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Heart Valve Disease

What is heart valve disease?

The heart has four valves, one at the exit of each of the four main chambers of the heart. The valves are tissue flaps that regulate the one-way flow of blood either into or out of the heart by opening and closing with each heartbeat. The opening and closing of these valves is what produces the "lub-dub" sound of your heartbeat.

When these valves are not working properly, the heart is forced to work harder to supply blood to the body. Without treatment, heart valve disease can lead to heart failure and other complications including stroke and even sudden death.

Diagram of the anatomy of the heart, with emphasis on the heart valves
Diagram of the anatomy of the heart, with locations of the four heart valves in bold text.

Serious heart valve disease affects 1 in 40 American adults, and is just as common in women as it is in men.1 Valve disease is a special challenge for women because they may be less likely to be properly diagnosed, putting them at risk for heart failure or early death.1 Although rare, valve disease in women of childbearing age is of special concern because it carries risks during pregnancy for both the mother and baby.2 Elderly women also require special evaluation when considering valve replacement surgery because of their smaller hearts and the risks that come with advanced age.

What are the signs of heart valve disease?

Heart valve disease can cause symptoms similar to the symptoms of heart failure such as tiredness, shortness of breath, and swelling in the ankles, feet, legs, or belly. Valve disease can lead to heart failure, and both conditions are related because they make the heart work harder and reduce the amount of blood that is pumped to the body.

The main way doctors detect heart valve disease is by listening through a stethoscope for a heart murmur, or unusual heartbeat sound. Since the valves opening and closing cause the heartbeat’s normal "lub-dub", variations in this sound can signal heart valve problems (although heart murmurs can also be harmless).

If your doctor suspects heart valve disease, the first choice test is an echocardiogram to look more closely at how your heart and its valves are working.

What are the different types and causes of valve disease?

Valve disease has many different causes. You can be born with heart valve disease (congenital valve disease), or it can develop later in life. Some people may have minor inborn problems that are not noticed until much later.

Although any of the four heart valves can be affected (often more than one), disease of the aortic and mitral valves on the left side of the heart are the most likely to cause symptoms—the left side of the heart pumps blood to the entire body. The two main ways the valves can be affected are stenosis (narrowing) and regurgitation (leaking).

Aortic Stenosis

The aortic valve sits between the heart's main pumping chamber (the left ventricle) and the aorta, the main artery leaving the heart that distributes blood to the body. Stenosis, or narrowing, happens when the leaflets (flaps) of the heart valve thicken, stiffen, or stick together. The prevents the valve from fully opening, so less blood is able to flow through and the heart muscle has to work harder to pump blood through the smaller opening. Aortic stenosis can be caused by:

  • Congenital (inborn) malformations of the valve - usually found in people younger than 30, although one form (in which the valve only has two flaps instead of three) is most often discovered in people aged 40 to 60
  • Rheumatic fever - an infection that causes inflammation of the heart valves; mainly occurs in developing countries
  • Degenerative disease - most common in the elderly; caused by age-related changes and the gradual buildup of calcium on the valve leaflets, making them stiff and thick

Aortic Regurgitation

Regurgitation, or leaking, happens when a valve does not close tightly, allowing some blood to flow backwards through the valve. Because of this backwards leak, the heart is a less efficient pump and has to work harder to pump the same amount of blood, putting stress on the heart muscle and over time leading to heart failure. Aortic regurgitation is usually caused by:

  • Congenital abnormalities of the valve
  • Rheumatic fever or other infection of the valves
  • Degenerative disease - most common in the elderly; caused by age-related changes and the gradual buildup of calcium on the valve leaflets, making them stiff and thick
  • Stretching of the valves caused by damage to other areas of the heart or the aorta (the large artery leaving the heart)

Mitral Stenosis

Oxygen-filled blood from the lungs enters the heart into the left atrium, then passes through the mitral valve into the heart's main pumping chamber (the left ventricle). Mitral stenosis (narrowing) is most often caused by rheumatic fever, an infection that causes inflammation and stiffening of the valve leaflets (flaps). In rare cases, mitral stenosis can also be caused by an inborn abnormality of the valve.

Mitral Regurgitation

Mitral valve regurgitation (leaking) happens when the valve does not close properly, and blood flows backwards from the main pumping chamber (the left ventricle) into the left atrium. It can be caused by

  • Prolapse (bulging out) of a valve leaflet, preventing the valve from closing normally; the most common cause of mitral regurgitation (see illustration below)
  • Rheumatic fever or other infections of the valves
  • The gradual buildup of calcium on the valves over time
  • Damage to the tendons or muscles that hold the valves in place, sometimes by a heart attack
  • Changes in the walls of the heart (such as those caused by heart failure) that cause the valve's position to change

 

Illustration of how valve prolapse can cause regurgitation (backflow)
Illustration of how prolapse can cause valve regurgitation (backflow).

 

How is heart valve disease treated?

In the early stages, healthy lifestyle changes (especially a healthy diet low in salt, fat, and cholesterol) and medications can improve symptoms, prevent complications, and slow the progression of heart valve disease. It is especially important to treat other heart conditions such as heart failure, heart rhythm problems, and high blood pressure. Blood thinning medication to prevent blood clots will also be considered by your doctor.

Eventually, surgery to repair or replace the valve may be necessary to protect the heart muscle and prevent complications like heart failure, stroke, and blood clots. The decision to have surgery depends on age, overall health, and how severe the heart valve disease is. While some heart valve repairs and replacements require open-heart surgery, some procedures can be done without opening the chest through a long, thin, tube called a catheter.

For Further Reading:

Heart Valve Disease & Heart Failure

  1. Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet. Sep 16 2006;368(9540):1005-1011.
  2. Bonow RO, Carabello BA, Chatterjee K, et al. 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. Sep 23 2008;52(13):e1-142.

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