Heart valve disease

Heart valve disease is when one or more of your heart valves don’t work as they should. This affects the way blood flows through your heart. It can put extra strain on your heart and causes 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 to all parts of your body. It’s divided into two sides, with two chambers on the left and two on the right. There are four one-way valves connecting these chambers, which open and close to make sure blood travels in only one direction.

• Aortic valve – blood leaves for the body through this valve, from the lower left chamber of your heart.
• Pulmonary valve – blood leaves for the lungs through this valve, from the lower right chamber.
• Mitral valve – allows blood to pass from the upper to the lower left chamber.
• Tricuspid valve – lets blood pass from the upper to the lower right chamber.

These valves stop blood from leaking back against the flow.

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 (also known as a leaky or incompetent valve).

Most people with heart valve disease have a problem with only 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 significant leakiness (mitral regurgitation) that needs treatment.

Causes of heart valve disease

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

• 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)
• damage or injury to your heart (for example, from a heart attack)
• rheumatic fever – an autoimmune condition where your immune system attacks and damages your heart valves, usually affecting 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 include:

• breathlessness, sometimes brought on by exercise
• difficulty breathing while lying flat compared with sitting up
• waking up at night with difficulty breathing
• coughing up blood
• 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 you have collapsed – 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. .

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 in this case. 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. The type of surgery you need will depend on what’s wrong with the valve, how it’s affecting your heart, and if you have other health problems. For conditions such as aortic stenosis, valve replacement is usually better than repair.

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 prevent blood clots and keep the valves working well.
• Animal tissue valves. These don’t usually 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 it later because they usually last around 15 to 20 years (ask your surgeon for more information).

Different types of procedure 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. They will usually do this via a blood vessel in your groin and then passing 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.

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:

• diuretics and ACE (angiotensin-converting enzyme) inhibitors to treat heart failure
• nitrates to ease chest pain
• beta-blockers to reduce the strain on your heart

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

Endocarditis is 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 has to pump harder and faster. If you have valve disease, your heart might have trouble coping if you become pregnant. But for most people, valve disease does not cause problems in the event of pregnancy.

Some people are first diagnosed with valve disease when they become pregnant because they get symptoms for the first time. If you have heart valve disease, speak to your doctor before planning a pregnancy. 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. 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. 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. Exercise stress tests can show how your body responds to exercise and if the exercise causes new symptoms.

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.