Heart Valve Injury

How the heart valves work

The heart has four valves: the tricuspid and pulmonary valves on the right side, and the mitral and aortic valves on the left. They open to let blood through and close to stop it flowing backward. The mitral and tricuspid valves are anchored by cords (chordae tendineae) attached to papillary muscles.

Causes of valve injury

Blunt chest trauma

High-energy blows, such as a steering wheel impact, fall or crush, can tear valve leaflets, cords or papillary muscles. The aortic valve is the most commonly injured, causing aortic regurgitation, followed by the mitral and tricuspid valves. Valve injury often comes with a bruised heart (heart contusion) and other chest trauma. Symptoms can appear immediately or days to weeks later.

Penetrating trauma

Stab or gunshot wounds can directly damage valves.

Infection

Infective endocarditis destroys valve tissue, causing holes, torn leaflets and abscesses. Risk is higher with artificial valves, previous valve disease, IV drug use and some congenital heart conditions.

Heart attack

A heart attack can rupture or weaken a papillary muscle, causing sudden severe mitral regurgitation, a life-threatening emergency.

Other causes

• aortic dissection extending into the aortic valve
• radiation therapy to the chest, causing valve thickening years later
• some medicines, such as older appetite suppressants (fenfluramine) and ergot derivatives
• rheumatic fever
• age-related wear and calcification
• catheter procedures and heart surgery

Symptoms

Sudden (acute) valve injury

• severe shortness of breath, often coming on over minutes to hours
• inability to lie flat
• coughing frothy or pink sputum (fluid in the lungs)
• rapid heartbeat
• low blood pressure, cold clammy skin, confusion (shock)

Gradual valve damage

• breathlessness on exertion
• fatigue and reduced exercise tolerance
• palpitations or atrial fibrillation
• swelling of the ankles, legs or belly, signs of heart failure
• chest pain or fainting with aortic valve problems

Diagnosis

• examination: a new heart murmur, signs of fluid overload
• echocardiogram: ultrasound of the heart, the key test; a transesophageal echo (probe passed into the esophagus) gives detailed views of valve tears and endocarditis
• ECG: rhythm problems, heart attack, contusion
• chest X-ray: fluid in the lungs, heart size
• blood tests: troponin for heart muscle injury, blood cultures for endocarditis
• CT or MRI: for aortic dissection or detailed anatomy
• cardiac catheterization in some cases

Treatment

Emergency stabilization

• oxygen and breathing support
• medicines to reduce the heart's workload: diuretics, vasodilators
• support for blood pressure
• an intra-aortic balloon pump in some cases of severe acute mitral regurgitation

Definitive treatment

• surgical valve repair: preferred when possible, especially for the mitral valve
• valve replacement: mechanical (needs lifelong blood thinners) or biological (tissue) valves
• catheter-based procedures: transcatheter aortic valve replacement (TAVR) or mitral clip repair in selected patients
• antibiotics for endocarditis, often for 4 to 6 weeks, with surgery if the valve is severely damaged

Mild valve injuries may be monitored with periodic echocardiograms and medicines.

Outlook

Acute severe valve injury is life-threatening, but prompt surgery greatly improves survival. After repair or replacement, most people return to normal activity, with ongoing follow-up. Those with artificial valves need preventive antibiotics before some dental procedures and regular monitoring.

Frequently asked questions

Can a car accident damage heart valves?

Yes. A blunt blow to the chest, such as from a steering wheel, can tear heart valve leaflets or their supporting cords, most often the aortic valve. Breathlessness or a new murmur after a crash should be evaluated with an echocardiogram.

What are the symptoms of heart valve damage?

Symptoms include shortness of breath, especially lying flat, fatigue, palpitations, swelling of the legs or belly, chest pain and dizziness. Sudden severe valve damage can cause rapid breathlessness, frothy sputum and shock.

How is a damaged heart valve diagnosed?

Doctors listen for a new heart murmur and confirm valve damage with an echocardiogram. A transesophageal echo gives more detailed images. ECG, chest X-ray and blood tests look for related problems.

Can a damaged heart valve heal on its own?

Valve tissue does not regenerate. Mild leaks may stay stable and need only monitoring, but significant damage usually needs repair or replacement. Treating the cause, such as infection, can prevent further damage.

What is the treatment for a leaking heart valve?

Treatment depends on severity. Mild leaks may need monitoring and medicines. Severe leaks often need surgical repair or valve replacement, or catheter procedures such as TAVR or mitral clip in selected people.