Heart Valve Diseases

What is heart valve diseases?

Heart valve diseases (also called valvular heart disease) is a group of conditions in which one or more of the heart’s four valves does not work properly. The heart has four valves: the mitral valve, the aortic valve, the tricuspid valve and the pulmonary valve. Each valve is a set of thin flaps, called leaflets, that open to let blood flow forward and close to stop it flowing backward. When a valve is damaged, the heart has to work harder to move blood around the body.

There are two main ways a valve can fail. Stenosis means the valve has become stiff or narrowed and does not open fully, so blood has to squeeze through a smaller opening. Regurgitation (also called insufficiency or a leaky valve) means the valve does not close tightly, so some blood flows backward. A valve can have both problems at the same time. A third, less common problem is atresia, in which a valve did not form properly before birth.

Heart valve diseases can affect people of any age, but they become more common with age because valves gradually wear and can develop calcium deposits over time. Some people are born with an abnormal valve, while others develop valve problems after an infection, a heart attack or other heart conditions. Many people with mild valve disease have no symptoms and are diagnosed only when a doctor hears an unusual sound, called a murmur, while listening to the heart. In hospital settings, heart valve diseases are typically managed by a Cardiology Department together with cardiac surgeons when procedures are needed.

Heart valve diseases symptoms

Symptoms depend on which valve is affected, how severe the problem is and how quickly it developed. Many people have no symptoms for years, because the heart can adapt to a faulty valve for a long time. When symptoms do appear, they often come on gradually and may be mistaken for normal aging or being out of shape.

• Shortness of breath, especially during activity or when lying flat
• Tiredness or a feeling of having less energy than usual
• Swelling in the ankles, feet or abdomen
• A fluttering, racing or irregular heartbeat (palpitations)
• Chest pain, pressure or tightness, often during exertion
• Dizziness or lightheadedness
• Fainting or near-fainting
• A heart murmur heard by a doctor during an examination
• Rapid weight gain from fluid buildup

Symptoms can differ by valve type. Aortic stenosis, a narrowed aortic valve, often causes chest pain, breathlessness and fainting during exertion once it becomes severe. Mitral regurgitation, a leaky mitral valve, may cause tiredness and breathlessness that slowly gets worse, and it can lead to an irregular heart rhythm called atrial fibrillation. Tricuspid valve problems more often cause swelling in the legs and abdomen because blood backs up in the veins of the body.

Symptoms also differ by stage. Mild disease is usually silent. Moderate disease may cause symptoms only during heavy activity. Severe disease can cause symptoms with light activity or at rest, and may lead to heart failure, a condition in which the heart cannot pump enough blood to meet the body’s needs. Sudden valve failure, for example after a heart attack or infection, can cause severe breathlessness that develops over hours or days and needs urgent care.

Causes and risk factors

Heart valve diseases causes fall into two broad groups: problems present from birth (congenital) and problems that develop later in life (acquired).

• Age-related wear and calcification: Over many years, calcium can build up on valve leaflets, making them stiff. This is the most common cause of aortic stenosis in older adults.
• Congenital valve abnormalities: Some people are born with a valve that has the wrong number of leaflets, such as a bicuspid aortic valve with two leaflets instead of three. These valves may wear out earlier than normal.
• Rheumatic heart disease: Rheumatic fever, a complication of untreated strep throat, can scar the heart valves. It remains an important cause in many parts of the world.
• Infective endocarditis: An infection of the inner lining of the heart and valves, usually caused by bacteria entering the bloodstream, can damage or destroy valve tissue.
• Heart attack and coronary artery disease: Damage to the heart muscle can affect the structures that support the mitral valve, causing it to leak.
• Cardiomyopathy and heart failure: When the heart’s chambers enlarge, the valve ring can stretch so the leaflets no longer meet.
• Mitral valve prolapse: The leaflets of the mitral valve bulge backward when the heart contracts, which can allow leaking.
• Other causes: Radiation therapy to the chest, certain autoimmune conditions, some medications and connective tissue disorders such as Marfan syndrome can also affect the valves.

Risk factors that make heart valve diseases more likely include older age, a history of rheumatic fever or endocarditis, being born with a heart defect, high blood pressure, high cholesterol, diabetes, smoking, previous heart attack, chronic kidney disease and a family history of valve problems. Intravenous drug use raises the risk of endocarditis, which can damage the valves. Having several risk factors does not mean a person will develop valve disease, and some people develop it without any known risk factor.

Heart valve diseases diagnosis

Diagnosis usually begins with a medical history and physical examination. The doctor asks about symptoms, past illnesses and family history, then listens to the heart with a stethoscope. A heart murmur, an extra whooshing or clicking sound, is often the first clue. The timing, location and character of the murmur give the doctor an idea of which valve is involved. However, a murmur alone does not confirm valve disease, and many murmurs are harmless.

The key test for confirming heart valve diseases is an echocardiogram, an ultrasound scan of the heart. It uses sound waves to create moving pictures of the valves and heart chambers. It shows how the leaflets move, how narrow or leaky a valve is, how large the heart chambers are and how well the heart is pumping. Doctors use standardized measurements from the echocardiogram to grade valve disease as mild, moderate or severe. In some cases a transesophageal echocardiogram is used, in which a small ultrasound probe is passed down the throat to get clearer pictures from behind the heart.

Other tests your doctor may recommend include:

• Electrocardiogram (ECG): Records the heart’s electrical activity and can show rhythm problems or signs of strain on the heart.
• Chest X-ray: Shows the size and shape of the heart and whether fluid has collected in the lungs.
• Cardiac MRI: Gives detailed pictures of the heart muscle and valves and may be used when echocardiogram results are unclear.
• CT scan of the heart: Measures calcium on the valves and helps plan certain procedures.
• Exercise stress testing: Checks how the heart and symptoms respond to activity, which is helpful when a person reports no symptoms at rest.
• Cardiac catheterization: A thin tube is passed through a blood vessel to the heart to measure pressures and check the coronary arteries, usually before surgery.
• Blood tests: May be used to check for infection, kidney function or markers of heart strain.

Because valve disease often progresses slowly, diagnosis is not a single event. Doctors typically repeat the echocardiogram at intervals, from every few years for mild disease to every few months for severe disease, to track any change.

Heart valve diseases treatment options

Treatment depends on which valve is affected, how severe the problem is, whether symptoms are present and the person’s overall health. Not everyone needs a procedure. Heart valve diseases treatment options generally fall into the following groups.

Watchful waiting and monitoring. For mild or moderate disease without symptoms, your doctor may recommend regular checkups and repeat echocardiograms rather than immediate treatment. This is often called active surveillance. Healthy lifestyle habits, such as not smoking, staying physically active within the limits set by your doctor, eating a heart-healthy diet and keeping blood pressure under control, are usually encouraged.

Medications. Medicines cannot repair a damaged valve, but they can ease symptoms, protect the heart and reduce complications. Depending on the situation, doctors may use water pills (diuretics) to reduce fluid buildup, blood pressure medicines to lower the strain on the heart, medicines to control heart rate or rhythm, and blood thinners (anticoagulants) for people with atrial fibrillation or certain artificial valves to lower the risk of blood clots. Antibiotics are used to treat endocarditis, and in some people antibiotics before dental work may be advised to reduce the risk of valve infection.

Catheter-based (minimally invasive) procedures. Some valve problems can be treated with thin tubes passed through blood vessels, usually from the groin, without opening the chest. Balloon valvuloplasty uses a small balloon to widen a narrowed valve, and is used mainly for certain types of mitral or pulmonary stenosis. Transcatheter aortic valve replacement (TAVR) places a new valve inside the diseased aortic valve; it is commonly considered for people with severe aortic stenosis, particularly those at higher risk from open surgery. Transcatheter techniques for repairing or replacing the mitral and tricuspid valves are also available for selected people.

Surgery. When a valve is severely damaged and causing symptoms or affecting heart function, surgery is often recommended. Valve repair keeps the person’s own valve and fixes it by reshaping leaflets, tightening the ring around the valve or repairing the supporting cords. Repair is often preferred for the mitral valve when it is possible. Valve replacement removes the damaged valve and replaces it with either a mechanical valve made of durable materials, which usually requires lifelong blood thinners, or a biological (tissue) valve made from animal or human tissue, which may wear out over time but usually does not need long-term blood thinners. The choice depends on age, other health conditions and personal preferences discussed with the care team. Surgery may be done through a traditional incision or, in some cases, through smaller incisions.

Cardiac rehabilitation. After a procedure or surgery, a supervised program of exercise, education and support is often recommended. It helps people recover strength, understand their medications and reduce future heart risk.

Every option carries benefits and risks, and the best plan varies from person to person. Decisions about timing are important: acting too early exposes a person to procedural risk without clear benefit, while waiting too long can allow permanent damage to the heart muscle. Your doctor may discuss these trade-offs with you over several visits.

Living with heart valve diseases and outlook

The outlook for heart valve diseases varies widely. Many people with mild disease live for decades without symptoms and never need a procedure. Others develop progressive disease that eventually requires repair or replacement. Once a severe valve problem starts causing symptoms, treatment often improves both quality of life and long-term outcomes, but no treatment can guarantee a particular result, and some people continue to have symptoms or need further procedures later in life.

Living well with valve disease usually involves several ongoing habits:

• Attending all scheduled follow-up visits and echocardiograms, even when you feel well
• Taking medications as prescribed and understanding what each one does
• Keeping teeth and gums healthy and telling your dentist about your valve condition, because dental infections can spread to the heart
• Reporting new or worsening symptoms promptly rather than waiting for the next appointment
• Staying active at a level agreed with your doctor; most people benefit from regular moderate exercise
• Managing blood pressure, cholesterol, diabetes and weight
• Avoiding smoking and limiting alcohol

People with mechanical valves need regular blood tests to keep their blood thinner at the right level. People with tissue valves or repaired valves need periodic scans to check that the valve is still working well. Women with valve disease who are planning a pregnancy are usually advised to discuss this with their cardiologist beforehand, because pregnancy places extra demands on the heart. Living with a long-term heart condition can also be emotionally difficult, and many people find it helpful to talk with their care team about anxiety or low mood.

Frequently asked questions

What is heart valve diseases in simple terms?

Heart valve diseases is a term for problems with the heart’s valves, the flaps that keep blood flowing in one direction. A valve may become too narrow to open fully (stenosis) or may leak because it does not close tightly (regurgitation). Either problem makes the heart work harder and, over time, may cause symptoms such as breathlessness, tiredness or swelling.

What are the first heart valve diseases symptoms people notice?

Often the first sign is not a symptom at all but a murmur heard by a doctor during a routine examination. When symptoms do appear, they are commonly a gradual reduction in energy and shortness of breath on exertion, which many people put down to aging or lack of fitness. Because these signs are vague, anyone with persistent, unexplained breathlessness or fatigue is generally advised to be checked.

What are the most common heart valve diseases causes?

In older adults, the most common cause is age-related wear and calcium buildup on the valve leaflets. Other frequent causes include being born with an abnormal valve, damage from rheumatic fever after untreated strep throat, infection of the valve (endocarditis), heart attack and enlargement of the heart from other heart conditions. In many people more than one factor plays a role.

How is heart valve diseases diagnosis confirmed?

The main test is an echocardiogram, an ultrasound scan of the heart that shows how each valve opens and closes and how much the heart is affected. Doctors combine this with a physical examination, an electrocardiogram and sometimes a chest X-ray, cardiac MRI, CT scan, stress test or cardiac catheterization. The echocardiogram is also repeated over time to see whether the disease is progressing.

What are the heart valve diseases treatment options if I have no symptoms?

If the disease is mild or moderate and you have no symptoms, your doctor may recommend monitoring with regular checkups and repeat scans rather than a procedure, along with heart-healthy habits and treatment of blood pressure or other conditions. In some cases of severe disease, a procedure may be considered even without symptoms if tests show the heart is starting to be affected. This decision is individual and made with your care team.

Can heart valve diseases be cured with medication?

Medications can relieve symptoms, reduce strain on the heart, control rhythm problems and prevent complications such as blood clots, but they cannot repair a damaged valve or make a narrowed valve open wider. When a valve is severely damaged and causing problems, repairing or replacing it through surgery or a catheter procedure is usually the only way to correct the underlying problem.

Is heart valve surgery always needed?

No. Many people never need surgery. Surgery or a catheter-based procedure is generally considered when the valve disease is severe and is causing symptoms or affecting how well the heart pumps. The choice between repair, replacement, open surgery and minimally invasive approaches depends on the specific valve, the type of damage, age and other health conditions.

When to see a doctor

If you have been told you have a heart murmur or a valve problem, keep the follow-up appointments your doctor recommends even when you feel well, because valve disease can worsen without obvious symptoms. Arrange a medical review if you notice new or gradually worsening breathlessness, tiredness, swelling in the legs or abdomen, palpitations or dizziness, or if you find you can do less activity than before.

Seek emergency care immediately if you or someone else experiences any of the following red-flag warning signs:

• Chest pain, pressure or tightness, especially with sweating, nausea or pain spreading to the arm, neck or jaw
• Sudden or severe shortness of breath, or breathlessness that makes it hard to speak or lie down
• Fainting or collapse
• A very fast, very slow or highly irregular heartbeat with dizziness or weakness
• Coughing up pink, frothy sputum
• Sudden weakness or numbness on one side of the body, facial drooping, trouble speaking or sudden vision loss, which can signal a stroke
• Fever with chills, night sweats or unexplained weight loss in someone with a known valve problem or an artificial valve, which could indicate a valve infection
• Signs of bleeding in someone taking blood thinners, such as black or bloody stools, vomiting blood or bleeding that will not stop

These symptoms do not always mean a valve emergency, but they need urgent assessment. Acting quickly can make a significant difference to the outcome.