Valve replacement or repair is the mainstay of therapy in patients with symptomatic heart valve disease. But for those patients who are not candidates for surgery or who refuse surgery, medical management of their valve disease symptoms is necessary. According to the Merck Manual, medical therapy is not particularly effective in slowly the progression of the disease but can help to manage symptoms. The goal of medical therapy for patients with valve disease is to manage chronic heart failure, arrhythmias and the potential for blood clots.
Diuretics
Diuretics, commonly called "water pills," are extremely important in the treatment of valve disease. These drugs assist the kidneys in excreting the excess fluid that accumulates in the vascular system. In valve regurgitation, or what is commonly called a "leaky valve," fluid backs up into the vascular system and causes lung congestion and foot and ankle swelling. Diuretics help to alleviate the excess fluid that causes the congestion. Medications such as furosemide and spironolactone are diuretics that pull fluid and excess salt from the body. Patients are told to weigh themselves daily, and if there is a sudden increase in weight, which reflects an increased fluid load, the dose of the diuretic will often be adjusted by the physician.
ACE Inhibitors
ACE inhibitors, such as lisinopril or quinapril, act as vasodilators. These medications dilate the blood vessels, which decreases the resistance that the heart has to pump against. In a valve that is stiff or not opening all the way, the heart has to pump hard to get blood to move into the system. Vasodilation makes the job of pumping blood easier. This makes contractions more effective as it decreases the heart's workload. ACE inhibitors are so named because they prevent a chemical called angiotensin-converting enzyme from forming.
Digoxin
Digoxin is a medication that helps improve the pumping action of the heart and prevent arrhythmias. Patients with valve disease are susceptible to atrial fibrillation, a chaotic rhythm of the atrium that makes pumping ineffective. By increasing the force of the heart's contractions, and maintaining normal rhythm, the heart pumps more blood into the system. In order to take digoxin, patients will need to have their blood checked regularly to make sure they are getting enough medication.
Anticoagulants
The risk of having a blood clot travel to the brain from the heart and causing a stroke is increased in patients with heart valve disease. According to the 2008 American College of Chest Physicians the guidelines for anticoagulation, or thinning the blood, in patients with mitral valve regurgitation is daily Coumadin. In patients with aortic valve disease, aspirin 50 to 100 mg daily is the recommended therapy.
