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The valves of the heart

November 12th, 2015


The valves of the heart

A patient once asked me whether a heart could talk, because all doctors always listen to the heart. I corrected him that I actually listen to the heart valves most of the time, and no, they don’t talk. Or maybe they do talk, but in a language incomprehensible for us human being.

In Thai, the heart valves are called the heart’s tongue, and in fact, they do share some similarities. They are both soft and flexible, but the tongue enjoys a bit more freedom but the heart valves are quite restricted and can only move when the heart says so.

While the tongue helps us pronounce words and push food down the food tract, the heart valves also guide blood into the right direction. This means the tongue is greeted with many bacteria, while the heart valves are relatively clean.

You might think the two are not related, but in reality, they do come in contact sometimes (figuratively speaking – they can’t really touch each other physically). A person with narrowed heart valves or valvular heart disease, if their oral cavity is infected, the bacteria can get into the blood stream and cause infection at the heart valves, complicating the matter.

Moreover, gingivitis is also associated with narrowed artery disease and myocardial infarction. Those with severe and chronic gingivitis are more likely to develop those diseases than those with a healthy mouth.

The heart chambers actually have specific names left and right atriums and left and right ventricles. The heart valves separate the atrium and ventricle and ventricles and main blood vessels exiting the hearts, which you already know and I will not bore you with details. In a nutshell, blood flows into the right atrium first, and fresh blood exits through left ventricle. The valves open and close, letting blood pass through and stopping the blood from flowing backward in rhythms.

The left ventricle is the strongest because it has the biggest job – to send blood to all parts of the body. The blood leaving the left ventricle exits through the aorta, the body’s main artery, where there is a valve, called aortic valve, preventing the blood to return to the chamber.

In a healthy person, the heart can transport 5-8 litres of blood throughout the body each minute. Considering how small our heart is, that’s pretty hard work.

If something is wrong with any of the heart valves, the heart has to work even harder to keep the blood supply at the same rate. This results in the heart being enlarged.

A narrowed heart valve will make it harder for blood to exit the chamber, like trying to leave a room with the door half open. The heart has to push harder to get the blood out, and the increased activity makes the muscles thicker.

A lot of people with heart valve infection do not show any symptoms. They have to be treated with antibiotics and they have to stay in the hospital for a long time. Some need operations to change the naughty heart valve. As a precaution in the past, when they have an appointment with their dentist, it is advised they take antibiotics ahead of time to prevent bacteria from entering the body through any opening resulting from dental work.

Just the other day, a patient called me from a dentist’s office, asking me whether he needed medication before removing his tooth. I remembered that he had no problem with his heart valve, so I said it was fine and he did not need medication.

A week later, he came to see me and complained that for a heart disease patient, going to the dentist is such a nightmare. It was actually miscommunication, and what he had meant by “medicine” at the time was actually local anesthetics. The poor man had had his tooth removed without numbing the area!

Prof Nithi Mahanonda is consultant cardiologist and interventionist, Perfect Heart Institute.




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