Valvular Heart Disease

Overview

The heart has four valves that act like one-way doors, keeping blood flowing in the correct direction through its chambers and out to the body and lungs. In valvular heart disease, one or more of these valves stops working properly. A valve may become stiff and narrowed so it cannot open fully (called stenosis), or it may fail to close tightly so blood leaks backward (called regurgitation). Some valves have both problems.

When a valve does not work well, the heart must work harder to keep blood moving, which over time can strain and weaken the heart muscle. Valve disease can be present from birth or develop later from aging, infection, or other heart conditions. Mild valve problems may cause no symptoms and only need monitoring, while severe disease can lead to heart failure and requires repair or replacement of the valve.

Symptoms

Many people with mild valve disease have no symptoms at all, and the problem is first noticed as a heart murmur during a routine exam. As the condition progresses, symptoms usually relate to the heart struggling to pump effectively.

• Shortness of breath, especially with activity or when lying flat
• Fatigue and reduced ability to exercise
• Palpitations or an irregular heartbeat
• Swelling in the ankles, feet, or abdomen
• Dizziness or fainting, particularly with aortic valve narrowing
• Chest pain or pressure

Severe, sudden breathlessness, chest pain, or fainting can signal a serious problem and should be treated as an emergency.

Causes

Valve problems can be present at birth or develop over a lifetime. Common causes include:

• Age-related changes: Over years, valves (especially the aortic valve) can thicken and stiffen with calcium deposits.
• Congenital valve defects: Some people are born with abnormally shaped valves, such as a bicuspid aortic valve.
• Rheumatic fever: A complication of untreated strep throat that can scar the valves, still common in some parts of the world.
• Endocarditis: An infection of the heart lining and valves that can damage them.
• Other heart conditions: Heart attacks, an enlarged heart, or high blood pressure can stretch or damage valves.

Risk Factors

• Older age
• A heart valve abnormality present from birth
• A past history of rheumatic fever or endocarditis
• High blood pressure and other heart disease
• Previous heart attack
• Conditions affecting the heart muscle or aorta

Diagnosis

Valve disease is often first suspected when a doctor hears a heart murmur. Tests confirm which valve is involved and how severe the problem is.

• Echocardiogram: An ultrasound of the heart and the main test, showing valve movement, narrowing, and leakage.
• Electrocardiogram (ECG): Records the heart's electrical activity and can detect rhythm problems or strain.
• Chest X-ray: Shows the size of the heart and fluid in the lungs.
• Cardiac MRI or CT: Provide detailed images in selected cases.
• Cardiac catheterization: Used before procedures to assess pressures and the coronary arteries.

Treatment

Treatment depends on which valve is affected, how severe the problem is, and whether symptoms are present. Many people are monitored for years before any intervention is needed.

• Monitoring: Mild disease may simply be watched with regular echocardiograms.
• Medications: Drugs do not fix the valve but can ease symptoms by controlling blood pressure, removing excess fluid, steadying the rhythm, or supporting a weakened heart.
• Valve repair: Surgeons may reshape or reinforce a leaky valve, preserving the person's own tissue.
• Valve replacement: A damaged valve can be replaced with a mechanical or tissue valve, either through open-heart surgery or, for some patients, a less invasive catheter-based procedure such as transcatheter aortic valve replacement (TAVR).

The timing of surgery is important, and a heart team helps decide the best approach for each person.

Prevention

• Treat strep throat promptly to prevent rheumatic fever
• Care for your teeth and gums and tell your dentist about valve disease, as good oral health lowers endocarditis risk
• Manage blood pressure, cholesterol, and other heart risks
• Avoid smoking and stay physically active as advised
• Attend regular check-ups so valve problems are caught and tracked early

When to See a Doctor

See a doctor if you have been told you have a heart murmur or valve problem and notice new or worsening breathlessness, swelling, palpitations, or reduced ability to exercise. Seek emergency care immediately for:

• Sudden or severe shortness of breath
• Chest pain or pressure
• Fainting or near-fainting
• A rapid, irregular heartbeat that does not settle

Related Topics

Frequently Asked Questions

References

1. American Heart Association. Heart Valve Problems and Disease.
2. National Heart, Lung, and Blood Institute (NHLBI). Heart Valve Diseases.
3. Mayo Clinic. Heart valve disease — Symptoms and causes.
4. MedlinePlus, U.S. National Library of Medicine. Heart valve diseases.