Heart valve disease

There are two main heart valve problems with a variety of causes and treatments.

The two main heart valve problems are:

What are heart valves?

There are four heart (cardiac) valves in the heart. The valves make sure that blood flows in a single direction through the heart by opening and closing in a particular time sequence during the normal cycle of the heart.

When heart valves become diseased or damaged, they may not fully open or close. This can seriously reduce cardiac function by causing blood to leak back into cardiac chambers or by requiring heart chambers to contract more forcefully to move blood across a narrowed valve.

Types of valve problems

There are two general types of cardiac valve defects: stenosis (narrowing) and insufficiency (regurgitation or back flow). Some patients, however, may have a combination of these.

Valvular stenosis results from a narrowing of the valve opening that is usually caused by a thickening and increased rigidity of the valve cusps (flaps of the valve), often accompanied by calcification. When this occurs, the valve does not open completely as blood flows across it, resulting in a high resistance to flow.

Valvular insufficiency results from the valve cusps not completely sealing when the valve is closed, so that regurgitation of blood occurs (backward flow of blood) into the chamber (also called valvular incompetence, valvular regurgitation).

Causes

The main causes of heart valve disease are:

  • being born with an abnormal valve or valves (congenital heart disease)
  • the effects of rheumatic fever (rheumatic heart disease)
  • ageing of the heart
  • as the result of cardiomyopathy (disease of the heart muscle, causing the heart muscle to become enlarged, thick or rigid)
  • heart disease
  • previously having endocarditis (infection of the endocardium – the tissue that lines the inside of the heart chambers – the infection usually involves one or more heart valves which are part of the endocardium).

Symptoms & diagnosis

Valve disease may have mild, moderate, or severe symptoms. If left untreated, heart valve disease ultimately results in heart failure.

Symptoms of heart valve problems can include:

  • shortness of breath
  • severe swelling
  • palpitations, rapid thumping or a pounding sensation in your chest
  • chest pain
  • fainting or light-headedness
  • low or high blood pressure (depending upon the affected valve)
  • abdominal pain
  • lethargy
  • increased wet coughing
  • decreased endurance.

Sometimes a doctor may hear a heart murmur (a swishing sound) when listening to the heart through a stethoscope.  A heart murmur may not be the result of a blood flow problem, but because it may signify a heart valve problem, further testing should be carried out.

Diagnostic tests

For an accurate diagnosis of heart valve disease, one or more of the following procedures may be needed:

  • electrocardiogram (ECG)
  • echocardiogram (echo)
  • chest x-ray
  • coronary angiography (cardiac catheterisation).

Treatment

Most valve problems can be treated using medicines or by surgery. Your treatment will depend on the cause of your problem and the effect that it is having on your heart.

Valve surgery

Heart valve surgery can stop or improve your symptoms, and may prevent permanent damage to your heart. There are two types of valve surgery:

  • Valve repair: Often used for mitral valves which leak but are not seriously damaged.
  • Valve replacement: The diseased valve is removed and replaced with a new valve. The most common types of replacement valves are a mechanical (manufactured) valve or a tissue (biological/animal) valve.

Mechanical valves are artificial valves and they can last for a lifetime. Tissue valves are made from human or animal tissue. They tend to wear out faster then mechanical valves.

Whether or not you have a repair or replacement will depend on how damaged the valve is and the cause of the problem. Your surgeon will advise which type of valve is appropriate for you.

Self care

In many cases, there is nothing you can do to prevent heart valve disease. It is often caused by a congenital heart disorder or advancing age. However, by knowing that you have a heart valve problem you can make some lifestyle changes to help you stay well and in control:

  • choose a heart healthy diet
  • quit smoking
  • enjoy at least 30 minutes of exercise a day.

Dental hygiene

Good oral and dental hygiene is also considered important. Any dental disease or gum abscess should be treated promptly, to reduce the risk of bacteria getting into the bloodstream and possibly damaging the heart valves or endocardium (tissue that lines the inside of the heart chambers).

It may be necessary, as a precautionary measure, to take a course of antibiotics when you are having dental procedures or some medical procedures; your doctor or dentist will advise on this for your own particular circumstance.

Learn more

Staying Well with Heart Failure Heart Foundation NZ
Mitral valve problems  NHS Choices
Heart valve surgery Heart Foundation NZ
Heart valves – Explained Watch, Learn, Live: Interactive Cardiovascular Library – American Heart Association

Credits: Heart Foundation of New Zealand, May 2010. Updated by Health Navigator, October 2014.