Cardiac Valve Disease

Cardiac valve disease affects the valves that control blood flow through your heart, and while many people live with mild valve problems without symptoms, more serious cases can weaken the heart and become life-threatening if left untreated.

Table of contents

• What is Cardiac Valve Disease?
• The Heart’s Valves
• Types of Heart Valve Problems
• Signs and Symptoms
• Causes and Risk Factors
• How Common is Heart Valve Disease?
• Diagnosing Heart Valve Disease
• Treatment Options
• Lifestyle Changes for Heart Valve Health

What is Cardiac Valve Disease?

Cardiac valve disease, also known as valvular heart disease, refers to any condition that prevents one or more of the valves in your heart from working properly^[1]. Your heart has four valves that keep blood flowing through the heart in the correct direction. When a valve doesn’t open or close all the way, it changes how blood flows through the heart to the rest of your body^[1].

Left untreated, heart valve disease may reduce blood flow and cause your heart to work harder^[2]. The condition can become life-threatening if not treated, but there is hope. In many cases, healthcare providers can perform surgery or minimally invasive procedures to repair or replace faulty heart valves, restoring normal function and allowing patients to return to normal activities^[2].

Heart valve disease, Valvular heart disease, Valvular disease

The Heart’s Valves

• Heart
• Aorta
• Pulmonary artery
• Left atrium
• Right atrium
• Left ventricle
• Right ventricle

A typical heart has two upper and two lower chambers. The upper chambers, called the right and left atria, receive incoming blood. The lower chambers, the more muscular right and left ventricles, pump blood out of the heart^[1].

The four valves in your heart make sure blood flows in only one direction. Your valves consist of small flaps of tissue called leaflets that open to allow blood to move forward through your heart during half of your heartbeat. These leaflets close to prevent blood from flowing backward during the other half of your heartbeat^[2].

Your heart’s four valves are^[2]:

• Mitral valve: Located between your left atrium and left ventricle
• Tricuspid valve: Located between your right atrium and right ventricle
• Aortic valve: Located between your left ventricle and aorta
• Pulmonary valve: Located between your right ventricle and pulmonary artery

The valves open and close to control or regulate the blood flowing into the heart and then away from the heart. Any valve in the heart can become diseased, but the aortic valve is most commonly affected^[5].

Types of Heart Valve Problems

There are different types of heart valve disease: stenosis, regurgitation, prolapse, and atresia. These problems can affect more than one valve^[2].

Stenosis

Stenosis occurs when the tissues forming the valve leaflets become stiffer, narrowing the valve opening and reducing the amount of blood that can flow through it^[2]. Mild narrowing may not reduce the overall functioning of your heart. However, the valve can become so narrow that it reduces your heart’s function, makes your heart pump harder, and puts it under strain. As a result, the rest of your body may not get enough blood flow^[2].

Regurgitation

Also known as insufficiency or “leaky valve,” regurgitation happens when your leaflets don’t close completely^[2]. This allows blood to leak backward across your valve. Your heart has to pump harder to make up for this backward flow, and the rest of your body may get less blood flow^[2].

Prolapse

Prolapse affects the mitral valve when it cannot close tightly because the leaflets are extra stretchy^[2]. They go back into your left atrium when your heart beats. This is usually harmless but can lead to regurgitation in some people^[2]. Prolapse most often affects the mitral valve, where the flaps of the valve flop or bulge back^[4].

Atresia

Atresia is a heart condition that may be present at birth, called a congenital heart defect, or rarely acquired later in life^[3]. It occurs when a heart valve has no opening at all. Instead, a solid piece of tissue forms where the valve opening should be^[3]. Healthcare providers usually diagnose valvular atresia very early in infancy^[2].

Signs and Symptoms

Many people with heart valve disease don’t have symptoms for many years^[1]. Some people live their whole lives with a heart valve that doesn’t work perfectly and never have any problems. Heart valve disease may stay the same throughout your life and not cause any problems, or the condition may slowly get worse over time^[11].

When symptoms occur, they might include^[1]:

• Shortness of breath at rest or when active or lying down
• Fatigue (this may be your first symptom)^[2]
• Chest pain
• Dizziness
• Swelling of the ankles, feet, abdomen, or veins in the neck
• Fainting
• Irregular heartbeat or palpitations (skipped beats or a flip-flop feeling in your chest)^[2]
• Quick weight gain^[2]

When heart valve disease develops more suddenly, people may experience fever and rapid weight gain in addition to the symptoms above^[5]. If you have symptoms of possible heart valve disease, make an appointment for a health checkup. You may be referred to a doctor trained in heart diseases, called a cardiologist^[1].

Causes and Risk Factors

Some people are born with heart valve disease, which is called congenital heart valve disease. It can happen alone or along with other congenital heart defects. Heart valve disease can also develop over time as you get older or have certain conditions that affect the heart^[4].

Common heart valve disease causes include^[2]:

• Rheumatic fever from strep throat that wasn’t treated. An untreated strep throat can become rheumatic fever, which can harm the heart valves. The damage may not show up for years. Today, most people take antibiotics to cure strep throat before it can cause heart valve damage^[4].
• Heart attack that damages your heart
• High blood pressure
• Endocarditis, a rare infection in the lining of the heart and heart valves, usually caused by bacteria in the bloodstream^[4]
• Aging – valve disease can develop as heart valves become thick and stiff with age^[4]

Your chance of having heart valve disease is higher if^[4]:

• You are older
• You have or have had other conditions that affect your heart and blood vessels, including coronary artery disease, high blood cholesterol, diabetes, obesity, or lack of physical activity
• You have a family history of early heart disease: a father or brother who had heart disease younger than 55, or a mother or sister who had heart disease younger than 65
• You were born with an aortic valve that wasn’t formed correctly

Heart valve disease is underdiagnosed and undertreated, especially in African American, Hispanic, and Asian populations. Women are more likely than men to not be diagnosed and to experience worse health outcomes from the condition^[5].

How Common is Heart Valve Disease?

About 2.5% of Americans — many of them older adults — have heart valve disease^[2]. More than 5 million people in the U.S. are diagnosed with heart valve disease each year^[5]. Each year, roughly 27,000 people die from heart valve disease in the United States^[2]. More than 25,000 deaths in the U.S. each year are due to heart valve disease^[5].

Mitral valve prolapse is a common heart valve problem^[2]. However, heart valve disease isn’t as common as many other heart conditions, so patients may not easily recognize its signs and symptoms^[5]. In fact, 75% of U.S. adults know little to nothing about heart valve disease. Even those at the highest risk, people 65 years and older, are poorly informed about heart valve disease^[5].

Diagnosing Heart Valve Disease

To diagnose heart valve disease, a healthcare professional examines you and asks questions about your symptoms and health history^[9]. A whooshing sound called a heart murmur may be heard when listening to your heart with a device called a stethoscope^[9]. Heart murmurs are often harmless, but they can also be a sign of heart valve disease^[8].

If you experience symptoms or your healthcare provider detects a heart murmur, you should see a specialist to be evaluated for heart valve disease^[8]. Blood and imaging tests may be done to check your heart health. Tests to diagnose heart valve disease may include^[9]:

• Echocardiogram: This test uses sound waves to create pictures of the beating heart. It shows how blood flows through the heart and the health of the heart valves. It provides valuable information about your heart and how blood flows through it^[8].
• Electrocardiogram (ECG or EKG): This quick test records the electrical signals in the heart. It shows how the heart is beating. Sensors, called electrodes, are attached to the chest and sometimes the legs^[9].
• Chest X-ray: A chest X-ray shows the heart and lungs. The test can tell if the heart is larger than usual or if there is fluid around the lungs^[9].
• Cardiac MRI: A cardiac MRI uses magnetic fields and radio waves to create detailed images of the heart. It can help determine the severity of heart valve disease^[9].
• Exercise tests or stress tests: These tests often involve walking on a treadmill or riding a stationary bike while the heart is checked. Exercise tests show how the heart responds to physical activity and whether valve disease symptoms occur during exercise^[9].
• Cardiac catheterization: A specialist guides a long, narrow tube (catheter) to your heart through a blood vessel in the arm or leg. Dye is injected and X-rays are used to get clear images^[16].

Treatment Options

Heart valve disease is a lifelong condition. However, many people have heart valve defects or disease but don’t have symptoms. The condition may stay the same throughout your life and not cause any problems, or the condition may slowly get worse until you start to notice symptoms^[11].

Treatment with medicine can help relieve symptoms, but it will not fix the valve^[21]. Heart valve disease treatment depends on the heart valve affected and the type and severity of the disease. Sometimes surgery is needed to repair or replace the heart valve^[1].

Medications

Your doctor may prescribe medicines to relieve the symptoms of your heart valve disease, prevent it from getting worse, or treat other heart problems that can affect your heart valves. These may include^[11]:

• Medicines to control high blood pressure, such as diuretics and vasodilators, to ease pressure on the heart and reduce the amount of work the heart must do to pump blood
• Medicines to control the heart rate
• Blood thinners to treat or prevent blood clots
• Antibiotics to treat infections that cause heart inflammation or prevent rheumatic fever

Heart Valve Repair and Replacement

Eventually, you may need to have your faulty heart valve repaired or replaced. After repair or replacement, you’ll still need certain medicines and regular checkups with your doctor^[11].

Heart valve repair involves using a patient’s own tissue to fix the defective valve^[13]. Whenever possible, doctors repair — rather than replace — the valve. Compared to replacing the valve, mitral valve repair is associated with better outcomes and faster recovery times^[14].

Heart valve replacement means putting in a new mechanism to replace a severely damaged valve. Replacement valves can be made from natural and artificial materials^[14].

Due to advances in surgical technology, there are now a range of innovative, minimally invasive procedures to treat heart valve disease. These include^[14]:

• Transcatheter aortic valve replacement (TAVR): A procedure that uses a small tube (catheter) to reach your heart through your blood vessels, usually in the leg or groin area, to replace a valve without opening the chest^[15]
• Percutaneous mitral valve repair (MitraClip): A minimally invasive procedure to repair the mitral valve^[14]
• Robotic mitral valve repair^[14]

These minimally invasive procedures can be effective for many valve repair surgery patients — even the most challenging repairs. Age or health can make open-heart surgery too risky, and these procedures offer alternatives that don’t require opening up the chest^[15].

Lifestyle Changes for Heart Valve Health

Your healthcare provider may recommend healthy lifestyle changes first to treat symptoms, which may delay problems^[11]. To maintain a healthy heart and lower the risks of heart disease, there are several healthy lifestyle changes you can make^[18].

Healthy Diet

Eat a heart-healthy diet^[21]. For example, eat more fruits, vegetables, fish, lean meats, whole grains, and other high-fiber foods. Limit sodium, sugar, and alcohol. Avoid processed foods, specifically processed meat, such as sausage, ham, and bacon. Avoid saturated fat, including animal fat, coconut, and palm oils^[18].

Regular Exercise

Be active. Ask your doctor what type and level of exercise is safe for you^[21]. Walking is a good choice. You also may want to swim, bike, or do other activities. Regular moderate to high-intensity exercises such as dancing, running, jogging, or speed walking can improve your physical fitness and mental health^[18].

Unless instructed not to by your healthcare professional, it is very important that you maintain physical activity as part of a healthy lifestyle. Gentle exercise to the extent that makes you mildly short of breath should be encouraged in virtually all heart valve disease patients^[24].

Maintain a Healthy Weight

Stay at a healthy weight. Lose weight if you need to^[21]. Being overweight increases the body’s need for oxygen and worsens the effect of any type of valve disease. Reducing weight can delay and occasionally even avoid the need for surgery^[24].

Quit Smoking

Do not smoke. Smoking can cause more heart problems^[21]. The chemicals in cigarettes lead to cholesterol plaque build-up in your heart arteries. There is also evidence that smoking increases the rate of progression of aortic stenosis^[24]. If you need help quitting, talk to your doctor about stop-smoking programs and medicines^[21].

Manage Other Health Problems

Manage other health problems. These include diabetes, high blood pressure, and high cholesterol^[21].

Prevent Infections

Avoid infections such as COVID-19, colds, and influenza (flu). Get a pneumococcal vaccine. If you have had one before, ask your doctor if you need another dose. Get a flu vaccine every year. Stay up to date on your COVID-19 vaccines^[21].

Dental Care

Take care of your teeth and gums. Get regular dental checkups^[21]. Good dental health is important because bacteria can spread from infected teeth and gums to the heart valves. According to research, people who brush their teeth twice a day for a minimum of 2 minutes have a three-fold lower risk of developing heart disease^[18]. If you have had a valve repaired or replaced, you may need to take antibiotics before you have certain dental or surgical procedures^[21].