“Does A Bad Heart Valve Cause Low Blood Pressure?” asks Trudy

I just received a great patient question about low blood pressure and heart valve disease.  In her email, Trudy asks me, “Can a bad heart valve cause low blood pressure?”

To provide Trudy an expert response and educate our patient community, I contacted Dr. John Mehall, a leading cardiac surgeon in Lakewood, Colorado near Denver.

Dr. John Mehall (Heart Surgeon)

As you may know, Dr. Mehall has successfully operated on several patients in our community including Gus Nicholson, Ray Hicks, and Steve Liebowitz.

Dr. Mehall Says…

Thankfully, Dr. Mehall responded to Trudy’s question quickly. To start, Dr. Mehall directly addressed Trudy’s question:

Yes, valve disease can cause low blood pressure. If valvular heart disease is not caught early patients generally present with symptoms of fatigue, shortness of breath, dyspnea on exertion that could be symptoms of low blood pressure or high blood pressure.

Then, Dr. Mehall addressed how aortic, mitral and tricuspid valve disease can impact the heart and blood pressure in different ways:

For example, severe aortic stenosis can cause hypotension or low blood pressure with exertion secondary to poor output or excretion of blood through stenotic valve. One of the criteria for diagnosis of aortic stenosis in patients with presumed asymptomatic aortic stenosis is to place a patient on a supervised treadmill and if BP drops approximately 10mmHg with exercise then patient is considered symptomatic severe aortic stenosis. Therefore, symptoms of low blood pressure with exertion or even at rest.

In the setting of mitral regurgitation patients can have low blood pressure due to poor forward flow leading to lower blood pressure readings. There is well known association between mitral valve prolapse and low blood pressure. Patients who have been diagnosed with mitral regurgitation are generally started on blood pressure agents to decrease systemic resistance/afterload reduction which can lower pressure even more- we watch these patients closely.

Tricuspid valve disease can present with hypotension or low blood pressure as well due to poor pre-load or filling of right side of the heart and forward flow and the regurgitant flow engorges liver and causes vasodilation and lower extremity swelling leading to hypotension and orthostatic hypotension.

Dr. Mehall then provided a summary for Trudy:

In general, low blood pressure in valvular heart disease is multifactorial depending on severity of valvular heart disease, which valve is affected if not multiple valve and what medications patient has been on for treatment etc. Thank you for allowing us to respond to this complex valvular heart disease question.

Many thanks to Dr. John Mehall for sharing his clinical experiences and research with our patient community. We really appreciate it!

Keep on tickin!
Adam