Your heart is divided into two sides which are separate but work as a team. 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.
Blood coming back to your heart enters the atria first. Your atria contract, pushing blood into your ventricles. The ventricles then contract to push blood out into your arteries. Two of your heart valves lie between the atria and ventricles, one on each side. The other two valves lie between the ventricles and the arteries. 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.
The type of heart valve disease you have gets its name from which valve is affected. It helps to know the names of these four valves. The valves between your atria and ventricles are the ‘mitral’, on the left, and the ‘tricuspid’ on the right side of your heart. The valves between your ventricles and your arteries are the ‘aortic’ on the left and the ‘pulmonary’ on the right side of your heart.
Heart valve disease occurs when there is a problem with one of your four heart valves. Here we describe the two main problems they may have.
- 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.
The type of heart valve disease you have depends upon which of these problems you have and which valve is affected. Each of your four heart valves (the mitral, aortic, tricuspid and pulmonary valves) may be affected by stenosis or regurgitation.
Usually you’ll have one of these problems in a single valve. However, you can have problems with more than one valve, or you may have both problems in a single valve.
Most people who have heart valve disease have problems with the aortic or the mitral valve. Aortic stenosis is the most common type of heart valve disease seen in Europe.
The symptoms of heart valve disease may depend on which of your valves is affected and how severely. You may not experience any symptoms, or your symptoms may come on so gradually you don’t really notice them. However, if your condition is severe you may suddenly get very noticeable symptoms.
Symptoms of heart valve disease may include:
- being out of breath
- palpitations (awareness of an irregular, fluttery or racing heartbeat)
- angina (chest pain when you exert yourself)
- swollen ankles or feet
- dizziness or fainting
It’s important to remember that the severity of your symptoms isn’t always closely linked to how severe your heart valve problem is. You may feel that your symptoms are mild, or hardly noticeable, but your doctor may still recommend that you have treatment.
Your GP will ask you about your symptoms and examine you. They may also ask you about your medical history, including whether you’ve ever had an illness called rheumatic fever. Your GP may then 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 GP suspects there may be a problem with your heart, they may refer you for more tests. They will probably recommend the following tests.
- Echocardiogram – this is the key test for heart valve disease. This painless test 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 your heart is 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. Your doctor may ask you to have an ECG while exercising, to see how your heart reacts when it’s working hard.
In some circumstances your doctor may recommend further tests. If so, ask them to explain why these might be helpful in your case. These further tests might include the following.
- CT scan or MRI scan – this provides detailed pictures of your heart muscles and valves.
- Coronary angiogram – this shows if there are any blockages in the arteries attached to your heart. Your doctor may recommend this test to see if you have coronary artery disease as well as heart valve disease. A special dye (contrast agent) is injected into the arteries around your heart, through a long tube inserted into a blood vessel in your groin. X-ray images show up the blood flowing through the coronary arteries.
You may not need any treatment at all for many years or at all if you have mild heart valve disease. Your doctor will probably recommend regular check-ups, and you should see your doctor if your symptoms get worse.
If and when you do need treatment, this will depend on what’s 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.
Medicines can’t cure your heart valve problems. However, your doctor may prescribe medicines to relieve your symptoms and slow down any worsening of the condition. The medicine that your doctor offers you will be the one that's most effective for your individual needs. Medicines used in heart valve disease include:
- Diuretics. 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 (angiotensin-converting enzyme) inhibitors. These help by lowering your blood pressure so the strain on your heart is reduced.
- Beta-blockers. These help the heart to beat more slowly to reduce its workload. You may find this helps with symptoms of palpitations.
- Digoxin. This controls your heart rate if it’s irregular (atrial fibrillation) and reduces your symptoms of palpitations so your heart pumps more effectively.
- Anticoagulant medicines. These help to reduce the risk of blood clots forming. This is important as blood clots may lead to you having a stroke.
Always read the patient information leaflet that comes with your medicine carefully.
Heart valve surgery
Your doctor may recommend heart valve surgery even if you’re not having symptoms. This is because surgery can correct the valve abnormality, improve symptoms and help prevent long term damage to your heart.
Your faulty heart valve may be repaired or replaced with an artificial valve. Heart valve repair is usually preferred over heart valve replacement. This is because a repair avoids the need for anticoagulants and may last longer than a replaced valve. You also have a lower risk of infection after surgery. However, not all valves can be repaired.
Both procedures are done under general anaesthesia. This means you’ll be asleep during the operation.
See our topic on heart valve surgery for much more information about what it involves.
Transcatheter aortic valve implantation (TAVI)
A newer type of valve surgery is transcatheter aortic valve implantation (TAVI) which your doctor may offer you if you have aortic stenosis. This procedure allows your doctor to replace your aortic valve without having to use 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.
Your TAVI procedure can be carried out under general anaesthesia, when you are asleep. Or it may be done under local anaesthesia, which means you’ll be awake. 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 your doctor places across your faulty valve. Another way of doing the TAVI procedure is for your doctor to make a small cut in the skin between two of your ribs. They then pass a catheter directly into your heart and up to your aortic valve.
At the moment TAVI is quite a new procedure and doctors don’t yet know for sure how long-lasting the new valve will be. Ask your doctor if TAVI is an option for you in your particular circumstances.
Balloon valve surgery (balloon valvuloplasty)
Balloon valve surgery (balloon valvuloplasty) is a procedure which is used occasionally for people with a narrowed valve (aortic or mitral stenosis). It may be used in young children until they are old enough for a valve replacement. Your doctor may also offer you balloon valvuloplasty if you can't have valve surgery, or to support your heart until you can have TAVI.
Your doctor threads a small tube (catheter) with a balloon on the tip through an artery, usually from your groin. They then feed the tube up to the faulty valve in your heart. Then they pass a guide wire, with a deflated balloon at the end, up the catheter. When it reaches your narrowed valve, the balloon is gently inflated to stretch the valve. Your doctor then deflates the balloon and removes it, leaving a widened valve that your blood can flow through more efficiently.
You’ll be awake during the procedure and you’ll usually need to stay in hospital for three or four days. 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.
Heart valve disease can be caused by several conditions, which include the following.
- Congenital heart valve defect. This means you were born with a faulty valve. Congenital heart valve faults don’t always cause symptoms, or may only cause problems when you are an adult. This type of valvular heart disease can sometimes run in families.
- Ageing. As you get older, your valves become thickened and stretched. 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.
- Disease of the heart muscle (cardiomyopathy). This might cause your heart to be enlarged and stretched, which stops the valves closing properly.
- Damage or injury to the heart, such as a heart attack. This can stretch and distort your heart so that the valves can’t work properly.
- Rheumatic fever. This causes inflammation of your heart muscles. One or more of your heart valves may be damaged or scarred as a result of your body fighting the infection. This is a common cause of heart disease in developing countries but is now rare in Western countries.
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). 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 question ‘I’ve got a faulty heart valve and my doctor says I’m at risk of endocarditis. What’s this?’ for more information.
During pregnancy, your heart works harder. It’s normal for your blood volume and heart rate to increase and your resistance to blood flow to decrease. If you have heart valve disease, you might have trouble coping with this increased blood flow. In fact you may get your first symptoms from a faulty valve while you are pregnant.
Most women with mild or moderate heart valve disease don’t have problems during pregnancy, although you may need to be supervised more closely. Your doctor may offer you medicines to help with your symptoms and you may be advised to rest.
If you have severe heart valve disease and are planning to get pregnant, discuss this with your cardiologist. They may advise you to have valve surgery before you become pregnant. You can have balloon valvuloplasty or valve surgery during pregnancy if it’s really needed. However, this can be risky for you and your baby. Speak to your doctor about how these risks apply to you.
Your doctor will discuss with you which is the safest way to deliver your baby in your particular circumstances. In some cases it may be best to have a caesarean section.
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.
Contacting other people who have heart valve disease through charities and patient groups can be a good way to obtain support and advice. See our Resources section for details of organisations that can help.
My doctor says I’m at risk of endocarditis. What’s this? I’ve got a faulty heart valve and my doctor says I’m at risk of endocarditis. What’s this?
Endocarditis is a serious infection of the lining of your heart and valves. If you have a faulty or artificial heart valve, bacteria or other micro-organisms in your bloodstream can settle there and cause this infection. Endocarditis can be a serious infection and may damage your heart and cause other complications if it isn’t treated.
Endocarditis is usually caused by bacteria. These get into your bloodstream through skin injuries, or damage to the lining of your mouth and gums. Even everyday activities like brushing your teeth may allow bacteria to get into your blood. They can then settle onto your heart valves and begin to grow, hiding from the body’s immune defences. Faulty or artificial heart valves are especially vulnerable to infection. Endocarditis can develop very quickly, called acute endocarditis, or more slowly, when it’s called sub-acute endocarditis.
The symptoms of endocarditis vary and it can be difficult to diagnose. 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:
- sweats or chills
- aching muscles
- unintentional weight loss or loss of appetite
- chest pain
Endocarditis can be treated with antibiotics. Antibiotics are usually given for two to six weeks through a drip into your bloodstream so you’ll need to go into hospital. How long you stay in hospital will depend upon how severe your infection is and which antibiotics you need. Your antibiotics may be continued via a drip at home after you leave hospital.
You might need surgery to repair or replace a damaged heart valve or to help clear up endocarditis.
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 piercings or tattoos.
Doctors used to recommend that you take antibiotics before procedures such as dental work, if you have faulty heart valves. This was thought to help prevent endocarditis. They now believe that this may do more harm than good so it's no longer recommended.
Are there any exercises that I shouldn't do? I have heart valve disease. Are there any exercises that I shouldn't do?
Exercise is very good for both your heart and overall health and it's important to stay physically active if you have heart valve disease. Many people with heart valve disease can manage a good level of physical activity. Others, with more severe disease, may find that they can’t do what they used to do, or what they’d like to do. Heart valve disease can affect people differently so you should ask your doctor which types of exercise are OK in your particular circumstances. .
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 or cardiologist about what type of exercise is best for you. You should increase your levels of physical activity gradually. You may be advised not to do any strenuous activities, such as weightlifting or press-ups, or vigorous sports like squash. That’s because 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
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? What is mitral valve prolapse and do I need treatment?
Mitral valve prolapse is a condition where the flaps of one of your heart valves, your mitral valve, are ‘floppy’ and don’t close properly. In most cases, mitral valve prolapse is harmless and doesn’t need treatment. If you have symptoms, such as chest pain or palpitations, your doctor may recommend lifestyle changes and beta blockers. Occasionally mitral prolapse can cause your valve to leak badly (regurgitation) and you may need heart valve surgery.
Your mitral valve controls the blood flow between the upper and lower chambers on the left side of your heart. If you have mitral valve prolapse, part of one or both flaps of the valve bulges back into the atrium when the lower chamber contracts. This can cause a heart murmur (a noise from your heart caused by turbulent blood flow heard with the stethoscope). If you have a heart murmur, your GP may refer you to a cardiologist to find out exactly what’s causing it. A cardiologist is a doctor specialising in identifying and treating conditions of the heart and blood vessels.
Around three in 100 people have mitral valve prolapse. It’s often caused by a minor gene abnormality, which causes the structural protein (collagen) in your valve tissue to be more flexible than normal.
Most people with mitral valve prolapse have no symptoms and don’t need treatment. A small number of people have symptoms including chest pain and palpitations (an unpleasant awareness of the heartbeat, like a thumping in your chest). Doctors don’t completely understand why this is. If you have these symptoms your doctor may advise you to give up coffee, alcohol and cigarettes which can stimulate your heart. They may offer you medicines called beta-blockers to help reduce your symptoms.
Occasionally, mitral prolapse can cause blood to leak backwards through the valve. This is called mitral regurgitation. If backflow of blood does occur, it can make you tired and also short of breath, especially when doing exercise or lying flat in bed. If your mitral regurgitation becomes severe you may need surgery to repair or replace your mitral valve. However, only a very small number of people with mitral valve prolapse need surgery.
The effects of heart valve disease vary greatly between people, so it’s not possible to give a definite answer that will be right for you. However, most people with heart conditions that are stable can fly safely. If you have severe symptoms from heart valve disease then it may not be safe for you to fly. Ask your doctor about the risks of flying in your particular circumstances.
When a plane is flying at altitude, the oxygen pressure in the cabin is lower than you’ll be used to. This may cause problems for people with heart conditions including heart valve disease.
Heart valve disease can affect you in very different ways. You may have no symptoms at all, or only mild or moderate symptoms. Or you may have severe symptoms. Because your condition is individual to you, it’s difficult to give a definite answer about whether it’s safe to fly.
However, doctors believe that most people with stable heart disease are safe to fly. Stable means that your condition tends to be the same from day to day. It may be best for you to allow yourself plenty of time at the airport so that you aren’t rushed or stressed. Your symptoms may mean that you need some assistance getting round the airport. If your doctor recommends that you have extra oxygen during your flight, contact your airline in advance to see how this can be arranged. A fee may be charged.
If you have severe symptoms, or your symptoms are unstable then it may be better to delay flying until your condition has improved.
Ask your doctor whether there is any reason you should not fly, and follow their advice. It’s a good idea too to check with your airline for their recommendations and to make any special arrangements you may need.
- British Heart Foundation
0300 330 3311
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