is normal. No hemodynamically significant mitral valve stenosis. Moderate to severe mitral valve regurgitation. “
I understand about 1/5 of what this report says. It appears to me that having the appearance of the word “normal” twice in the paragraph is a good thing. I say this despite the fact that I spent my whole life trying to be unique, and not always succeeding. I finally came to a point in my life when being normal is a fantastic benchmark.
It also seems to me that the term that there was no “hemodynamically significant stenosis” is also a good thing (even if the phrase is difficult to say and to type). But I am puzzled that my mitral valve leaflet has the time and money to go on an excursion. Seriously – it needs to get back in my heart chamber and start doing its job! (This is why my doctors probably don’t give me a lot of technical reports. I just love weaving a humorous interpretation into the technical terms).
As you can see, it is in that last element that my mitral valve fails to do the job. My mitral valve does not close properly, and as a result, blood leaks back into the chamber. This regurgitation causes my heart to have to pump some of the blood twice, thus working less efficiently. No wonder I’m a little tired!
My next question was: what is the problem that results from mitral regurgitation? According to the American Heart Association, leakage can increase blood volume and pressure in the area. The increased blood pressure in the left atrium can increase pressure in the veins leading from the lungs to the heart (pulmonary veins). If regurgitation is severe, increased pressure may result in congestion (or fluid build-up) in the lungs. (Hmmmm – maybe this is why my advanced heart failure doctor wants me to have a right cardiac catheterization periodically to check the pressure within the heart, and the pressure between the heart and the lung).
It would require surgery at this point to fix the valve. I think my doctors feel that since I am still functioning really well, the risk of surgery is not worth taking. It also looks like there is a fix on the horizon that would not require surgery. It is a clamp that can be inserted with a catheter to close the valve. So it appears that we will just wait until this process gets the approval for patients like me. Then we will assess to see if the process is something that we want to pursue.
This weak little heart is beginning to remind me of the little engine that could – pumping and re-pumping blood to pull this body through each day of life. I not only think my heart can continue to function well, I am positive that it can. Still, I can only wonder if life will be a little easier if and when we fix the valve.
But even with the leaks in my heart, I am confident that the secrets of my exciting life will not leak into the media.
Melanie discovered that she had heart failure in 2013. Since that time, she has been learning how to live with the condition, and how to achieve balance and personal growth.