Heart Valve Disease

What is heart valve disease?

Heart valve disease, or valvular heart disease, is an umbrella term for when one, or more, of the heart’s valves are diseased or damaged meaning that they are not working properly to pump blood around the heart and the rest of the body.

A normal heart has four major valves, the mitral valve, tricuspid valve, aortic valve, and the pulmonary valve. They open and close with every heartbeat to allow blood to flow through the heart in the right direction.

When any of these valves are damaged or diseased, the heart has to work harder to pump blood and heart valve disease can stop blood flowing correctly around the body.

There are different types of heart valve disease and any of the valves can be affected, however commonly the aortic or mitral valves become diseased.

If left untreated, heart valve disease can lead to heart failure, and even death.

What types of heart valve disease are there?

It is possible for the heart to be affected by more than just one type of valve disease at the same time and multiple valves can be affected.

• Stenosis - Stenosis is when the valve becomes very stiff, causing it to narrow. This restricts the blood flow as the valve cannot open fully. One of the most common heart valve diseases is Aortic Stenosis.

• Regurgitation - Regurgitation is when a diseased valve doesn’t close fully, meaning that blood is able to flow backwards, reducing the amount of blood that can be pumped around the rest of your body. Another word for valve regurgitation is incompetence.

• Atresia - Atresia is when any of the heart valves have not formed properly during development. The valve is completely blocked by tissue and no blood can flow through it.

• Bicuspid aortic valve - Each of the heart valves has either 2 or 3 leaflets (the pieces of tissue that open and close with each heartbeat). The aortic valve normally has 3 leaflets, but some people are born with only 2 leaflets for the aortic valve – this is known as a bicuspid aortic valve. It is also possible to develop a bicuspid aortic valve later in life if 2 of the 3 aortic valve leaflets become stuck together – this is a slow process that happens over many years. While in younger people a bicuspid aortic valve might work well, bicuspid valves in later life often become narrowed, leading to aortic stenosis.

What are the symptoms of heart valve disease?

It is possible for there to be no signs or symptoms in mild cases of heart valve disease.

Signs and symptoms of heart valve disease can include:

• Chest pain
• Shortness of breath
• Dizziness, light-headedness
• Blackouts
• Irregular heartbeat
• Fatigue
• Fever (with heart valve infection)
• Gaining weight and body fluid

What are the causes of heart valve disease?

Heart valve disease can have a number of causes. It can be that one or more of the heart’s valves did not develop properly and the condition is present from birth (congenital). Or it can be caused by degenerative change, infections, or other heart conditions later in life.

Some of the most common causes of heart valve disease are:

Congenital heart valve disease

This is when a heart valve or valves don’t form properly, leading to structural abnormalities. 

Leaflets are the flaps on a valve that open and close when the heart beats, sometimes heart valves do not develop all their leaflets. Of this type of birth defect, the most common is a Bicuspid Aortic Valve, where the aortic valve develops with only two leaflets instead of three.

Other Heart Diseases

Other types of heart disease that can then lead to valve disease are:

• Heart failure/cardiomyopathy
• Heart attack
• Atrial fibrillation causing atrial functional mitral regurgitation

Infection

Heart valve disease can be caused by other infections, some of these include:

• Endocarditis: This is caused by severe blood infections. Once the infection has reached the heart, it can damage the leaflets on the valves.
• Rheumatic fever:  This occurs when strep throat is left untreated as the infection can leave scarring on the heart valves, weakening the valves.

Aging

Aging can cause number of complications in the heart that may lead to heart valve disease. These include:

• Calcification:  This is where calcium builds up on the heart’s valves, this will usually lead to Aortic Stenosis, the most common type of acquired heart valve disease.
• Degenerative valve disease: A common degenerative heart valve condition is mitral valve regurgitation, and this can lead to the mitral valve needing to be repaired or replaced.

How is heart valve disease diagnosed?

It is important to have regular heart checks, as one of the most common ways heart valve disease is diagnosed is by a doctor listening to the heart through a stethoscope. They are listening for a heart murmur, often one of the first signs of heart valve disease, which in most cases can only be heard using a stethoscope.

Other methods of diagnosis your doctor may want to perform are:

• Transthoracic echocardiogram
• Transesophageal echocardiogram
• Stress echocardiogram
• Electrocardiogram (this can be a simple screening test to find major heart problems including some valve diseases, but it can’t actually diagnose valve disease on its own)
• Chest X-ray
• Left and right heart catheter
• Cardiopulmonary exercise test
• CT scan
• Cardiac MRI

How is heart valve disease treated?

The treatment for heart valve disease will vary depending on the cause of the heart valve disease and how much it is affecting the heart’s ability to function properly.

Available treatments include:

• Medications to manage symptoms
• Surgical interventions such as valve repair and valve replacement
• Transcatheter interventions (avoiding open heart surgery) such as balloon valvuloplasty- this uses a balloon to widen a narrowed heart valve.

With advancements in transcatheter technology and advanced echocardiographic imaging, minimally invasive therapies are increasingly able to be used to treat heart valve disease.

How can heart valve disease be prevented?

Heart valve disease can potentially be life-threatening, but it is important to remember that regular heart checks will help with early diagnosis while the disease is mild, making it easier to treat.

It is also important to know and monitor the risk factors that can contribute to or worsen heart valve disease, and where possible, make lifestyle changes that reduce your risk.

Common risk factors that can cause or worsen valve diseases include:

• High blood pressure
• High cholesterol
• Diabetes
• Obesity
• History of heart disease or heart attack
• Previous infections that can affect the heart
• Congenital heart disease
• Older age
• Family history of heart valve disease
• Lack of healthy teeth and many cavities (poor 'mouth hygiene')

By exercising regularly, eating a healthy diet, and maintaining a healthy weight, many of these risk factors can be reduced. If you develop any symptoms of heart valve disease, seeing your doctor can help identify heart valve disease early. Download our Heart Health Check Guide to take with you to your next doctor's appointment.

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