Overview
The heart has four valves: the aortic, mitral, tricuspid and pulmonary valves. They open and close with every heartbeat so that blood flows in one direction. In heart valve disease, one or more valves does not work well. There are two main problems:
- Stenosis: the valve is stiff or narrowed and does not open fully, so less blood gets through (aortic stenosis is a common example)
- Regurgitation: the valve does not close tightly, so blood leaks backwards (mitral regurgitation is a common example)
In both cases the heart has to work harder. Mild disease may cause no problems for years.
Symptoms
Some people have no symptoms, and the problem is found when a doctor hears a heart murmur. When symptoms appear they can include:
- Breathlessness
- Tiredness or weakness
- Dizziness or fainting
- A racing, pounding or fluttering heartbeat (palpitations)
- Swollen ankles and feet
- Chest pain, especially during activity
When to see a doctor
See a doctor if you are often breathless, tired or dizzy during normal activities, if you have swollen ankles or palpitations that keep coming back, or if chest pain comes and goes. These symptoms have many causes, so they need to be checked. If you already know you have a valve problem, keep up your regular check-ups.
Causes
Some people are born with a valve problem. In others it develops later, because of:
- Wear and thickening of the valves with age
- Rheumatic fever, which can scar the valves after a throat infection
- Infection of the heart lining and valves (endocarditis)
- Damage from a heart attack
- Heart muscle disease (cardiomyopathy)
Risk factors
- Older age
- A history of rheumatic fever
- High , high or diabetes
- Smoking and other tobacco use
- Coronary artery disease or a previous heart attack
- Being overweight or physically inactive
- A family history of early heart disease
Complications
If a badly affected valve is not treated, it can lead to:
- Heart failure
- An irregular heartbeat, such as
- Blood clots and stroke
- Infection of the heart valves (endocarditis)
- High in the lungs
- Cardiac arrest
Most people with mild disease have no problems, which is why regular check-ups matter.
Prevention
Not every valve problem can be prevented, but these steps may help:
- Having a child's sore throat checked, because untreated strep throat can lead to rheumatic fever
- Keeping , and blood sugar under control
- Not smoking or using tobacco
- Staying active and keeping to a healthy weight
Diagnosis
A doctor listens to the heart for a murmur and may refer you to a heart specialist (cardiologist). Tests may include:
- An , an scan that shows how the valves move
- An to record the heart's rhythm
- A chest X-ray
Treatment
Mild disease often needs no treatment, only regular check-ups to see whether it is changing. Medicines cannot cure a faulty valve, but they can ease symptoms and protect the heart. They include medicines that remove extra fluid, slow the heart rate, lower or reduce the risk of blood clots.
A procedure may be advised when the disease is severe, and sometimes before symptoms start, because fixing the valve can prevent later problems. Repair is preferred when it is possible. If a valve cannot be repaired, it is replaced with a tissue valve (from an animal or human) or a mechanical valve. Tissue valves do not last as long, while mechanical valves need blood-thinning medicines for life.
Women with a valve problem who are pregnant, or planning to be, should speak to a heart specialist first, because pregnancy can make symptoms worse.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“A heart murmur always means a serious heart problem.”What is true?
Fact
A murmur is an unusual sound that a doctor hears through a stethoscope, and it can be a sign of a valve problem. Many people have a valve that works imperfectly for life without any trouble, so a murmur should be checked with a heart scan to find out which it is.
Myth“Getting breathless on the stairs is just age or weakness, so it can be ignored.”What is true?
Fact
Breathlessness, tiredness and swollen ankles have many causes, and ageing is one of them. They can also be signs of a valve problem or other heart disease, so they need to be checked. Valve disease that is not treated can lead to heart failure.
Myth“Valve disease always means open-heart surgery.”What is true?
Fact
Mild valve disease may need only regular check-ups, and medicines can ease symptoms. When a procedure is needed, repair is preferred where it is possible. Some valves, such as in aortic stenosis, can be replaced through a thin tube passed along a blood vessel (TAVI) instead of open-heart surgery. The heart team decides what suits each person.
Myth“Once the valve is replaced, the problem is over for life.”What is true?
Fact
A new valve helps a great deal, but it still needs follow-up. Tissue valves do not last as long and may need replacing, while mechanical valves are long-lasting but need blood-thinning medicines for life. Regular check-ups continue either way.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
What is the difference between a narrow valve and a leaking valve?
In stenosis the valve is stiff or narrowed and does not open fully, so the heart must push harder to get blood through. In regurgitation the valve does not close fully, so some blood leaks backwards. A valve can have both problems at once.
Will I need surgery?
Not always. Mild valve disease may need only regular check-ups, and medicines can ease symptoms. A procedure is advised when the disease is severe or getting worse, and your heart team will explain the options.
Can I exercise with a heart valve problem?
Many people can stay active, but strenuous exercise may need to be limited, depending on the valve and how severe the problem is. Ask your doctor what level of activity is safe for you.
