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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.

About heart valve 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.

Illustration showing the blood flow in the heart and major blood vessels

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.

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

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.

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.

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 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.

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

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

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

 

Produced by Alice Rossiter, Bupa Health Information Team, October 2012.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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