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Heart valve disease

Your health expert: Dr Mary Lynch, Consultant Cardiologist
Content editor review by Rachael Mayfield-Blake, Freelance Health Editor, September 2022.
Next review due September 2025.

Heart valve disease is when one or more of your heart valves doesn’t work as it should, which affects the way blood flows through your heart. This can put extra strain on your heart and cause difficulty breathing, tiredness, and chest pain. Heart valve disease can be mild to severe and is sometimes life-threatening if you don’t get treatment.

About your heart and heart valves

Your heart pumps blood around your body and to your lungs. It’s divided into two sides, with two chambers on the left and two on the right.

Blood that returns to your heart 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 your heart goes to your 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.

There are four one-way valves inside your heart, which open and close, to make sure blood travels in one direction:

  • aortic valve
  • mitral valve
  • tricuspid valve
  • pulmonary valve

The valves stop blood from leaking back against the flow.

  • Two of the heart valves are between your atria and ventricles (the mitral valve on the left, and the tricuspid valve on the right).
  • 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 so your heart has to work harder to force blood through a smaller gap.
  • Regurgitation: the valve doesn't close properly so blood leaks backwards (a leaky or incompetent valve).

Most people with heart valve disease have a problem with one valve (either stenosis or regurgitation). But you may have problems with more than one valve. You can also have both stenosis and regurgitation in a single valve.

Heart valve disease most commonly affects the aortic or mitral valves. In Europe, aortic stenosis is the most common type of heart valve disease that needs treatment, followed by mitral valve regurgitation. Mitral valve regurgitation can be caused by mitral valve prolapse. This happens when one or both of the flaps of your mitral valve don’t close properly. This is usually harmless and you won’t need any treatment. But, rarely, it can cause complications that require treatment.

Causes of heart valve disease

As you get older, your heart valves get stiffer and thicker, which can lead to problems. This is more likely to happen if you smoke, or have high blood pressure, type 2 diabetes or high cholesterol. Several health conditions are associated with heart valve disease, which include:

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

Symptoms of heart valve disease

Heart valve disease symptoms depend on which valve is affected. 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.

Heart valve disease symptoms may include:

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

If you have any of these symptoms, see a GP.

If you have chest pain or collapse – call 999 and ask for immediate medical help.

If you’re not sure how serious your symptoms are, call 111 for advice from the NHS.

Diagnosis of heart valve disease

Your GP will examine you and ask about your symptoms, lifestyle and day-to-day health. They’ll also ask about your medical history.

Your GP 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 but it’s important to check.

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

Echocardiogram (Echo)

An echocardiogram will show how well your heart is pumping and the flow of blood through it. 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 probe is held against your chest. If your doctor wants a more detailed picture, you may have a transoesophageal echocardiogram , where a probe is passed into your oesophagus (food pipe).

Chest X-ray

A chest X-ray will help to rule out other conditions that may be causing your symptoms. It can also show if your heart has got bigger, which can be a sign of heart valve disease.

Electrocardiogram (ECG)

An 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 at rest, or while exercising, to show how your heart reacts when it’s working hard.

Your doctor may suggest more tests, such as a:

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.

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. If you start to get symptoms, arrange to see your doctor.

If heart valve disease is causing symptoms, the main treatment is usually surgery. A team of heart specialists will decide what the best treatment is for you. You may need to travel to a specialised centre, a hospital with a specialist team, to have treatment.

Heart valve surgery

Surgery can repair or replace heart valves. 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 aortic stenosis, valve replacement is usually better.

There are two main types of replacement valve.

  • Artificial mechanical valves. These are usually used in younger people because they should last for a lifetime. You’ll need to take an anticlotting medicine called warfarin for life to keep them working well and prevent blood clots.
  • Animal tissue valves. These tend not to last as long as mechanical valves. But you don’t need to take warfarin for the rest of your life unless there are other medical reasons why you should. If you have a tissue valve when you’re young, you may need to replace the valve again later on as they usually last around 15 to 20 years (ask your surgeon for more information).

Different types of procedures can repair or replace valves. Here are some of the main ones.

  • Open heart surgery – your surgeon will make a large cut in your chest to do the operation.
  • Transcatheter aortic valve implantation (TAVI) – your surgeon will use a thin wire to guide a replacement valve into a blood vessel (usually in your groin) and up into your heart. This may be an option if you have aortic stenosis and are over 75, or if 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 will make a small cut in the vein in your groin and pass a thin catheter (tube) along it until it reaches your heart valve. The tip of the catheter has a balloon that your doctor will inflate when it reaches the narrowed part of your valve, to stretch it. Sometimes, this can be a temporary solution for aortic stenosis before you have a permanent procedure.

Ask your surgeon to explain the different procedures to you.

Medicines

Medicines can’t cure your heart valve problems. But your doctor may prescribe them to:

  • help ease symptoms
  • treat any other heart problems
  • slow down any worsening of your 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. For example, you may have:

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

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. Complications of heart valve disease include the following.

  • Heart failure.
  • Irregular heart rhythms (arrhythmia).
  • A stroke.
  • Endocarditis – an infection of the lining of your heart. If your body can’t fight off this infection, it can quickly become serious. Seek urgent medical advice if you have any flu-like symptoms or unexplained weight loss. You may need some antibiotics to treat it, or potentially surgery. You can reduce your risk of endocarditis by maintaining good oral hygiene and seeing your dentist every six months.

Considerations for heart valve disease

Pregnancy

The way your heart and circulation work changes when you’re pregnant – your heart soon has to pump harder and faster. If you have valve disease, your heart might have trouble coping. 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’ll probably need to have regular check-ups while you’re pregnant and you and your baby will need to be monitored after you give birth. But most women with valve disease can have a pregnancy without any problems. Depending on your health and the type of valve disease you have, you might need treatment while you’re pregnant. You may also need specialist care when you give birth. Ask your midwife and obstetrician for more information.

Exercise

It's important to exercise if you have any type of heart disease. Exercise won’t improve how well your valve works but it will be good for your general health.

Your doctor can tell you what type, and how much exercise is safe for you. They may do some exercise stress tests to see how your body responds to exercise and whether it causes new symptoms. With any type of activity, stop immediately and contact your doctor, if you have any chest pain, breathlessness or extreme tiredness.

If you have aortic stenosis or regurgitation, you might not be able to do vigorous exercise but ask your doctor.

You may have an exercise stress test (depending on your symptoms) to help assess how severe your heart valve disease is.

Travelling

You may be able to travel safely but check with your GP or heart specialist before you book a flight. If you have severe symptoms of heart valve disease, you may not be allowed to fly. Your doctor will have to assess your condition and give you the OK.

If you’re very breathless or usually have oxygen, you will need to talk to your airline well in advance of travel. If they allow you to fly, they may arrange for help at the airport and on your flight.

If you travel overseas, make sure your travel insurance covers you for treatment abroad, and that your insurer knows about your condition.

Exercise won’t improve how well your valve works but it will help with your fitness. Ask your doctor about the best type of exercise and how much is safe for you. You may need some tests (exercise stress testing) to see how your body responds to exercise, but your doctor can tell you more.

See our section: Considerations for heart valve disease above for more information.

Just some heart valve disease symptoms may include breathlessness, which can be brought on by exercise, and an irregular, fluttery or racing heartbeat (palpitations). You may also get swollen ankles or feet and feel dizzy.

See our section: Symptoms of heart valve disease above for more information.

Aortic stenosis is the most common type of heart valve disease that needs treatment (in Europe), followed by mitral valve regurgitation.

See our section: Types of heart valve disease above for more information.

You won’t always need treatment if you have mild heart valve disease and don’t have any symptoms. If you do have heart valve disease symptoms, the main treatment is usually surgery.

See our section: Treatment of heart valve disease above for more information.

Age can cause heart valve disease because as you get older, your heart valves get stiffer and thicker, which can lead to problems. More than half of people 65 years or over are thought to have heart valve disease without symptoms. If you smoke, or have high blood pressure, type 2 diabetes or high cholesterol , you further increase your chance of getting heart valve disease.

See our section: Causes of heart valve disease above for more information.

More on this topic

Heart valve surgery

Heart valve surgery is an operation to treat leaking or narrowed valves.

Read more

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