Early catch leads to heart valve disease treatment
In 2019, Oakville resident Karen Timmerman thought she had the flu. Her persistent symptoms resulted in a trip to her local hospital. While trying to find the source of her illness, doctors discovered a heart murmur which turned out to be caused by a defective heart valve.
Timmerman has a bicuspid aortic valve, which is when a heart valve has only two flaps instead of three. This can cause the opening to narrow or become easily blocked, making it harder for the heart to pump blood. In most cases, the valve eventually needs to be replaced.
In Timmerman’s case, the valve was slightly blocked. She and her health care team needed to keep an eye on it and if it got worse, she could need surgery.
“Being in my early 60s with no symptoms, I never thought anything would be wrong with my heart.”
Knowing the signs
Heart valve disease is fairly common as it refers to any abnormality of the heart’s valves that affects blood flow. It’s typically associated with aging, however, Timmerman was born with the bicuspid aortic valve which eventually caused the heart valve disease.
Symptoms can include chest tightness, shortness of breath, fatigue, irregular heartbeat, fainting and reduced physical activity. But some people can be symptom free.
“Being in my early 60s with no symptoms, I never thought anything would be wrong with my heart,” says Timmerman.
As an avid hiker, Timmerman continued to stay active. She eventually started to notice her endurance and stamina weren’t what they used to be, and last fall she really felt a difference. Once while hiking, she suddenly felt faint and unwell. After that episode, her health didn’t improve.
“I knew something wasn’t right, so despite not being due to visit my cardiologist, I booked an appointment,” she says.
And she was right. Her bicuspid valve was blocked and it was time to have it replaced. She was referred to Hamilton Health Sciences’ (HHS) Aortic Valve Clinic at Hamilton General Hospital, the regional cardiac centre.
“It’s great to have a patient like Karen recognize the symptoms and come to us before it’s reached a serious stage.”
“Heart valve disease is actually under recognized and often results in delayed treatment,” says Dr. Madhu Natarajan, HHS interventional cardiologist, who was a member of Timmerman’s care team. “It’s great to have a patient like Karen recognize the symptoms and come to us before it’s reached a serious stage.”
Determining the best treatment option
Replacing a heart valve can be done through open heart surgery or a less invasive procedure called a transcatheter aortic valve replacement (TAVR) also known as TAVI (transcatheter aortic valve insertion). This is where a catheter is inserted in the groin and extended up to the heart to replace the heart valve. Since it’s minimally invasive, it allows patients to go home much sooner. More than 85% of patients go home the next day after a TAVR. However, each patient’s condition and situation will determine which process is best.
“When considering open heart surgery or TAVR, our team also considers any future care that a patient may need,” says Natarajan. “Replacement valves typically last 10 to 15 years and may need to be replaced again, especially if a patient is on the younger side, like Karen.”
The TAVR program within HHS’ Aortic Valve Clinic has a unique approach. The entire cardiac team – surgeons, cardiologists and the specialists the perform echocardiograms and special x-ray tests like CAT scans – meet with each patient to determine the individual’s best treatment options.
“By bringing the full team together we look at the whole picture which can be more beneficial for the patient long-term.”
“Too often the treatment offered is based on the doctor the patient is referred to – a surgeon suggests open heart surgery and an interventional cardiologist suggests a TAVR,” says Dr. Tej Sheth, HHS cardiologist and Director of the Aortic Valve Clinic and TAVR program. “But by bringing the full team together we look at the whole picture which can be more beneficial for the patient long-term.”
Timmerman met with her HHS cardiac care team in early 2022. Together, they decided her next step would be a TAVR procedure. She had the procedure a month ago and she was able to go home the next day.
She’s already feeling good enough to hit the hiking trails and also just started heading back to the gym.
“I was of course nervous, but the team was great, the procedure simple, and recovery was fast,” she says. “I’m feeling better and others have noticed that I don’t get out of breath during a conversation anymore.”
The Canadian Cardiovascular Society has identified September 12 to 18 as heart valve disease awareness week to raise awareness about the common symptoms of heart valve disease and encourage the public to get a stethoscope check for early detection. The campaign is run in partnership with Heart Valve Voice Canada.