Cardiac valve disease occurs when one or more of the four valves in your heart don’t work as they should, affecting how blood flows through your heart and out to the rest of your body. Understanding this condition is important because while some people live for years without symptoms, others may experience serious complications that can affect their daily activities and overall health.
Understanding Cardiac Valve Disease
The heart contains four valves that act like gates, making sure blood moves in only one direction through your heart. These valves are called the mitral valve, tricuspid valve, aortic valve, and pulmonary valve. Each valve consists of small flaps of tissue, known as leaflets, that open to let blood pass through during one part of your heartbeat and close to prevent blood from flowing backward during the other part.[2]
When valve disease develops, these valves may not open or close correctly. The opening may become too narrow, preventing enough blood from passing through. Or the valve may not close completely, allowing blood to leak backward. In either case, your heart has to work harder to pump blood throughout your body, and over time, this extra strain can lead to serious health problems.[1]
The mitral valve lies between the left atrium and left ventricle. The tricuspid valve sits between the right atrium and right ventricle. The aortic valve controls blood flow from the left ventricle to the aorta, the large artery that carries blood from your heart to the rest of your body. Finally, the pulmonary valve regulates blood flow from the right ventricle to the pulmonary artery, which carries blood to your lungs.[3]
How Common Is This Condition
Heart valve disease affects a significant portion of the population, though many people may not be aware they have it. About 2.5 percent of Americans, many of them older adults, have heart valve disease.[2] Each year, more than 5 million people in the United States are diagnosed with this condition.[5]
The impact of cardiac valve disease is substantial. Each year, roughly 27,000 people die from heart valve disease in the United States. More than 25,000 deaths annually are attributed to this condition, making it a serious public health concern.[2][5]
Despite how common valve disease is, awareness remains low. Research shows that 75 percent of U.S. adults know little to nothing about heart valve disease. Even those at the highest risk, people aged 65 years and older, are poorly informed about this condition. This lack of awareness can delay diagnosis and treatment, potentially leading to worse health outcomes.[5]
Heart valve disease is underdiagnosed and undertreated, especially in certain populations. African American, Hispanic, and Asian communities face particular challenges in getting properly diagnosed and treated. Women are also more likely than men to not be diagnosed and tend to experience worse health outcomes from the condition.[5]
Types of Valve Problems
There are several different types of heart valve disease, and each affects how your valves function in specific ways. Understanding these different types can help you recognize what might be happening in your heart.
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. 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. Aortic valve stenosis is a common type of stenosis.[2][4]
Regurgitation, also known as insufficiency or “leaky valve,” happens when your leaflets don’t close completely. This lets blood 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. This condition can affect any of the four heart valves.[2]
Prolapse is a condition where your mitral valve may not close tightly because the leaflets are extra stretchy. They go back into your left atrium when your heart beats. This is usually harmless, but it can lead to regurgitation in some people. Mitral valve prolapse is actually a common heart valve problem.[2][3]
Atresia is a heart condition that may be present at birth, called a congenital heart defect, or rarely acquired later in life. It occurs when a heart valve has no opening at all. Instead, a solid piece of tissue forms between the heart chambers. Healthcare providers usually diagnose this very early in infancy.[2][3]
Sometimes, heart valve disease can be described as structural heart disease because valve problems can impact the structure and function of your heart. Any valve in the heart can become diseased, but the aortic valve is most commonly affected.[5][8]
What Causes Cardiac Valve Disease
Heart valve disease can develop from various causes, and understanding these can help you recognize your own risk. Some people are born with valve problems, while others develop them over time due to aging, infections, or other health conditions.
Congenital heart valve disease means someone is born with the condition. This can happen alone or along with other congenital heart defects. For example, a bicuspid aortic valve forms with two flaps instead of the normal three. When a heart valve did not form properly before birth and does not have an opening for blood to pass through, this is called atresia.[3][4]
Rheumatic fever is one of the most common causes of heart valve disease worldwide. This condition develops when a strep throat infection is not treated properly. While antibiotics have made rheumatic fever much less common in the United States today, it remains an important cause globally. The damage to heart valves from rheumatic fever may not show up for years after the initial infection.[2][4]
A heart attack can damage your heart and its valves. When the heart muscle is injured during a heart attack, the valves may not work properly afterward. Heart failure, coronary artery disease, and high blood pressure can also contribute to valve problems over time.[2][4]
Endocarditis is a rare but serious infection in the lining of the heart and heart valves. It is usually caused by bacteria in the bloodstream. This infection can damage the valves and cause them to malfunction. Maintaining good dental health is important because bacteria can spread from infected teeth and gums to the heart valves.[2][4]
As people age, heart valves can naturally become thick and stiff due to wear and tear. This process, sometimes called calcification, is related to aging and other risk factors. The valve leaflets may accumulate calcium deposits that prevent them from opening and closing properly.[8]
Chest radiation used for cancer treatment can also affect the heart valves. Other causes include infection, heart muscle failure, and certain diseases that affect the heart’s structure.[8]
Who Is at Higher Risk
Certain groups of people have a higher chance of developing heart valve disease. Knowing whether you fall into one of these groups can help you be more vigilant about your heart health.
Age is one of the most significant risk factors. Older individuals are at higher risk because heart valves can become thick and stiff with age. The wear and tear on valves over many years can eventually lead to problems. This is why heart valve disease is particularly common among older adults.[4]
People who have or have had other conditions that affect the heart and blood vessels face increased risk. These conditions include rheumatic fever, endocarditis, heart attack, heart failure, and coronary artery disease, especially when it affects the aorta. High blood pressure, high cholesterol, diabetes, obesity and overweight, and lack of physical activity all increase the likelihood of developing valve problems.[4]
Family history plays an important role. Your risk is higher if you have a family history of early heart disease. This means a father or brother who had heart disease younger than 55 years old, or a mother or sister who had heart disease younger than 65 years old.[4]
If you were born with an aortic valve that wasn’t formed correctly, you may develop problems. Sometimes this causes issues right away, but other times the valve may work well enough for years before causing problems.[4]
Smoking increases the risk of heart valve disease, particularly aortic stenosis. The chemicals in cigarettes can damage the heart and blood vessels. High cholesterol or lipids, also called dyslipidemia, chronic kidney disease, and previous chest radiation for cancer treatment also put people at higher risk.[8]
Recognizing the Symptoms
Many people with heart valve disease don’t have symptoms for many years, which is why the condition can go undetected for a long time. Some people live their whole lives with a heart valve that doesn’t work perfectly and never have any problems. However, when the condition worsens over time, your heart beats harder to make up for the reduced blood flow, and symptoms begin to appear.[1][2]
Heart valve disease can develop quickly or over a long period. When it develops more slowly, there may be no symptoms until the condition is quite advanced. Understanding the signs can help you recognize when something might be wrong and seek medical attention.[5]
Shortness of breath is one of the most common symptoms. You might feel short of breath at rest, during physical activity, or when lying down. This happens because your heart isn’t pumping blood efficiently, and your body isn’t getting enough oxygen. Many people first notice they can’t do activities they used to do without becoming breathless.[1][2]
Fatigue or feeling extremely tired is another frequent symptom. This may actually be your first symptom of valve disease. The fatigue occurs because your body isn’t receiving adequate blood flow and oxygen, making even simple daily tasks feel exhausting.[1][2]
Swelling in your feet, ankles, legs, or abdomen can develop when your heart isn’t pumping effectively. This swelling, called edema, happens because fluid builds up in your tissues. You might also notice swelling in the veins in your neck. Some people experience rapid weight gain, such as more than 1 to 1.3 kilograms in a day or 2 kilograms in a week.[1][2]
Chest pain or discomfort, especially when you’re physically active or exerting yourself, can be a warning sign. This pain might feel like pressure or tightness in your chest.[1][2]
An irregular heartbeat or heart palpitations may occur. You might feel like your heart is skipping beats, fluttering, or racing. Some people describe it as a flip-flop feeling in their chest. These sensations happen because valve problems can affect your heart’s electrical system and rhythm.[1][2]
Dizziness, light-headedness, weakness, or fainting can happen when your brain isn’t getting enough blood flow. These symptoms are particularly concerning and should prompt immediate medical attention.[1][2]
A heart murmur, which is a whooshing sound heard when a doctor listens to your heart with a stethoscope, can be a sign of valve disease. While heart murmurs are often harmless, they can indicate that a valve isn’t working properly. If your healthcare provider detects a heart murmur, you should be evaluated by a specialist to determine if heart valve disease is present.[8][1]
When heart valve disease develops more suddenly, people may experience fever along with other symptoms. This might indicate an infection of the valve or heart lining.[5]
Preventing Valve Disease
While some forms of heart valve disease are congenital and cannot be prevented, there are many steps you can take to reduce your risk of developing valve problems or prevent existing mild conditions from worsening.
Maintaining a healthy diet is one of the most important preventive measures. Eating a heart-healthy diet means consuming more fruits, vegetables, fish, lean meats, whole grains, and other high-fiber foods. It’s important to limit sodium, sugar, and alcohol. Eating a variety of foods in the right amounts helps protect your heart and valves from damage. Avoiding processed foods, especially processed meats like sausage, ham, and bacon, is also beneficial. Saturated fats, including animal fat, coconut, and palm oils, should be limited.[18][19]
Being physically active helps maintain heart health. Regular moderate to high-intensity exercise such as dancing, running, jogging, or speed walking can strengthen your heart and improve your overall physical fitness. Exercise helps control weight, lowers high blood pressure and bad cholesterol, and reduces stress, all of which benefit your heart valves. It is recommended for adults to exercise for 150 to 300 minutes a week at moderate to high intensity for aerobic or cardio activities, along with resistance or weight training 2 to 3 days a week. Even gentle exercise like walking is beneficial and will not harm your heart valve disease, unless your doctor specifically instructs otherwise.[18][19]
Staying at a healthy weight is crucial. 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. Being severely overweight makes operations more risky and recovery slower. A Body Mass Index between 18.5 and 24.9 is considered a healthy weight.[24]
Not smoking is essential for heart valve health. Smoking or tobacco use is hazardous to almost every organ in your body and is one of the main risk factors for cardiovascular diseases. The chemicals in cigarettes can damage the heart and blood vessels, and there is evidence that smoking increases the rate of progression of aortic stenosis. Quitting smoking benefits not only your health but also protects others from secondhand smoke.[18][24]
Managing other health conditions is important. This includes keeping diabetes, high blood pressure, and high cholesterol under control. These conditions can contribute to valve disease, so proper management helps protect your valves.[19][21]
Preventing infections is another key strategy. Infections like COVID-19, colds, and influenza can stress your heart. Getting a pneumococcal vaccine and a flu vaccine every year helps protect you. Staying up to date on your COVID-19 vaccines is also recommended.[19][21]
Taking care of your teeth and gums through good dental hygiene is more important than you might think. Getting regular dental checkups helps prevent infections. Good dental health is crucial because bacteria can spread from infected teeth and gums to the heart valves. Research shows that 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][19]
Treating strep throat infections promptly with antibiotics is critical to prevent rheumatic fever, which can damage heart valves. This is one of the most preventable causes of valve disease in developed countries.[2]
Learning about heart valve disease and understanding its causes and symptoms helps you recognize and prevent problems. Being aware of your family health history and individual risk factors enables you to discuss concerns with your healthcare provider and take appropriate preventive action.[5]
How the Disease Affects Your Body
Understanding what happens inside your body when you have valve disease can help you appreciate why symptoms occur and why treatment is important. The changes that take place affect not just your heart, but your entire body.
In a healthy heart, the four valves work together in a coordinated sequence during each heartbeat. During one part of your heartbeat, the valves open to allow blood to move forward through your heart. During the other part, they close to prevent blood from flowing backward. This ensures that blood flows efficiently from the upper chambers of your heart, called the atria, into the lower chambers, called the ventricles, and then out to your lungs and the rest of your body.[3]
When a valve becomes diseased, this smooth flow is disrupted. If a valve has stenosis and doesn’t open fully, the heart muscle must work much harder to push blood through the narrowed opening. This extra work puts strain on the heart muscle. Over time, the heart chambers may enlarge as they try to compensate for the obstruction, and the heart muscle may thicken. Eventually, this can lead to heart failure, where the heart can no longer pump blood effectively.[5]
When a valve has regurgitation and doesn’t close completely, blood leaks backward through the valve during the part of the heartbeat when it should be sealed. This means that with each beat, some of the blood that was just pumped forward flows back into the chamber it came from. The heart has to pump this same blood again, along with the new blood coming in. This volume overload makes the heart work harder and pump more blood with each beat to compensate for the leakage. Over time, the chambers handling this extra volume can stretch and enlarge.[5]
When the heart cannot pump blood effectively due to valve disease, several things happen throughout your body. The reduced blood flow means your organs and tissues don’t receive enough oxygen and nutrients. This is why you feel fatigued and weak. Your muscles and brain need oxygen to function properly, and when they don’t get enough, even simple activities become exhausting.[5]
The backup of blood can cause fluid to accumulate in various parts of your body. When the right side of your heart can’t pump efficiently, blood backs up in your veins, causing fluid to leak into your tissues. This leads to swelling in your legs, ankles, and feet. When the left side of your heart can’t pump well, blood and fluid can back up into your lungs, making it hard to breathe, especially when lying down or during physical activity.[5]
The increased pressure and volume in your heart chambers can affect the heart’s electrical system. This can lead to irregular heart rhythms or arrhythmias, which you might feel as palpitations or a racing heartbeat. Some arrhythmias can be dangerous and increase the risk of stroke.[5]
If diseased valves are not treated, the heart can become progressively weaker. The constant strain eventually damages the heart muscle itself, leading to heart failure. Heart failure means the heart can no longer pump enough blood to meet the body’s needs. This condition can become life-threatening. In severe cases, untreated heart valve disease can lead to sudden cardiac arrest, when the heart stops beating altogether.[5]
