Exercise recommendations in patients with valvular heart disease

Gati S, Malhotra A, Sharma S

Exercise recommendations in patients with valvular disease

BMJ Heart, January 2019 {Abstract}

Valvular heart disease affects approximately 3% of young individuals, many of whom aspire to partake in competitive sport or high intensity recreational exercise. Although reports on the natural history of valvular heart disease in athletes are sparse, there is a theoretical possibility that a large stroke volume coupled with vigorous mechanical contractions of the heart and an increased chronotropic state may accelerate valve dysfunction. The ensuing effects of chronic stenotic or regurgitant lesions may cause compensatory cardiac hypertrophy and impaired ventricular function, myocardial ischaemia, cardiac arrhythmias and sudden cardiac death.

The management of exercising individuals with valvular heart disease requires a structured approach which incorporates several key factors including symptomatic status, functional capacity, type and nature of the valvular lesion, impact on ventricular structure and function and effect on pulmonary artery pressure. Asymptomatic individuals with minor valvular abnormalities may engage in all forms of competitive sport whereas those with lesions of moderate severity may exercise intensively if an exercise stress test tailored to the type of physical exercise engaged reveals good functional capacity, absence of symptoms, myocardial ischaemia, haemodynamic disturbances or arrhythmia.

Mitral valve prolapse and bicuspid aortic valve are the commonest valvular abnormalities in young exercising individuals. The risk of adverse events is low but both diseases are associated with potentially serious adverse events.

Exercising individuals with valvular heart disease should undergo annual 1-2 yearly assessments depending on the severity of valve disease and should be informed about the warning symptoms of progressive deterioration of valve function.