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Heart valve disease

Expert reviewer, Mark Yeatman, Cardiothoracic Surgeon
Next review due, December 2020

Heart valve disease is when one or more of your heart valves become diseased or damaged, affecting the way that blood flows through your heart. This can put extra strain on your heart and cause symptoms such as chest pain, difficulty breathing and tiredness. Heart valve disease can vary from mild to severe. Sometimes it can be life-threatening and need urgent treatment.

If you have heart valve disease and it isn’t causing symptoms, you may not need any treatment. Sometimes the symptoms of heart valve disease can develop so slowly that you may not notice them at all. But if your symptoms become more severe, you may need treatment to have the valve repaired or replaced.

About your heart and heart 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 side and two on the right side of your heart.

Blood coming back to your heart first goes into the two smaller chambers at the top of your heart (the atria). The atria squeeze 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, around your body and lungs.

There are four one-way valves inside your heart that open and close, making sure that 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 side of your heart). The other two valves are between your ventricles and arteries (the aortic valve on the left and pulmonary valve on the right side of your heart).

Types of heart valve disease

Heart valve disease can affect any of the four main valves – the mitral, aortic, tricuspid and pulmonary valves. There are two main ways that the valves can be affected.

  • Stenosis is when the valve gets narrower. This means your heart has to work harder to force the blood through a smaller space.
  • Regurgitation is when the valve doesn't close properly and blood can leak backwards. It’s sometimes called a leaky valve or incompetent valve.

Most people will have one valve affected by either stenosis or regurgitation. 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 in Europe. Mitral valve regurgitation is the second most common.

Symptoms of heart valve disease

The symptoms you get will depend on which of your valves is affected and how severely. You may not have any symptoms, or your symptoms may come on so gradually you don’t really notice them. However, if your condition is severe, the symptoms can come on quickly and may need urgent treatment.

Symptoms of heart valve disease may include:

  • being out of breath, sometimes brought on when you’re more active
  • finding it more difficult to breathe when you’re lying flat, compared to when you’re sitting up
  • waking up at night with difficulty breathing
  • coughing up blood
  • extreme tiredness
  • finding you’re less able to tolerate exercise
  • feeling an irregular, fluttery or racing heartbeat (palpitations)
  • chest pain
  • swollen ankles or feet
  • dizziness, fainting or having a black out (where you lose consciousness temporarily)

For more severe symptoms – particularly if you have chest pain or collapse – you should call 999 and ask for immediate medical help. If you have milder symptoms, you should arrange to see your GP. If you’re not sure how serious your symptoms are you can call 111 for advice from the NHS.

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, your doctor may still suggest treatment.

Diagnosis of heart valve disease

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

Your doctor may then listen to your heart with a stethoscope. Your heart valves make a sound when they close and can also 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 the valves. Sometimes it’s simply caused by blood flow, which is known as a flow murmur.

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

  • Echocardiogram – this 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 key 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 transthoracic echocardiogram, where a sensor is held against your chest. If your doctors want a more detailed picture, you may have a transoesophageal echocardiogram, where a probe is passed into your oesophagus (food pipe).
  • Chest X-ray – this 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) – this measures the electrical activity of your heart to see how well it's working. It can show up any changes in heart rhythm. Your doctor may ask you to have an ECG while exercising, to show more clearly how your heart reacts when it’s working hard.

Sometimes, your doctor may suggest more tests, such as a magnetic resonance imaging (MRI) scan, a computer tomography (CT) scan or an angiogram. This is usually to find out if you have related conditions, such as coronary heart disease, as well as how severe your heart valve disease is. This extra information can help your doctor to decide which treatment is best for you.

Treatment of heart valve disease

You may not need any treatment if you have mild heart valve disease without any symptoms, or if your blood pressure is under control. Your doctor will probably recommend regular check-ups and echocardiograms. You should also see your doctor if you start to get symptoms.

If your heart valve disease is causing you symptoms, the main treatment is usually surgery. Deciding on what treatment is best for you can be complicated, 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 either be repaired or replaced during surgery. Which treatment you need will depend on what’s wrong with your valve, the effect that it’s having on 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.

  • Mechanical. These are artificial and are usually used in younger people because they last for a long time. But to keep them working well, and to prevent blood clots, you will need to take an anti-clotting medicine called warfarin for the rest of your life.
  • Tissue valves. These come from animals and they tend not to last as long as mechanical valves. However, you won’t need to take warfarin if you have a tissue valve.

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. This means having a large cut in your chest, through which your surgeon does the operation.
  • Transcatheter aortic valve implantation (TAVI). This is a newer kind of procedure. It involves using a thin wire to guide a replacement valve into a blood vessel and up into your heart. You may be offered this procedure if you have aortic stenosis and you can’t have open heart surgery for some reason.
  • Balloon valvuloplasty. This procedure is used to widen a narrowed valve; for example, if you have mitral stenosis. Your surgeon will make a small cut in the vein in your groin and pass a thin catheter (tube) into it until it reaches your heart valve. On the end of a catheter is a balloon your doctor will inflate when it reaches the narrow part of your valve.

Any type of procedure on your heart will carry some risk. Ask your surgeon to explain the pros and cons of different procedures to you. See our topic on heart valve surgery for much 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 your 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. So you may need medicines to manage these.

Medicines you may be prescribed include diuretics and ACE (angiotensin-converting enzyme) inhibitors to treat any heart failure, nitrates to ease chest pain and beta-blockers to reduce the strain on your heart.

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

Causes of heart valve disease

As you get older, your valves become thickened and stretched, which can lead to problems. This is more likely to happen if you smoke, or if you have high blood pressure, type 2 diabetes or high cholesterol. You can also be born with a heart valve problem, such as aortic stenosis.

There are several different conditions that are also associated with heart valve disease. These include the following.

  • Diseases that affect your heart muscle (cardiomyopathy).
  • Being born with a faulty heart valve (a congenital heart valve defect).
  • Infection, such as endocarditis. This is an infection of the lining on the inside of your heart.
  • Damage or injury to the heart, such as damage caused by a heart attack.
  • Rheumatic fever – an autoimmune condition in which your immune system starts to attack and damage 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, the complications of heart valve disease can be very serious and sometimes life-threatening. They include:

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

Special considerations if you're pregnant

When you’re pregnant, the way that your heart and circulation work changes, and this can put strain on your heart. These changes start when you’re just a few weeks pregnant and mean that your heart has to pump harder and faster.

If you have valve disease, your heart might have trouble coping with this. 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 to have treatment while you’re pregnant. You may also need specialist care when you give birth. Talk to your midwife and obstetrician for more information.

Frequently asked questions

  • If you have heart valve disease, or have had a valve repaired or replaced, you’re more likely than other people to develop endocarditis. Endocarditis is a serious infection of the lining of your heart and valves. If it’s not treated it can potentially be life-threatening because it can cause heart failure, a heart attack or other serious heart problems. The main treatment for endocarditis is antibiotics.

    Endocarditis is usually caused by bacteria. If you have a damaged heart valve or an artificial replacement valve, it’s easy for bacteria in your bloodstream to lodge there and grow. Your body may not be able to fight off this infection and it can quickly become a serious health problem.

    Endocarditis can be difficult to diagnose because the symptoms vary and they can be quite vague. Symptoms of endocarditis are sometimes like those of 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 and backache
    • feeling very tired
    • losing weight or not wanting to eat
    • chest pain

    The main treatment for endocarditis is antibiotics. These are usually given through a drip into your bloodstream so you may need to go into hospital. If your condition is stable and you’re well enough, you may be able to have this done at home or as an outpatient instead. Sometimes, you might need surgery to help get rid of endocarditis.

    Taking antibiotics to prevent endocarditis before you have a dental or other procedure is no longer recommended. But your doctor may prescribe them if there’s a high chance that you might develop endocarditis – for instance, if you’ve had it before.

  • Being physically active is good for your heart as well as your overall health. It's important to stay physically active if you have any type of heart disease. You may be able to manage a good level of physical activity if you have mild valve disease. If your valve disease is more severe, you may find you can’t do what you used to do, or what you’d like to do.

    Everyone who has heart valve disease will be affected differently, so it’s important to talk to your doctor before you start doing more activity. They can tell you how much it’s safe for you to do. If you have significant aortic stenosis, then you shouldn’t do vigorous exercise.

    If you have an operation to replace or repair a valve, you should have cardiac rehabilitation afterwards. This includes exercise training to gradually build up the activity you do and this can help to improve your overall fitness.

  • Mitral valve prolapse is a condition in which one or both of the leaflets of your mitral valve don’t close properly. This is usually harmless and doesn’t need treatment.

    Most people who have mitral valve prolapse don’t have any symptoms. In fact, many people find out they have it during an examination for something else. If you do develop symptoms, this usually means that the condition is getting worse. Symptoms can include tiredness and shortness of breath.

    If you’re getting symptoms, your doctor may suggest lifestyle changes, such as cutting out caffeine and alcohol, in addition to treatment with beta-blockers. Occasionally the valve can start to leak badly (regurgitation) and if this happens, you may need heart valve surgery.

  • Most people with heart problems can travel by air safely without risking their health.

    However, you should always check with your GP or heart specialist that you’re fit enough to travel by air, particularly if you’ve recently had surgery or been in hospital due to your heart condition. If you’re very breathless or usually have oxygen, then you should also talk to the airline about travelling before you book you tickets. This is so that they can arrange for help at the airport and on your flight. If you’re travelling overseas, make sure that your travel insurance would cover you if you needed treatment, and that your insurer knows about your condition. If you’re travelling in the European Union, check that you have an up-to-date European Health Insurance Card (EHIC). You can find out more about the EHIC on the Gov.uk website.


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Related information

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  • Reviewed by Graham Pembrey, Lead Health Editor, Bupa Health Content Team, December 2017
    Expert reviewer, Mark Yeatman, Cardiothoracic Surgeon
    Next review due, December 2020



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