Spinal pain examination unexpectedly discovered heart valve stenosis

Dr. Tran Vu Minh Thu, Head of Cardiology Department 2, Cardiovascular Center, Tam Anh General Hospital, Ho Chi Minh City, said that mild and moderate aortic valve stenosis often does not show clear symptoms in the early stages. When the valve is tight, the patient may notice some signs that occur during exertion including chest pain, shortness of breath, fatigue, lightheadedness or fainting, and palpitations. There are very few cases of asymptomatic aortic valve stenosis like Mr. Sang’s.

Three years ago, Mr. Sang suffered from lumbar spine pain. Thinking he had old age bone and joint disease, he did not go to the doctor but took painkillers and massage. At the beginning of this year, the frequency of pain was high, he ate poorly, and often had insomnia, so he went to Tam Anh General Hospital in Ho Chi Minh City to have his bones and joints examined.

In addition to MRI of the lumbar spine, patients have a general examination, abdominal ultrasound, carotid ultrasound, and cardiovascular screening with echocardiography (a simple, non-invasive method and the most important standard for diagnosing heart valve disease). The results showed that he had severe aortic valve stenosis, and the doctor advised him to be hospitalized for treatment.

MSc.BS.CKII Nguyen Thi Ngoc, Department of Internal Medicine, Cardiovascular Center, Tam Anh General Hospital, Ho Chi Minh City, explained that aortic valve stenosis occurs when the valve gate does not open completely, causing the opening between the left ventricle and the aorta to narrow. At this time, the heart has to work harder to pump blood through the smaller hole, causing the ventricular chambers to dilate, the ventricular walls to become thicker, and the heart to weaken. The narrower the valve, the more difficult it is for blood to pass through, preventing the aorta from supplying blood to the body’s organs. The heart must create higher pressure to eject blood through the narrow valve opening, over time causing the left ventricle to thicken and weaken.

According to Dr. Ngoc, some common causes of aortic valve stenosis are calcific degeneration in the elderly (common in people aged 70-80), congenital heart defects and rheumatic heart valves. Mr. Sang’s aortic valve was severely calcified, and there were many cholesterol plaques on the heart valve. His habit of smoking nearly a pack of cigarettes a day for more than 30 years accelerated the process of valve degeneration, causing his valve leaflets to become severely narrowed before he was 60 years old. The patient does not have heart failure but has complications of left ventricular thickening. If valve replacement is not quickly intervened, the disease progresses, leading to the risk of infective endocarditis, arrhythmia, blood clots, stroke, and death.

The surgical team replaced Mr. Sang’s mechanical valve. This type of valve is highly durable, has a lifespan of over 30 years, is less susceptible to degeneration, and is suitable for patients under 60 years old. In 4 hours, the doctor opened an incision in the middle of the sternum to access the heart, remove the damaged valve leaflet and replace it with an artificial valve. The incision dries quickly, with no signs of infection.

Mr. Sang recovered to good health and was discharged from the hospital after 5 days of open heart surgery. He needs to take anticoagulants for life to prevent blood clots from forming, combined with drugs to treat lumbar disc herniation to improve symptoms of pain and fatigue.

After aortic valve replacement, patients need good post-operative care to shorten the recovery process, reduce complications, and ensure the new heart valve works effectively. Patients need to pay attention to unusual signs such as fever, chest pain, difficulty breathing, dizziness, irregular heartbeat, and check blood pressure and heart rate at home regularly. At the same time, patients should eat healthy, get enough nutrition, and exercise properly.

Doctors recommend that people over 60 years old or with high blood pressure, smoking or other cardiovascular risk factors should have regular cardiovascular examinations to detect underlying diseases early.