Heart valve disease

About your heart and valves

Your heart is a large muscular organ that pumps blood around your body and lungs. It’s divided into two sides, with two chambers on the left and two on the right.

Blood returning to your heart first goes into the two smaller chambers at the top of your heart (the atria). The atria contract and push blood into the two larger chambers at the bottom of your heart (the ventricles). The ventricles then squeeze, pushing blood out into your arteries. Blood from the right side of the heart goes to the lungs to pick up more oxygen and then comes back to the left atrium. Blood from the left side goes around your body, supplying oxygen and nutrients, before coming back to the right atrium.

Four one-way valves inside your heart open and close, making sure your blood travels in one direction. This stops blood from leaking back against the flow. Two of these heart valves are between your atria and ventricles (the mitral valve on the left, and the tricuspid valve on the right). The other two valves are between your ventricles and arteries (the aortic valve on the left and pulmonary valve on the right).

Types of heart valve disease

Heart valve disease can affect any of the four main valves – the mitral, aortic, tricuspid and pulmonary valves – in two main ways.

• Stenosis: the valve gets narrower – your heart has to work harder to force blood through a smaller gap.
• Regurgitation: the valve doesn't close properly – blood leaks backwards (a leaky or incompetent valve).

Most people have one affected valve, with either stenosis or regurgitation. But some have problems with more than one valve. You can also have stenosis and regurgitation in a single valve.

Most people with heart valve disease have problems with the aortic or mitral valve. Aortic stenosis is the commonest type of heart valve disease needing treatment in general. Mitral valve regurgitation is second commonest.

Symptoms of heart valve disease

Symptoms depend on which valve is affected and how badly. You may not have any symptoms, or they may come on so gradually that you don’t really notice them. If your condition is severe, symptoms can come on quickly and may need urgent treatment.

Symptoms may include:

• breathlessness, sometimes brought on by exercise
• more difficulty breathing lying flat, compared to sitting up
• waking at night with difficulty breathing
• coughing up blood
• extreme tiredness
• being less able to tolerate exercise
• an irregular, fluttery or racing heartbeat (palpitations)
• chest pain
• swollen ankles or feet
• dizziness, fainting or having a black out (losing consciousness temporarily)

For more severe symptoms – particularly if you have chest pain or collapse – reach out to nearest medical help for immediate support. 

It’s difficult to tell from your symptoms alone how severe your condition is. Sometimes you can have mild symptoms but severe valve disease. So, even if your symptoms are mild, you still need to see your doctor who may suggest treatment.

Diagnosis of heart valve disease

Your doctor will examine you and ask about your symptoms, lifestyle and day-to-day health. They may also ask about your medical history, including whether you’ve ever had rheumatic fever.

Your doctor may listen to your heart with a stethoscope. Your heart valves can make unusual sounds (a murmur) if the valve isn’t working properly. A murmur doesn’t always mean there’s a problem with your heart or valves. Sometimes it’s caused by blood flow (a flow murmur).

If your doctor thinks there may be a problem with your heart, they’ll refer you for more tests. These may include the following.

Echocardiogram (Echo)

Echocardiogram uses sound waves to create a moving picture of your heart as it beats. It shows how well your heart is pumping and the flow of blood through it. Echocardiogram is the main test for heart valve disease. It can help your doctor to see how severe any valve disease is and what treatment you might need. The standard type is a [LW1] , where a sensor is held against your chest. If your doctors want a more detailed picture, you may have a , where a probe is passed into your oesophagus (also known as your food pipe or gullet).

Chest X-ray

Chest  helps to rule out other conditions that may be causing your symptoms. It can also show if your heart has got bigger – a sign of heart valve disease, because your heart has been working harder.

Electrocardiogram (ECG)

Electrocardiogram measures the electrical activity of your heart to see how well it's working. It can show up changes in heart rhythm. Your doctor may ask you to have an ECG while exercising, to show how your heart reacts when it’s working hard.

Your doctor may suggest more tests, such as a (MRI), a (CT) or an . This is usually to find out if you have related conditions, such as , as well as how severe your heart valve disease is. This extra information can help your doctor to decide which treatment is best.

Treatment of heart valve disease

You may not need treatment if you have mild heart valve disease without symptoms. Your doctor will probably recommend regular check-ups and echocardiograms. You need to see your doctor if you start to get symptoms.

If your heart valve disease is causing symptoms, the main treatment is usually surgery. Deciding on the best treatment can be complex, so it’s usually done by a team of heart specialists. This may mean travelling to a hospital with a specialist team to have your treatment.

Heart valve surgery

Heart valves can be repaired or replaced during surgery. Which treatment you need will depend on what’s wrong with the valve, how it’s affecting your heart and whether you have other health problems. For some conditions, such as mitral regurgitation, valve repair is generally better, whereas for other conditions, such as aortic stenosis, valve replacement is usually better.

There are two main types of replacement valve.

• Artificial mechanical valves are usually used in younger people because they last for a long time. To keep them working well and prevent blood clots, you need to take an anti-clotting medicine called warfarin for life.
• Animal tissue valves tend not to last as long as mechanical valves. But you don’t need to take warfarin for life with a tissue valve (unless there are other medical reasons why you should).

Valves can be repaired or replaced using different types of procedures. These are some of the main procedures you may be offered.

• Open heart surgery – you have a large cut in your chest, through which your surgeon does the operation.
• Transcatheter aortic valve implantation (TAVI) – a thin wire is used to guide a replacement valve into a blood vessel and up into your heart. You may be offered this if you have aortic stenosis and you can’t have open heart surgery for some reason.
• Balloon valvuloplasty – a procedure used to widen a narrowed valve, for example, if you have mitral or aortic stenosis. Your surgeon makes a small cut in the vein in your groin and passes a thin catheter (tube) along it until it reaches your heart valve. The tip of the catheter has a balloon your doctor inflates when it reaches the narrowed part of your valve, to stretch it.

Any type of heart surgery carries some risk. Ask your surgeon to explain the pros and cons of different procedures to you. See our topic on Hfor more information about what each one involves.

Medicines

Medicines can’t cure your heart valve problems. But your doctor may prescribe them to help ease symptoms, treat any other heart problems and slow down any worsening of the condition. Heart valve disease can sometimes lead to other heart problems, such as heart failure and an irregular heartbeat. You may need medicines to manage these. You may have [LW1]  and ACE (angiotensin-converting enzyme) inhibitors to treat heart failure, nitrates to ease chest pain or beta-blockers to reduce the strain on your heart.

Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist or doctor for advice.

Causes of heart valve disease

As you get older, heart valves become thickened and stretched, which can lead to problems. This is more likely to happen if you smoke, or have , type 2 diabetes or high cholesterol. There are also several different conditions associated with heart valve disease, including:

• diseases affecting heart muscle (cardiomyopathy)
• being born with a faulty heart valve (congenital heart valve defect) such as aortic stenosis
• infection, such as endocarditis (an infection of the lining of your heart)
• damage or injury to the heart, such as damage caused by a heart attack
• rheumatic fever – an autoimmune condition where your immune system attacks and damages your heart valves, usually the mitral valve

Complications of heart valve disease

With the right treatment, many people with heart valve disease have few, if any complications. But for some people, complications can be very serious and sometimes life-threatening. They include:

• heart failure
• irregular heart rhythms (arrhythmia)
• a stroke
• endocarditis – an infection of the lining of your heart

Special considerations if you're pregnant

The way your heart and circulation works changes when you’re pregnant. From just a few weeks into your pregnancy, your heart has to pump harder and faster.

If you have valve disease, your heart might have trouble coping. In fact, some women are first diagnosed with valve disease when they become pregnant because they get symptoms for the first time.

If you have heart valve disease, you’re likely to need regular check-ups while you’re pregnant and close monitoring for you and your baby. Depending on your health and the type of valve disease you have, you may need treatment while you’re pregnant. You may also need specialist care when you give birth. Talk to your midwife and obstetrician for more information.