Summary about Disease
A bicuspid aortic valve (BAV) is a heart valve defect present at birth (congenital). Instead of having three leaflets (cusps), the aortic valve has only two. This can affect blood flow out of the heart. Some people with BAV may not experience any problems, while others may develop valve stenosis (narrowing), regurgitation (leaking), or other complications like aortic aneurysm or dissection. The severity and progression of BAV-related problems vary significantly.
Symptoms
Many people with BAV don't experience symptoms, especially early in life. When symptoms do develop, they often result from valve dysfunction (stenosis or regurgitation) and may include:
Shortness of breath, especially during exercise
Chest pain or pressure (angina)
Fatigue
Lightheadedness or dizziness
Fainting (syncope)
Heart murmur (detected during a physical exam)
Palpitations (feeling of rapid or irregular heartbeat)
Swelling in the ankles and feet (edema), if heart failure develops
Causes
BAV is a congenital heart defect, meaning it's present at birth. The exact cause isn't fully understood, but it is believed to be caused by genetic factors that affect the formation of the aortic valve during fetal development. In some cases, BAV can run in families.
Medicine Used
Medications do not cure BAV. However, they are used to manage symptoms and complications associated with it. Examples include:
ACE inhibitors and ARBs: To lower blood pressure, especially in cases of aortic enlargement or dysfunction.
Beta-blockers: To slow heart rate and lower blood pressure, reducing stress on the aorta.
Diuretics: To reduce fluid retention, particularly if heart failure develops.
Medications to prevent blood clots: if atrial fibrillation or other arrhythmias develop.
Antibiotics: Preventative antibiotics are no longer routinely recommended before dental procedures to prevent endocarditis. The need is determined on an individual basis.
Is Communicable
No, bicuspid aortic valve is not communicable. It is a congenital heart defect, not an infectious disease.
Precautions
Precautions depend on the severity of the BAV and any associated complications. General recommendations include:
Regular checkups with a cardiologist: To monitor valve function and aorta size.
Echocardiograms: Periodic echocardiograms to assess the degree of stenosis or regurgitation.
Healthy lifestyle: Maintaining a healthy weight, exercising regularly (as advised by a doctor), and avoiding smoking.
Blood pressure control: Managing high blood pressure with lifestyle changes and/or medication.
Avoidance of strenuous activity: In some cases, particularly with significant valve dysfunction or aortic enlargement, strenuous activities may need to be limited.
Inform healthcare providers: Alert all healthcare providers (including dentists) about the BAV.
Prophylactic antibiotics: The need for antibiotic prophylaxis before certain procedures is now individualized. Consult with your cardiologist.
How long does an outbreak last?
This is not applicable, as BAV is not an infectious or communicable disease, so it does not have outbreaks.
How is it diagnosed?
Physical exam: A heart murmur may be detected during a routine exam.
Echocardiogram: This is the primary diagnostic test. It uses sound waves to create images of the heart and valves, allowing doctors to visualize the aortic valve structure and function.
Electrocardiogram (ECG or EKG): Records the electrical activity of the heart and can detect arrhythmias or signs of heart enlargement.
Chest X-ray: Can show enlargement of the heart or aorta.
Cardiac MRI or CT scan: May be used to assess the aorta in more detail.
Cardiac Catheterization: In some cases, this invasive procedure may be necessary to assess the valve and heart pressures.
Timeline of Symptoms
The timeline of symptoms is highly variable:
Birth/Childhood: Many people with BAV have no symptoms in childhood or early adulthood. The defect is often discovered incidentally during a routine checkup.
Adolescence/Young Adulthood: Some may develop mild symptoms, such as fatigue or shortness of breath during exercise.
Adulthood: Symptoms are more likely to appear as the valve becomes stenotic or regurgitant, or as the aorta enlarges. This may occur gradually over many years or more rapidly.
Later Life: Severe valve dysfunction or aortic complications can lead to significant symptoms and the need for intervention.
Important Considerations
Aortic Aneurysm/Dissection: People with BAV have an increased risk of developing an aneurysm (enlargement) or dissection (tear) of the aorta, the large artery that carries blood from the heart. Regular monitoring of the aorta is crucial.
Endocarditis: Though antibiotic prophylaxis guidelines have changed, people with BAV may still be at a slightly increased risk of endocarditis (infection of the heart valve). Maintaining good oral hygiene and promptly treating infections are important.
Family Screening: Because BAV can run in families, screening of first-degree relatives (parents, siblings, children) with echocardiograms may be recommended.
Valve Replacement/Repair: If the BAV becomes severely stenotic or regurgitant, surgery to replace or repair the valve may be necessary. Aortic root replacement may also be required.
Pregnancy: Women with BAV should be closely monitored during pregnancy, as pregnancy can place additional stress on the heart and aorta.
Lifelong Monitoring: Regardless of symptoms, individuals with BAV require ongoing monitoring by a cardiologist to detect and manage any complications.