Valvular Heart Disease in Aging Women
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Valvular Heart Disease in Aging Women John W. Petersen & Marian C. Limacher
Published online: 11 March 2011 # Springer Science+Business Media, LLC 2011
Abstract Elderly women are at risk for aortic and mitral valve disease that may be challenging to manage because of co-morbidities. Many reports focus on the evaluation and management of elderly patients, but only limited information that is directed specifically at women is available. Until more research can be completed, current guidelines offer updated recommendations for the diagnosis and treatment of significant valvular lesions. On-line and point-based risk assessment instruments are valuable tools for guiding treatment decisions in individual patients. Keywords Women . Elderly . Valvular heart disease . Aortic valve . Aortic stenosis . Aortic insufficiency . Mitral valve . Mitral stenosis . Mitral insufficiency
Introduction As with many forms of cardiovascular disease, valvular heart disease occurs more commonly in older individuals when management is complicated by a greater likelihood of significant co-morbidities. Although both men and women are faced with the burden of valvular heart disease at older age, two factors emphasize our need to address these conditions in older women. First, more women than men survive beyond middle age and thus are at risk for chronic degenerative cardiac conditions, including valve disease, at J. W. Petersen : M. C. Limacher (*) Division of Cardiovascular Medicine, University of Florida, PO Box 100277, 1600 SW Archer Road, Gainesville, FL 32610–0277, USA e-mail: [email protected] J. W. Petersen e-mail: [email protected]
older age. Second, virtually every surgical series reports that women have a greater risk for morbidity and mortality with valve surgery than men. Despite the importance of valvular disease in older women, little research and few reports focus directly on this problem. Therefore, our aim in this report is to review the major forms of valve disease in elderly women and to highlight the considerations most relevant in their care and management. We address aortic and mitral valve conditions but not right heart lesions due to limited available information regarding tricuspid and pulmonic valve disease in elderly women. The principles for evaluating patients for significant valve disease are widely known and practiced. Potential cardiac symptoms are systematically assessed with questioning and by a careful physical examination. Older women may be less physically active at baseline and thus may not recognize a decrease in capacity until later in the disease process than men [1]. In addition, common presentations of dyspnea, fatigue, limited exercise, and edema may arise from many etiologies, and valvular disease must be carefully considered for proper diagnosis and management. Once suspected, echocardiography with Doppler hemodynamic assessment is the established diagnostic technique for identifying the presence and severity of valvular abnormalities. Current guidelines categorize the severity of ste
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