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In patients with valvular heart disease, the symptoms normally appear slowly and progressively, so that a person may not have any symptoms for years. Sometimes, the appearance of another disease, such as an infectious condition or a rapid arrhythmia, causes the first decompensation.
Shortness of breath (dyspnoea). This initially manifests when the sufferer makes a significant physical effort, like walking up a hill or going up stairs, and, if no medical action is taken, it can progress to the point where it occurs when the person is at rest. It may be accompanied by nocturnal symptoms, such as difficulties lying down and the need to sleep propped up (orthopnoea), the need to get up to urinate several times a night, and in advanced cases, shortness of breath (paroxysmal nocturnal), which forces the patient to get out of bed to try and get more air, by opening the window, for example.
Oedema or swelling of both feet. This can extend to the calf muscles in the legs and appears in advanced cases. This should be distinguished from oedema produced by varicose veins, which is much more frequent and benign.
Instability or loss of consciousness. Patients with aortic stenosis may experience these symptoms if they make a significant physical effort. There may also be chest discomfort that can range from a tightness to stabbing pains.
Palpitations. The heartbeat feels fast and/or irregular. This arrhythmia is studied to diagnose valvular heart disease. Infrequently, this arrhythmia is so fast that it is accompanied by feelings of instability and even loss of consciousness.
Signs of valvular heart disease
The signs involve changes in the body that are secondary to the disease and which, if present, help lead to a diagnosis that is eventually confirmed through diagnostic tests.
Heart murmur. The murmur is the sound of blood turbulence as it passes through a diseased valve, which either does not open properly (what we call valve stenosis) or does not close sufficiently (valve insufficiency or regurgitation). This is detected using a stethoscope. The characteristics of the murmur, where in the chest it is heard, at what point during the heartbeat, and its intensity, help the medical team diagnose it.
Arrhythmia. While the sound of the heartbeat is being monitored, the doctors check that the heartbeat is rhythmic. If it is not, it could be cardiac arrhythmia.
Fluid retention. What the skin looks like and the hardness of the oedema (or swelling) in the feet, ankles, and calves shows how chronic the process is. The lungs are also monitored for sound.
Enlarged liver. Sometimes the enlargement of the liver can be determined by feeling the abdomen.