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Heart valve disease

Heart valve disease occurs when one or more of your heart valves aren’t working fully and blood isn't flowing through your heart as it should. It’s also known as valve disease or valvular heart disease.

Heart valve disease can put extra strain on your heart and cause your heart to pump less efficiently.

The heart

Your heart is a muscular organ that pumps blood around your body. It’s divided into two sides. The right side of your heart pumps blood to your lungs to get oxygen and the left side pumps oxygenated blood around your body. There are four chambers inside your heart – two on the left side and two on the right side. The two smaller upper chambers are called the atria and the two larger lower chambers are called the ventricles.

Heart valves

There are four valves in your heart. The valves act like ‘gates’, which open and close. This makes sure that your blood travels in one direction through your heart and stops blood from leaking back against this flow.

  • Two are between your atria and your ventricles. The mitral valve is on the left side and the tricuspid valve is on the right side.
  • Two are in the arteries leaving your heart. The aortic valve is on the left side and the pulmonary valve is on the right side.

Heart valve disease

Heart valve disease occurs when there is a problem with one of your valves.

  • Valve stenosis – this is when your valve becomes narrow and your blood can't easily flow into the next chamber or blood vessel. Your heart has to work harder to pump blood through.
  • Valve regurgitation (also known as valve incompetence or a leaky valve) – this is when your valve doesn't close properly and blood can leak backwards.
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Image showing the blood flow in the heart and major blood vessels

Details

  • Symptoms Symptoms of heart valve disease

    The symptoms of heart valve disease depend on which valve is affected and how severely. If your valves are only mildly affected, you may not experience any symptoms, but if you do, common symptoms include:

    • being out of breath
    • tiredness or fatigue
    • palpitations (awareness of an irregular, fluttery or racing heartbeat)
    • angina (chest pain) – this happens with aortic valve stenosis, because your heart has to work harder to pump blood from the heart
    • swollen ankles or feet
    • dizziness or fainting

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  • Diagnosis Diagnosis of heart valve disease

    Your GP will ask you about your symptoms and examine you. He or she may also ask you about your medical history. Your GP may listen to your heart with a stethoscope to check for a murmur (an unusual sound). A murmur doesn’t always mean there is a problem with your heart – people with normal hearts can have murmurs.

    If your doctor suspects there may be a problem with your heart, you may be referred to a cardiologist (a doctor specialising in conditions of the heart and blood vessels) to have further tests.

    • Transesophageal echocardiogram – this is a type of echocardiography, which uses sound waves to create a moving picture of your heart as it beats. It shows the pumping action of your heart and the function of your heart valves.
    • Chest X-ray - this helps to rule out any other conditions that may be causing your symptoms. It can also show if certain sections of your heart are enlarged, if you have fluid in your lungs or if calcium deposits are in your heart.
    • Electrocardiogram (ECG) - this measures the electrical activity of your heart to see how well it's working.
    • CT scan or MRI scan - this provides detailed pictures of your heart muscles and valves.
    • Angiogram (or cardiac catheterisation) – this involves putting a long, thin, flexible tube called a catheter into a blood vessel in your groin or wrist. The catheter is then guided to your heart and a special dye (contrast agent) is injected through the catheter so that X-ray images show your heart more clearly.
  • Treatment Treatment of heart valve disease

    Your treatment will depend on what is wrong with your valve and the effect that it’s having on your heart. Most heart valve problems can be treated using medicines or by surgery. You may not need any treatment at all if you have mild heart valve disease, but you will most likely have regular check-ups. You should see your doctor if your symptoms get worse.

    Medicines

    You may be prescribed medicines to relieve your symptoms and slow down any worsening of the condition. The medicine you're given will be the one that's most effective for your individual needs.

    • Diuretics (eg furosemide, spironolactone). These help to reduce the build up of fluid in your lungs, so you can breathe more easily. They also help to reduce any swelling in your feet and ankles, so you can be more active.
    • ACE inhibitors (eg ramipril, perindopril). These help by lowering your blood pressure and reducing strain on your heart.
    • Digoxin. This stabilises your heart rhythm and helps your heart pump harder.
    • Warfarin. This is an anticlotting medicine that helps to reduce the risk of blood clots forming.

    Always ask your GP for advice and read the patient information leaflet that comes with your medicine.

    Surgery

    Heart valve surgery

    Your faulty heart valve may be replaced with an artificial valve (valve replacement) or your valve may be repaired, if possible (valve repair). Both procedures are done under general anaesthesia. This means you will be asleep during the operation.

    Heart valve repair is usually preferred over heart valve replacement because it preserves the strength of your heart muscle. You also have a lower risk of infection after surgery. However, not all valves can be repaired.

    Balloon valve surgery (balloon valvuloplasty)

    For children and younger people with a narrowed valve (stenosis), or adults who can't have open valve surgery, your doctor may recommend balloon valve surgery (balloon valvuloplasty). This procedure is less invasive than open valve surgery.

    A small tube (catheter) with a balloon on the tip is threaded up to the faulty valve in your heart through an artery, usually from your groin. A guide wire, with a deflated balloon at the end, is passed up the catheter. When it reaches your narrowed valve, the balloon is gently inflated to stretch the valve. The balloon is then deflated and removed, leaving a widened valve that your blood can flow through more efficiently.

    You will be awake during the procedure and you will usually need to stay in hospital overnight. Balloon valve surgery can help to relieve your symptoms of heart valve disease, but it may not cure it. You may still need to take medicines or have surgery to repair or replace your faulty valve.

    Transcatheter aortic valve implantation (TAVI)

    A newer type of valve surgery is transcatheter aortic valve implantation (TAVI), which allows your aortic valve to be replaced without having to have full open heart surgery. Your doctor may recommend that you have this type of surgery if open heart surgery is too high a risk for you. During this procedure, a catheter is inserted into a blood vessel, usually in your groin, and then guided up to your heart. The catheter carries an artificial valve, which can be placed across your faulty valve.
  • Heart treatment on demand

    You can access a range of our health and wellbeing services on a pay-as-you-go basis, including heart treatment.

  • Causes Causes of heart valve disease

    Heart valve disease can be caused by several conditions.

    • Congenital heart valve defect. This means you were born with a faulty valve. A common inherited condition is floppy mitral valve. This causes your mitral valve to leak. Congenital heart valve defects are usually diagnosed in childhood.
    • Disease of the heart muscle (cardiomyopathy). You might have been born with this or developed it as a complication of another disease, such as rheumatic fever or endocarditis. The enlargement of your heart from inflammation (swelling) can lead to a secondary valve leak.
    • Ageing. As you get older, your valves become less flexible, more stretched or torn. Men older than 65 and women older than 75 are prone to developing calcium and other types of deposits on their heart valves. These deposits stiffen and thicken your valves, limiting blood flow.
    • Rheumatic fever. This causes inflammation of your heart muscles, and one or more of your heart valves may be damaged or scarred as a result of your body fighting the infection. However, this is no longer seen in Western countries.
  • Complications Complications of heart valve disease

    If you have a damaged heart valve, it’s more likely to become infected. Endocarditis is an infection of the inner lining of your heart chambers and valves (also known as infective endocarditis). This lining is called the endocardium. Endocarditis happens if bacteria or other germs enter your bloodstream and reach your heart. The infection can damage your heart and cause serious complications. See our frequently asked questions for more information.

    If you have heart valve disease, you may need to take antibiotics before you have surgery or certain dental procedures to reduce your risk of infection. Ask your GP for more advice.

  • Special considerations Special considerations

    If you're pregnant

    During pregnancy, your heart works harder. Your blood volume and heart rate increases and your resistance to blood flow decreases. If you have heart valve disease, you might have trouble tolerating this increased blood flow.

    Mild or moderate heart valve disease during pregnancy can usually be managed with medicines or bed rest. Your GP can prescribe you medicines that are safe to take during your pregnancy.

    If you have severe heart valve disease and are planning to get pregnant, see your GP. You may be advised to have valve surgery before you become pregnant. You can have your valves repaired or replaced during pregnancy if it’s needed. However, this carries several large risks. Speak to your surgeon about how these risks apply to you.

  • Living with heart valve disease Living with heart valve disease

    Heart valve disease is a lifelong condition. For some people, the condition will stay the same throughout their lives and won’t cause any problems. For others, the condition slowly gets worse and symptoms develop.

    If you have heart valve disease, you may need to have regular check-ups with your cardiologist. These check-ups are very important, even if you feel completely well. Always call your doctor if your symptoms get worse or you develop new symptoms.

  • Help and support Help and support

    Contacting other people who have heart valve disease through charities and patient groups can be a good way to obtain support and advice.

  • FAQs FAQs

    I had a heart valve replaced and my doctor says I am at risk of endocarditis. What is this?

    Answer

    Endocarditis is an infection of the inside lining of your heart. If you have a faulty or artificial heart valve, it can become infected and result in heart failure if it isn't treated quickly.

    Explanation

    Endocarditis is when the lining of your heart becomes inflamed, usually because of a bacterial infection. Endocarditis is a serious condition that can cause heart failure if it isn't treated quickly.

    A faulty or artificial heart valve is vulnerable to infection. When an infection occurs in the lining of your heart, it can spread to your heart valve and stop it from working properly.

    Symptoms of endocarditis are sometimes similar to flu. You should seek urgent medical advice if you have a heart valve condition and have any of these symptoms:

    • fever
    • sweats or chills
    • aching muscles
    • unintentional weight loss or loss of appetite
    • breathlessness or a cough that won't go away
    • chest pain
    • blood in your urine
    • swelling in your feet, legs or abdomen

    Endocarditis can be treated with antibiotics. Antibiotics are usually given for two to six weeks through a drip into your bloodstream. You will usually have to stay in hospital for a week or two. Once you’re allowed to go home, the antibiotics are usually continued via a drip at home.

    You might need surgery to repair or replace a damaged heart valve or to help clear up endocarditis. Endocarditis caused by a fungus often requires surgery.

    If you have a heart condition, it's important you take steps to reduce your risk of infection.

    • Practice good dental hygiene and have regular dental checkups. This will help reduce the risk of bacteria entering your bloodstream through your mouth.
    • Take care of your skin. Bacteria can enter your bloodstream through an infected wound or cut on your skin. Wash any cuts or grazes carefully as soon as you notice them to help prevent infection.
    • Don’t have any body piercing or tattoos.
    • If you have a temperature, your doctor may take a blood sample to check for bacteria in your bloodstream.

    For more information about preventing endocarditis, talk to your GP.

    I have heart valve disease. Are there any exercises that I shouldn't do?

    Answer

    Exercise is very good for both your heart and overall health. It's important to stay physically active if you have heart valve disease, but you shouldn't do any type of strenuous activity that brings on symptoms such as chest pain (angina) or palpitations.

    Explanation

    Your heart is a muscle, therefore, like the other muscles in your body, it gets stronger with exercise.

    If you have heart valve disease, talk to your GP about what type of exercise is best for you. You should increase your levels of physical activity gradually. If your heart valve disease is mild, you can usually achieve a good level of physical activity. You may be advised not to do any strenuous activities, such as weightlifting or press-ups, or vigorous sports like squash, as these can put a strain on your heart. Good types of exercise include walking, swimming or light jogging. You should stop exercising immediately if you feel:

    • short of breath
    • pain in your chest
    • dizzy or light-headed
    • sick

    If you develop any of these symptoms and they don't go away after a few minutes you should seek medical attention as soon as possible.

    What is mitral valve prolapse and do I need treatment?

    Answer

    Mitral valve prolapse means there is a problem with the valve that separates your upper and lower chambers on the left side of your heart. In most cases, mitral valve prolapse is harmless and it does not affect your health, but if you have symptoms, such as chest pain or palpitations, you might be prescribed beta blockers.

    Explanation

    Mitral valve prolapse can be the cause of a heart murmur (a noise from your heart caused by turbulent blood flow heard with the stethoscope), but it doesn't usually cause serious problems. If you have a heart murmur, your GP will refer you to a cardiologist (a doctor specialising in identifying and treating conditions of the heart and blood vessels) to find out exactly what is causing it.

    Mitral valve prolapse is often caused by a minor gene abnormality, which causes the structural protein (collagen) in your valve tissue to be more flexible than normal.

    If you have mitral valve prolapse, the flaps of your valve are "floppy" and don't close tightly. In a small number of cases, the prolapse can cause blood to leak backwards. This is called mitral regurgitation. If backflow of blood does occur, it can cause shortness of breath, chest pain (angina) or palpitations (an unpleasant awareness of the heartbeat, often described as a thumping in your chest).

    You won't usually need treatment unless it's causing you problems. Your GP may prescribe you beta blockers (eg bisoprolol fumarate) to help with your chest pain and palpitations.

    In the past, patients with heart valve problems were usually given antibiotics before dental work or surgery. The antibiotics were given to prevent infection of your damaged heart. However, antibiotics are now used much less often. Your GP or cardiologist will be able to advise you about taking antibiotics before any procedures that you have.

    Although rarely done, you may need surgery to repair or replace your mitral valve if it becomes leaky (regurgitation). You’re more likely to need mitral valve repair or replacement if:

    • your symptoms get worse
    • the left ventricle of your heart is enlarged
    • your heart function gets worse
  • Resources Resources

    Further information

    Sources

    • What is heart valve disease? National Heart Lung and Blood Institute. www.nhlbi.nih.gov, published November 2011
    • Valvular heart disease. Map of Medicine. www.mapofmedicine.com, published March 2012
    • Heart valve disease. British Heart Foundation. www.bhf.org.uk, accessed 17th August 2012
    • What is the heart? National Heart Lung and Blood Institute. www.nhlbi.nih.gov, published November 2011
    • How your heart works. British Heart Foundation. www.bhf.org.uk, accessed 17 July 2012
    • What are the signs and symptoms of heart valve disease? National Heart Lung and Blood Institute. www.nhlbi.nih.gov, published November 2011
    • Aortic stenosis. The Merck Manuals. www.merckmanuals.com, published May 2006
    • What is endocarditis? National Heart Lung and Blood Institute. www.nhlbi.nih.gov, published October 2010
    • Endocarditis. PubMed Health. www.ncbi.nlm.nih.gov, published April 2010
    • Camm AJ, Luscher TF, Serruys PW. Cardiovascular Medicine. 2nd ed. Oxford: Oxford University Press, 2009
    • Joint Formulary Committee. British National Formulary. 62nd ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain; 2011
    • Transcatheter aortic valve implantation. The British Cardiac Patients Association. www.bcpa.co.uk, accessed 28 September 2012
    • Personal communication, Dr Tim Cripps, Consultant cardiologist, Bristol Royal Infirmary, 28 September 2012
    • Henriquez DD, Roos-Hesselink JW, Schalij MJ, et al. Treatment of valvular heart disease during pregnancy for improving maternal and neonatal outcome. Cochrane Database of Systematic Reviews 2011, Issue 5. doi: 10.1002/14651858.CD008128.pub2
    • Mitral valve prolapse. PubMed Health. www.ncbi.nlm.nih.gov, published April 2012
    • How is mitral valve prolapse treated? National Heart Lung and Blood Institute. www.nhlbi.nih.gov, published July 2011
    • Physical activity and your heart. British Heart Foundation. www.bhf.org.uk, published August 2009
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    Produced by Alice Rossiter, Bupa Health Information Team, October 2012.

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