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Understanding Heart Valve Disease

Your heart has four valves and problems can arise when one or more of the valves aren't opening or closing properly. Read this helpful guide to learn everything you need to know about valve disease.

Our hearts work in a very rhythmic, synchronized way. Each time your heart beats, it first fills with blood and then pumps that blood out. The heart has valves that open and close with every heartbeat, helping the blood to flow smoothly and freely in one direction through the chambers of the heart and to the rest of your body. 

But if a valve doesn’t open or close properly, problems can arise. The body may not get a sufficient supply of blood or, in some cases, blood can seep back into the heart.  

About heart valve disease 

Heart valve disease happens when one (or more) of your heart valves isn’t working as it should. More than 5 million Americans are diagnosed with it every year. 

There are four valves in your heart: tricuspid, pulmonary, mitral and aortic. Most heart valve problems involve the aortic and mitral valves.

Your Heart Valves

  • Aortic (ay-OR-tik)
  • Pulmonary (PULL-mun-ary)
  • Mitral (MI-trul)
  • Tricuspid (tri-CUSS-pid)

Heart valve disease can disrupt the way blood flows through the heart. The name of the affected valve appears before the specific problem. For example, aortic stenosis (narrowing) or mitral valve regurgitation (backflow).

Under normal circumstances, your blood is supposed to flow one-way through your heart. It comes in through the top chamber (the left atrium), then passes down to the bottom chamber (the left ventricle) and to your body. As blood builds in the atria, the mitral and tricuspid valves open—and quickly shut—to allow blood to flow into the ventricles. The aortic and pulmonary valves control blood flow out of the ventricles into your body. Click to see where the valves are located and how blood flows in a normal heart

Two main problems can occur when heart valves are diseased or damaged: 

Regurgitation occurs when the valve doesn’t close all the way. As a result, blood can flow backwards rather than being pumped out of the heart. The left ventricle has to work harder to pump the extra blood that has come back into the heart and, over time, it can thicken. The backwards flow can also result in a build-up of fluid in the lungs. 

Regurgitation, or backflow, is often due to the failure of the leaflets of the valve to come together, leaving a hole through which the blood can go back. This situation can happen for a variety of reasons. For mitral regurgitation, which is the most common leakage problem in the heart, it is often due to prolapse—when the soft flaps of the mitral valve fail to close together smoothly. Instead, part of the valve bulges into the upper chamber, allowing blood to flow in the wrong direction. Sometimes the soft flaps can tear, so a large amount of the blood can leak backward. 

Stenosis happens when the tissue of the valve thickens or becomes very stiff. This can block or limit blood flow through the heart and to the rest of the body. A build up of calcium and other deposits on the heart valves themselves can lead to stenosis. With stenosis, the heart will get thicker over time. Initially, this is a helpful situation as the muscle builds more strength. But over time the heart will tire out because the blood supply to the heart remains the same and is not enough to sustain this extra muscle. 

Heart valve problems may develop suddenly or over time. With heart valve disease, the heart has to work harder and may not be able to pump as well. As a result, many people report being short of breath. If heart valve disease isn’t treated, it can lead to heart failurestroke or sudden cardiac death. 

Who gets it 

Some people are born with a predisposition to have weak leaflets, which can lead to leakage of the valves. Stenosis is more likely as people age. 

Problems usually arise due to: 

  • age-related changes—as you age, the shape or flexibility of your valve can change; calcium and other deposits can also thicken or stiffen the flaps of the valves
  • infections of the valves (endocarditis)
  • rheumatic fever as a result of untreated strep infection
  • other conditions that might harm or scar the heart valves—heart attack, advanced heart failure or a build up of plaque (atherosclerosis) inside the arteries 

Other factors linked to heart valve disease include: 

What it feels like 

Many people with heart valve disease don’t have symptoms during the early stages of the disease; others do. Some people may limit activities to try to feel better or avoid feeling out of breath. But early treatment is very important. If you suspect there is something wrong, talk with your doctor.  

Common signs and symptoms include:

  • a heart murmur or unusual heartbeat
  • shortness of breath, especially after being active or when lying flat in bed
  • unusual fatigue (extreme exhaustion) or weakness
  • dizziness or fainting (especially with aortic or mitral valve stenosis)
  • heart palpitations
  • swelling in ankles, feet or belly

Some of the above may also be signs of heart failure or other coexisting heart problems.

How it’s diagnosed 

Heart valve disease is often found during an exam when the doctor listens to the heart and hears a heart murmur. 

Other tests will be ordered to confirm the diagnosis and to determine the nature of the damage or issue with your heart valve. Your doctor will want to see:

  • the size and shape of heart valves and chambers
  • how well the heart is pumping
  • whether valves seem narrow or are allowing blood to leak backwards

Tests might include:  

  • an echocardiogram
  • stress or regular electrocardiogram (EKG)
  • chest X-ray
  • if more information is needed, your cardiologist may also do a stress test, cardiac catheterization, cardiac MRI or other test

Common treatments 

Some valve problems are minor and just need to be watched closely, while others require treatment. There are several treatment options. These include lifestyle changes, medications and procedures to fix or replace the valve. It is important to talk with your doctor and weigh the benefits and risks of each type of treatment. 

The goals of treatment may be to:

  • prevent or relieve symptoms
  • repair or replace faulty valves

Lifestyle changes 

Your doctor may recommend making changes such as adopting a healthy diet, not smoking, paying more attention to your health and, in some cases, refraining from competitive athletic activity or overexerting yourself. 

Medications  

Medications may be prescribed to relieve symptoms, delay problems or treat other related conditions, such as heart failure. These might include: 

  • diuretics – to help remove extra fluid from the body
  • anti-arrhythmic medications – to help control the heart’s rhythm
  • vasodilators, ACE inhibitors – to help lower blood pressure and dilate and relax the blood vessels to support good blood flow
  • beta blockers – to treat high blood pressure and slow the heart beat
  • blood-thinners – to reduce the risk of clots forming; people who have man-made valves implanted need to take these medications 

Take the time to talk with your health care team about why you are taking each medicine and when and how to take each one. Make sure to provide a list of all of the medications you take, including any dietary supplements. 

Procedures to repair or replace your heart valve 

Many people can live with valve disease and do not require surgery. However, in some cases, the valve needs to be fixed or replaced. There are several ways doctors can repair or replace the valve. Exactly which procedure is needed will depend on the extent of your heart valve disease, your age, general health and any other heart-related surgeries that might be needed, such as bypass surgery. 

Generally, valve repair is preferred to replacement. Mending the existing valve can help maintain the strength of the heart muscle. During surgical repair procedures, the doctor can try to reshape the tissue, fix any tears or holes or separate flaps that might have become stuck together. 

In some cases it may be better to replace certain valves. These valves can be made of other tissue (biologic) or man-made.  

Valve surgery has traditionally been done by cutting the breastbone (median sternotomy) open to get to the heart and using the heart-lung machine. Newer approaches to repair or insert a new valve are less invasive and include minimally invasive or robotic valve surgery, as well as catheter-based techniques to replace aortic valves.

What is TAVR?

You may have heard about TAVR, but what is it? TAVR is one of the latest advances in medical care. It is a less invasive procedure that can help replace the aortic valve. Doctors insert a catheter into an artery--usually in the groin crease but may require an incision between the ribs or part of the breastbone, and carefully thread it to the heart and place the new valve. This procedure is called transcatheter aortic valve replacement, or TAVR. Research suggests TAVR is a safe option for certain patients for whom surgery is too risky.

Living well with heart valve disease 

There are steps you can take to protect and strengthen your heart and prevent future problems and these are true for patients with valve disease as well. 

  • Stop smoking
  • Commit to a heart healthy diet
  • Talk with your doctor about what exercise is right for you; you might need to limit certain physical activities depending on the type of valve problem you have
  • Take all of your medications as directed
  • Practice good dental hygiene by flossing and brushing your teeth regularly, especially if you have had a man-made valve implanted. Gum infections and tooth decay can make heart infections more likely, which can worsen valve disease. 
  • Make and keep appointments to see your doctor for routine checkups and follow up tests; always report any new or worsening symptoms
  • Get support by leaning on trusted caregivers and seeking support from other people living with heart valve disease 

Talk to your care team

Learn about your heart valve disease, and share any concerns or questions with your doctor. Here are some questions you might want to ask: 

  • What type of heart valve problem do I have?
  • How does it affect the way my heart works?
  • Are there activities I should be avoiding?
  • Are certain exercises OK for me?
  • What should I do to prevent further damage?
  • When is treatment necessary?
  • Are there side effects that I should watch for?
  • Will I need surgery?
  • Am I a good candidate for minimally invasive options, such as TAVR?
  • How will I know if my heart condition is getting worse?
  • How can I learn more about my condition?

Helpful resources

To learn more about valve disease, visit these CardioSmart Condition Centers:


You can find out more about heart valve disease at: 

American Heart Association
www.heart.org

National Heart, Lung, and Blood Institute
www.nhlbi.nih.gov


Published: June 2015
Medical Reviewer: Christina Vassileva, MD, FACS, FACC, Southern Illinois University School of Medicine

Infographic: Heart Valve Disease

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