Flap de­fect

Defects can occur individually or together as a so-called "combined valve defect".
Depending on the localisation, valve defects (stenosis or insufficiency) are also summarised under the collective term of aortic, mitral, pulmonary or tricuspid vitium.

Heart valve defects initially cause no symptoms. Over time, however, the performance of the heart decreases significantly with potentially serious consequences.

Important causes of acquired heart valve defects are

• rheumatic fever (preferably mitral and aortic valve)
• Degenerative changes in valve components
• Infections (e.g. endocarditis, myocarditis or a combination of both)
• underlying cardiac diseases (condition after myocardial infarction, overstretching of the valves in pulmonary hypertension)

If they develop over a long period of time, heart valve defects can be haemodynamically compensated by adaptations of the heart (e.g. hypertrophy). In the case of sudden development (e.g. endocarditis), the possibilities of compensation are limited, resulting in an acute course.

• Measurement of the heart rate at rest (resting ECG)
• Exercise ECG (ergometry)
• Cardiac ultrasound examination (echocardiogram)
• Blood test
• Medical history of the affected patient (family history)

Additional further investigations:

• Myocardial scintigram
• MRI with visualisation of the coronary vessels (angio-MR)

Cardiac catheterisation (coronary angiography) provides precise information about the existing stenoses in the coronary arteries and the performance of the heart.

Conservative
Acute chest pain is treated with nitrates (nitoglycerin). If a heart attack is suspected
heart attack, aspirin and heparin are administered to "thin the blood".
In long-term therapy, drugs with different modes of action are used to relieve the heart (beta blockers, calcium channel blockers)
The causes of arteriosclerosis are treated by changing the diet (balanced, low-fat, low-salt), exercise therapy, stopping smoking, weight regulation and optimising blood pressure and blood sugar control in diabetics in order to prevent or slow down the progression of the disease.

Interventional
A cardiac catheterisation can be used to determine whether significant constrictions in the coronary vessels are impairing blood flow. Such constrictions can usually be treated by widening and inserting a stent.

Surgical treatment
If there are constrictions in all three coronary arteries, these are bridged with a piece of vein or artery during bypass surgery.