Interventional cardiologist Dr. Jayendrakumar Patel discusses heart valve disease including signs, symptoms and when to see a cardiologist.
Learn more about BayCare's heart valve centers
Selected Podcast
Heart Valve Disease
Featured Speaker:
He then went on to earn his medical degree at The University of Alabama School of Medicine, where he graduated summa cum laude at the top of his class. He was awarded the Hugh J. Dempsey Memorial Award and election into Alpha Omega Alpha during his junior year.
Dr. Patel completed residency at Washington University in St. Louis where he received numerous honors including intern and resident physician of the year, the distinguished service teaching award, and the house staff leadership award. He was asked to stay on staff for an additional year to serve as Chief Medical Resident.
Dr. Patel completed cardiology fellowship at The Cleveland Clinic in Ohio where he was awarded the First Year Fellow of the Year award for exceptional performance. During fellowship, he was also awarded a scholarship to pursue additional studies in clinical effectiveness at Harvard University in Boston. Dr. Patel then stayed at The Cleveland Clinic for an additional 2 years of training in interventional cardiology where he focused on advanced high-risk coronary, peripheral, and structural heart interventions.
Dr. Patel is actively involved in clinical research. He has published numerous articles in peer-reviewed journals and book chapters on minimally invasive catheter-based coronary and valve treatments.
Learn more about Jayendrakumar Patel, MD
Jayendrakumar Patel, MD
Born and raised in Alabama, Dr. Patel completed his undergraduate studies as an Emory Scholar at Emory University in Atlanta, where he graduated in the top 10% of his class and was awarded membership in Phi Beta Kappa.He then went on to earn his medical degree at The University of Alabama School of Medicine, where he graduated summa cum laude at the top of his class. He was awarded the Hugh J. Dempsey Memorial Award and election into Alpha Omega Alpha during his junior year.
Dr. Patel completed residency at Washington University in St. Louis where he received numerous honors including intern and resident physician of the year, the distinguished service teaching award, and the house staff leadership award. He was asked to stay on staff for an additional year to serve as Chief Medical Resident.
Dr. Patel completed cardiology fellowship at The Cleveland Clinic in Ohio where he was awarded the First Year Fellow of the Year award for exceptional performance. During fellowship, he was also awarded a scholarship to pursue additional studies in clinical effectiveness at Harvard University in Boston. Dr. Patel then stayed at The Cleveland Clinic for an additional 2 years of training in interventional cardiology where he focused on advanced high-risk coronary, peripheral, and structural heart interventions.
Dr. Patel is actively involved in clinical research. He has published numerous articles in peer-reviewed journals and book chapters on minimally invasive catheter-based coronary and valve treatments.
Learn more about Jayendrakumar Patel, MD
Transcription:
Heart Valve Disease
Deborah Howell: Welcome to BayCare HealthChat. I'm Deborah Howell, and I invite you to listen as we discuss heart valve disease. Today, we're going to find out how it's treated and all about the heart team approach. I'm joined today by Dr. Jay Patel, an interventional cardiologist at BayCare's Morton Plant Hospital. Dr. Patel, a true pleasure to have you on with us today, sir.
Dr. Jay Patel: A real pleasure to be here today. Deborah. Many thanks for the opportunity.
Deborah Howell: Our pleasure. Jumping right in then. What is heart valve disease?
Dr. Jay Patel: So the heart has four valves, the aortic, mitral, pulmonic, and tricuspid, and these valves are pretty complicated structures, but they're essentially made of thin flaps of tissue that open and close and allow blood to flow in only one direction through the heart. Heart valve disease occurs when the valves don't work normally, and this can be either in the form of not opening properly, which is also known as stenosis or not closing properly, which is also known as regurgitation.
Now, in both of these cases, the heart has to work harder in order to compensate and maintain normal circulation. So in many cases, the heart can compensate for quite a long time. But at some point, the heart will stop compensating and then symptoms will appear. Now the most commonly diseased valves are mitral and aortic.
Deborah Howell: Got it. And what are the presenting signs and symptoms of heart valve disease?
Dr. Jay Patel: If the valve disease is moderate, then oftentimes the only sign is a murmur that your primary care provider may hear during a visit for another medical problem or a well checkup. If the valve disease is severe, then you may experience common symptoms of an overly stressed heart, which is also known as heart failure.
And some of these symptoms can include shortness of breath, reduction in your ability to work or function, chest discomfort, swelling in the legs or abdomen, palpitations, or even passing out. And it's important to remember that these signs and symptoms often progress in a gradual or subtle way, such that you may not even realize that something is wrong, unless you pay close attention to your body.
Deborah Howell: Sounds good. Now, when does heart valve disease need to be treated and when should I see a cardiologist?
Dr. Jay Patel: I honestly never think that it's too early to see a cardiologist if you're experiencing any of the symptoms that we just reviewed, or if your doctor has mentioned that they've heard a murmur. The earlier that we catch problems, the better patients tend to do and, quite frankly, the more options we have for treatment. In general, heart valves are treated when the valve is severely malfunctioning or the heart's not compensating and the patient's symptomatic.
Deborah Howell: I see. Now, how is heart valve disease treated and what is the heart team approach?
Dr. Jay Patel: Well, as I mentioned earlier, heart valves are incredibly complex structures and, when they fail to work properly, we often prescribe medications like diuretics or beta-blockers or ACE inhibitors in order to help the heart work more efficiently. Unfortunately, these medications can only do so much. And at some point, we may ultimately have to fix the valve itself in order to restore normal heart function and that a decision of if and when to pull the trigger for an invasive treatment is a complex one.
And this is where the heart team comes in. The heart team is a group of doctors and nurses from a variety of specialties, which includes general cardiology, anesthesiology, surgery, and interventional cardiology. Now within the heart team, we all work together and leverage the expertise of each specialist on the team in order to come up with the best treatment plan for each individual patient. And we do this for each and every patient with severe valve disease.
Deborah Howell: It takes a village sometimes to get the right diagnosis and the right treatment option, correct?
Dr. Jay Patel: Absolutely.
Deborah Howell: Now, you mentioned a couple of different valves. You mentioned the aortic valve and the mitral valve. Are there different options for each valve?
Dr. Jay Patel: Yes, absolutely. So this is a very exciting and rapidly evolving field. And I'm happy to say that treatment of valve disease continues to move towards minimally invasive catheter-based therapies where we don't have to stop the heart or open the chest. Now for many decades, open-heart surgery was really the only way to correct severe valve disease and that would involve stopping the heart and repairing or replacing the malfunctioning valve.
Now, we have minimally invasive catheter-based techniques to correct certain valve disorders. For aortic valve stenosis, the United States Food and Drug Administration has approved catheter-based aortic valve replacement also known as TAVR across the entire spectrum of surgical risk after many years of rigorous clinical study.
Now, during this procedure, we replace the aortic valve without stopping the heart or doing open-heart surgery. And we do this usually without making an incision. We typically puncture the artery in the groin and place a small tube inside the artery. And this tube is also known as a catheter, we then pass the new valve through the tube and push it all the way up to the heart. And then the new valve gets implanted inside your old malfunctioning valve. The great thing is that most patients are typically home the next day and back to doing their normal routine within a week.
Now for leaky mitral valves, aside from open-heart surgery, we have another FDA approved, rigorously studied catheter-based treatment option, where we're able to bring together the two leaflets of the mitral valve and clip them together using a device that looks similar to a clothes pin. This is called transcatheter edge-to-edge repair. And with this procedure, we go through a puncture again in the groin vein, and nearly all patients go home the next day and they're back to doing their usual activities within a week.
We offer similar repair techniques for leaky tricuspid valves through an ongoing national clinical trial. And we're also involved in ongoing clinical trials of catheter-based mitral valve replacement for leaky or narrowed mitral valves. I have to say there's so much on the horizon and we will have many more minimally invasive techniques in our arsenal over the next five to 10 years. And the best part is that these less invasive treatment options will undoubtedly reduce recovery time and get patients back to living a good quality of life.
Deborah Howell: That was my follow-up question. What is recovery time for someone who has a mitral or one of these minimally invasive procedures?
Dr. Jay Patel: Sure. So typically patients will come in to the hospital on the day of the procedure. We'll do the procedure, which typically can take about 90 minutes and then we watch them for about 12 hours and they go home the next day, usually after lunch. And then after that, there will be a period of monitoring for about a week or so. We'll touch base with them over the phone, but really the patients can do whatever they would like to do after we discharge them.
Deborah Howell: Just an incredible leap forward for heart patients.
Dr. Jay Patel: Absolutely.
Deborah Howell: What else should we know about heart health doctor?
Dr. Jay Patel: I think that It's important to not ignore your heart or your symptoms. And you should really talk to your doctor about any symptoms that you may be having. Symptoms are often the last manifestation of an ongoing chronic disease process. Especially in the time of COVID, many patients with symptoms are scared to come to the hospital out of fear of catching the virus. And unfortunately, I've experienced many instances where these patient's heart function got worse because they waited. So my big takeaway would be do not wait to talk to your doctor.
Deborah Howell: That's fine for you, but what if you have say a husband who isn't very vocal or maybe aware of, you know, his bodily functions and tends to downplay any symptoms, what can you look for in a spouse or even a child, anyone close to you, by the way of symptoms, if they're not noticing them or talking about them themselves?
Dr. Jay Patel: Well, sometimes patients, their spouses or their significant others know them way more in terms of their functional abilities than the patients themselves. And so patient's spouses may notice that the patients aren't able to climb up a flight of stairs as they used to without being out of breath or they may notice swelling in their legs. Their spouse may notice that they're not able to sleep at night completely throughout the entire night. They may wake up in the middle of the night several times, feeling short of breath or waking up in a cold sweat. These are all symptoms that family members can look out for.
Deborah Howell: That is really, really helpful. Dr. Patel, this has been so incredibly enlightening. Thank you for all the work you do. We're as excited as you are about the horizon of heart health. Thanks for all the good information. And we really appreciate you being on the podcast today.
Dr. Jay Patel: It's been a great pleasure. Thank you so much for giving me the opportunity today.
Deborah Howell: To learn more about heart valve disease and all the cardiovascular services at BayCare, please visit our website at BayCareHeartValve.org. And that wraps up this episode of BayCare HealthChat. Always remember to subscribe, rate, and review this podcast and all the other BayCare podcasts, so we can share the wealth of information from our experts together.This is Deborah Howell. Have yourself a terrific day.
Heart Valve Disease
Deborah Howell: Welcome to BayCare HealthChat. I'm Deborah Howell, and I invite you to listen as we discuss heart valve disease. Today, we're going to find out how it's treated and all about the heart team approach. I'm joined today by Dr. Jay Patel, an interventional cardiologist at BayCare's Morton Plant Hospital. Dr. Patel, a true pleasure to have you on with us today, sir.
Dr. Jay Patel: A real pleasure to be here today. Deborah. Many thanks for the opportunity.
Deborah Howell: Our pleasure. Jumping right in then. What is heart valve disease?
Dr. Jay Patel: So the heart has four valves, the aortic, mitral, pulmonic, and tricuspid, and these valves are pretty complicated structures, but they're essentially made of thin flaps of tissue that open and close and allow blood to flow in only one direction through the heart. Heart valve disease occurs when the valves don't work normally, and this can be either in the form of not opening properly, which is also known as stenosis or not closing properly, which is also known as regurgitation.
Now, in both of these cases, the heart has to work harder in order to compensate and maintain normal circulation. So in many cases, the heart can compensate for quite a long time. But at some point, the heart will stop compensating and then symptoms will appear. Now the most commonly diseased valves are mitral and aortic.
Deborah Howell: Got it. And what are the presenting signs and symptoms of heart valve disease?
Dr. Jay Patel: If the valve disease is moderate, then oftentimes the only sign is a murmur that your primary care provider may hear during a visit for another medical problem or a well checkup. If the valve disease is severe, then you may experience common symptoms of an overly stressed heart, which is also known as heart failure.
And some of these symptoms can include shortness of breath, reduction in your ability to work or function, chest discomfort, swelling in the legs or abdomen, palpitations, or even passing out. And it's important to remember that these signs and symptoms often progress in a gradual or subtle way, such that you may not even realize that something is wrong, unless you pay close attention to your body.
Deborah Howell: Sounds good. Now, when does heart valve disease need to be treated and when should I see a cardiologist?
Dr. Jay Patel: I honestly never think that it's too early to see a cardiologist if you're experiencing any of the symptoms that we just reviewed, or if your doctor has mentioned that they've heard a murmur. The earlier that we catch problems, the better patients tend to do and, quite frankly, the more options we have for treatment. In general, heart valves are treated when the valve is severely malfunctioning or the heart's not compensating and the patient's symptomatic.
Deborah Howell: I see. Now, how is heart valve disease treated and what is the heart team approach?
Dr. Jay Patel: Well, as I mentioned earlier, heart valves are incredibly complex structures and, when they fail to work properly, we often prescribe medications like diuretics or beta-blockers or ACE inhibitors in order to help the heart work more efficiently. Unfortunately, these medications can only do so much. And at some point, we may ultimately have to fix the valve itself in order to restore normal heart function and that a decision of if and when to pull the trigger for an invasive treatment is a complex one.
And this is where the heart team comes in. The heart team is a group of doctors and nurses from a variety of specialties, which includes general cardiology, anesthesiology, surgery, and interventional cardiology. Now within the heart team, we all work together and leverage the expertise of each specialist on the team in order to come up with the best treatment plan for each individual patient. And we do this for each and every patient with severe valve disease.
Deborah Howell: It takes a village sometimes to get the right diagnosis and the right treatment option, correct?
Dr. Jay Patel: Absolutely.
Deborah Howell: Now, you mentioned a couple of different valves. You mentioned the aortic valve and the mitral valve. Are there different options for each valve?
Dr. Jay Patel: Yes, absolutely. So this is a very exciting and rapidly evolving field. And I'm happy to say that treatment of valve disease continues to move towards minimally invasive catheter-based therapies where we don't have to stop the heart or open the chest. Now for many decades, open-heart surgery was really the only way to correct severe valve disease and that would involve stopping the heart and repairing or replacing the malfunctioning valve.
Now, we have minimally invasive catheter-based techniques to correct certain valve disorders. For aortic valve stenosis, the United States Food and Drug Administration has approved catheter-based aortic valve replacement also known as TAVR across the entire spectrum of surgical risk after many years of rigorous clinical study.
Now, during this procedure, we replace the aortic valve without stopping the heart or doing open-heart surgery. And we do this usually without making an incision. We typically puncture the artery in the groin and place a small tube inside the artery. And this tube is also known as a catheter, we then pass the new valve through the tube and push it all the way up to the heart. And then the new valve gets implanted inside your old malfunctioning valve. The great thing is that most patients are typically home the next day and back to doing their normal routine within a week.
Now for leaky mitral valves, aside from open-heart surgery, we have another FDA approved, rigorously studied catheter-based treatment option, where we're able to bring together the two leaflets of the mitral valve and clip them together using a device that looks similar to a clothes pin. This is called transcatheter edge-to-edge repair. And with this procedure, we go through a puncture again in the groin vein, and nearly all patients go home the next day and they're back to doing their usual activities within a week.
We offer similar repair techniques for leaky tricuspid valves through an ongoing national clinical trial. And we're also involved in ongoing clinical trials of catheter-based mitral valve replacement for leaky or narrowed mitral valves. I have to say there's so much on the horizon and we will have many more minimally invasive techniques in our arsenal over the next five to 10 years. And the best part is that these less invasive treatment options will undoubtedly reduce recovery time and get patients back to living a good quality of life.
Deborah Howell: That was my follow-up question. What is recovery time for someone who has a mitral or one of these minimally invasive procedures?
Dr. Jay Patel: Sure. So typically patients will come in to the hospital on the day of the procedure. We'll do the procedure, which typically can take about 90 minutes and then we watch them for about 12 hours and they go home the next day, usually after lunch. And then after that, there will be a period of monitoring for about a week or so. We'll touch base with them over the phone, but really the patients can do whatever they would like to do after we discharge them.
Deborah Howell: Just an incredible leap forward for heart patients.
Dr. Jay Patel: Absolutely.
Deborah Howell: What else should we know about heart health doctor?
Dr. Jay Patel: I think that It's important to not ignore your heart or your symptoms. And you should really talk to your doctor about any symptoms that you may be having. Symptoms are often the last manifestation of an ongoing chronic disease process. Especially in the time of COVID, many patients with symptoms are scared to come to the hospital out of fear of catching the virus. And unfortunately, I've experienced many instances where these patient's heart function got worse because they waited. So my big takeaway would be do not wait to talk to your doctor.
Deborah Howell: That's fine for you, but what if you have say a husband who isn't very vocal or maybe aware of, you know, his bodily functions and tends to downplay any symptoms, what can you look for in a spouse or even a child, anyone close to you, by the way of symptoms, if they're not noticing them or talking about them themselves?
Dr. Jay Patel: Well, sometimes patients, their spouses or their significant others know them way more in terms of their functional abilities than the patients themselves. And so patient's spouses may notice that the patients aren't able to climb up a flight of stairs as they used to without being out of breath or they may notice swelling in their legs. Their spouse may notice that they're not able to sleep at night completely throughout the entire night. They may wake up in the middle of the night several times, feeling short of breath or waking up in a cold sweat. These are all symptoms that family members can look out for.
Deborah Howell: That is really, really helpful. Dr. Patel, this has been so incredibly enlightening. Thank you for all the work you do. We're as excited as you are about the horizon of heart health. Thanks for all the good information. And we really appreciate you being on the podcast today.
Dr. Jay Patel: It's been a great pleasure. Thank you so much for giving me the opportunity today.
Deborah Howell: To learn more about heart valve disease and all the cardiovascular services at BayCare, please visit our website at BayCareHeartValve.org. And that wraps up this episode of BayCare HealthChat. Always remember to subscribe, rate, and review this podcast and all the other BayCare podcasts, so we can share the wealth of information from our experts together.This is Deborah Howell. Have yourself a terrific day.