Heart Valve Disease

What is heart valve disease?

Heart valve disease refers to any of several conditions that prevent one or more of the valves in your heart from working right. Left untreated, heart valve disease can cause your heart to work harder. This can reduce your quality of life and even become life-threatening. In many cases, your healthcare provider can do surgery or a minimally invasive procedure to repair or replace your heart valves, restoring normal function and allowing you to return to normal activities.

The four valves in your heart make sure blood flows in only one direction through your heart. Your heart’s valves are:

• Mitral (between your left atrium and left ventricle).
• Tricuspid (between your right atrium and right ventricle).
• Aortic (between your left ventricle and aorta).
• Pulmonary (between your right ventricle and pulmonary artery).

Oxygen-poor blood comes back from your body to your heart’s right atrium, then goes through your tricuspid valve and into your right ventricle. From there, it goes through your pulmonary valve and pulmonary artery to get oxygen from your lungs.

Blood with oxygen returns through your pulmonary veins to your heart’s left atrium. Your mitral valve lets the blood travel from the left atrium to your left ventricle. From there, oxygen-rich blood goes through your aortic valve and out through your aorta to the rest of your body.

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. Your mitral valve has two leaflets, but the others have three leaflets.

The leaflets in two of your valves (the mitral and tricuspid) also have tough, fibrous strands of tissue called chordae tendineae that connect the valve leaflets to the papillary muscles inside the walls of your ventricles. The chordae tendineae and papillary muscles keep the leaflets stable against any backward flow of blood.

What are the types of heart valve disease?

There are different types of heart valve disease, and it is possible for more than one valve to be affected.

Valvular stenosis

With valvular stenosis, 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 (stenotic) 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.

Valvular insufficiency

Valvular insufficiency (or regurgitation, incompetence, "leaky valve"), happens when the leaflets don’t close completely, letting blood leak backward across the valve. This backward flow is referred to as “regurgitant flow.” Your heart has to pump harder to make up for this backward flow, and the rest of your body may get less blood flow.

You can get a backward flow if you have mitral valve prolapse, a common problem in which the valve flaps go back into your left atrium when your heart beats.

Valvular atresia

Valvular atresia happens when a heart valve doesn’t form correctly before birth. This is usually diagnosed very early in infancy.

How common is heart valve disease?

About 2.5% of Americans — many of them older adults — have heart valve disease. Each year, roughly 28,000 people die from heart valve disease in the United States. Mitral valve prolapse is a common heart valve problem.

How does heart valve disease affect my body?

When a heart valve isn’t working right, it puts a strain on your heart because it makes it work harder. Also, it can cause less blood flow to your body.

What are the symptoms?

It’s common for people with heart valve disease to be without symptoms. But when the heart valve problem worsens, your heart beats harder to make up for the reduced blood flow. Over time, heart valve disease may get bad enough that these symptoms begin to appear:

• Increasing shortness of breath, especially with physical activity or lying down.
• Palpitations (skipped beats or a flip-flop feeling in the chest).
• Edema (swelling of the ankles, feet or abdomen).
• Weakness or dizziness.
• Quick weight gain.
• Chest discomfort, especially when you exert yourself.
• Fatigue.
• If the valve disease is caused by infection, you may notice fevers, chills, or body aches.

What causes heart valve disease?

Common heart valve disease causes include:

• Rheumatic fever from strep throat that wasn’t treated.
• Heart attack that damages your heart.
• High blood pressure (advanced).
• A congenital problem that’s been present since birth, such as a pulmonary or aortic valve that didn’t develop right.
• Degeneration or calcification of the valve tissue, with loss of function over time.
• Thoracic aortic aneurysm(dilation of the aorta, which stretches the aortic valve leaflets and can cause leakage).
• Heart failure.
• Infection in your heart (infective endocarditis).

How is heart valve disease diagnosed?

When your healthcare provider does a physical examination and listens to your heart through a stethoscope, they may find these signs of heart valve disease:

• Fluid in your lungs.
• An enlarged heart.
• A heart murmur, which could mean blood is moving through a stenotic or leaky valve.
• Swelling in your ankles.

Several medical tests can also show heart valve disease. Repeating tests over time can help your provider see the progress of your valve disease and help them make decisions about your treatment.

What tests will be done to diagnose heart valve disease?

Tests for heart valve disease diagnosis include:

• Echocardiogram (ultrasound of the heart) — A moving image of your heart’s valves and chambers using sound waves from a handheld wand placed on your chest.
• Transesophageal echocardiogram (TEE) — An ultrasound of your heart, performed by inserting a probe with an ultrasound transducer down your esophagus. This can provide clearer images than a regular echocardiogram because the esophagus sits very close to the heart.
• Exercise stress echocardiogram — After walking on a treadmill or riding a bike, an echocardiogram is performed to see how the valves and heart function respond to exercise.
• Chest X-ray — A quick X-ray scan of your chest.
• Cardiac catheterization (angiogram) — X-ray movies of your coronary arteries, heart chambers and heart valves. An injection of contrast dye into a catheter in your arm or leg helps produce the images.
• Electrocardiogram (EKG or ECG) — Using small electrode patches attached to your skin to get the information, this records the electrical activity of your heart on graph paper.
• Magnetic resonance imaging (MRI) — Radio waves and a magnet work together to create high-quality images of your heart.

How is heart valve disease treated?

A heart valve problem can be serious if it’s not treated. Although you can’t undo damage to a heart valve, you can treat the issue.

Heart valve disease treatments depend on the underlying cause and may include:

• Protecting your valve from further damage.
• Taking medications.
• Having surgery or invasive procedures if necessary.
• Seeing your heart doctor for regular visits.

The decision to prescribe medical treatment, surgical repair or surgical replacement depends on several factors, including:

• The type of valve disease.
• The severity of the damage.
• Your age.
• Your medical history.

If you’re pregnant and have heart valve disease, you can get extra rest and/or take certain medicines that are safe for your baby.

If you know about your valve disease before pregnancy, you should ask your healthcare provider if any tests or visits with a cardiologist are recommended before trying to become pregnant. This can help ensure that you are treated appropriately before and during pregnancy. If you have a severe valve problem, your doctor may recommend valve repair or replacement before pregnancy.

Surgical repair or replacement

Heart valve disease is a mechanical problem in the opening or closing of the leaflets, and you may eventually need surgery to repair or replace your valve. Some infants and children who are born with a valve problem need surgery during childhood.

Usually, the surgeon and cardiologist will know which treatment will be best before surgery day. Other times, the surgeon makes the decision during surgery, when they can see your valve.

Often, valve surgery may be combined with other procedures (such as more than one valve procedure, bypass surgery or surgery to treat atrial fibrillation) to fully treat your heart disease.

Heart valve repair allows your surgeon to fix your faulty valve, often without the use of artificial parts. In some cases, such as a narrow mitral valve, your provider may use a balloon on a catheter to widen your valve.

The advantages of valve repair are:

• Lower risk of infection.
• Decreased need for lifelong blood thinner medication.
• Preserved heart muscle strength and function.

Surgeons have to replace valves they can’t repair. Replacing your heart valve involves removing your old valve and sewing a new valve to the ring-shaped part of your old valve. The new valve could be a mechanical or biological (made with tissue from a human, cow or pig) valve. These replacement valves can provide adequate function when repair can’t. However, depending on the type of valve your provider uses, you may have to take certain medications to prevent blood clots or get a new valve again in 10 or 15 years.

Depending on the type of valve problem and your other medical conditions, you may be a candidate for minimally invasive valve repair or replacement. Ask your cardiologist if a minimally invasive procedure may be right for you.

What medications are used?

Although medicines can’t cure heart valve disease, they — and a healthier lifestyle — can help with symptoms and decrease your chance of having a stroke or sudden cardiac arrest. You may be able to stop taking some medications after valve surgery, but you may need to take other medicines for the rest of your life.

Your healthcare provider may prescribe medications to help you with:

• Preventing arrhythmias or blood clots.
• Bringing down your blood pressure or cholesterol levels.
• Treating heart failure or coronary artery disease.

Your provider will review your medication information with you before you leave the hospital. It’s important to know:

• The names of your medications.
• Their purpose.
• How often and at what times to take them.

Complications/side effects of the treatment

Older people and those whose health is not good to begin with have a higher risk of complications from valve replacement surgery.

Complications, which are rarely fatal, may include:

• Infection.
• Atrial fibrillation or another type of abnormal heart rhythm.
• Bleeding.
• Blood clots.
• Kidney failure.
• Stroke or transient ischemic attack (TIA).

How long does it take to recover from heart valve surgery?

You may be in the hospital for about five to seven days after heart surgery. After that, it can take approximately four to eight weeks to recover. Your provider may recommend cardiac rehabilitation, a carefully monitored exercise program to assist with your recovery.

How can I reduce my risk of heart valve disease?

Although you can’t change some risk factors, like growing older, there are things you can do that may reduce your risk of heart valve disease. These include:

• Getting treatment quickly for infections.
• Being physically active.
• Eating healthy foods.
• Staying at a healthy weight.
• Continuing to take medicine for high blood pressure and/or high cholesterol if you have those conditions.
• Not using tobacco products.
• Not using recreational drugs, especially IV drugs which increase your risk for heart valve infection.

Protecting your valve from further damage

People with heart valve disease should talk to their healthcare provider about the increased risk of getting infective endocarditis. This infection can greatly damage or destroy your heart valves and can be fatal. You are at risk even if you had surgery to repair or replace your valve. To prevent infective endocarditis:

• Tell your medical and dental providers that you have valve disease.
• Call your provider if you have symptoms of an infection.
• Take good care of your teeth and gums.
• Ask your heart doctor if you should take antibiotics before any dental procedures, major or minor surgeries, or invasive tests.

What can I expect if I have heart valve disease?

If you have heart valve disease, you’ll have it for your whole life. However, your experience of heart valve disease depends on the valve affected and the severity of the problem. Some people may have valve disease and never experience any symptoms. Others may have many symptoms and require valve repair/replacement. It is important to follow up regularly with a healthcare provider to monitor the progression of your valve disease over time. Untreated valve disease may eventually lead to:

• Heart failure.
• Blood clots.
• Stroke.
• Sudden cardiac arrest.

Even if your healthcare provider repairs or replaces your valve, you’ll still need to take medicine and possibly have another replacement in 10 or 15 years.

How do I take care of myself?

Keep taking any medicines your healthcare provider prescribed for you and go to all follow-up appointments.

When should I see my healthcare provider?

You’ll need to schedule regular follow-up appointments with your cardiologist to make sure your heart valves work as they should. Ask your provider how frequent these appointments should be. Contact your provider sooner if your symptoms become more severe or frequent. You should also tell your provider if you have infective endocarditis.

You may also need to repeat tests, such as an echocardiogram.

When should I go to the ER?

You should call 911 if you have these symptoms after heart valve surgery:

• Fainting.
• Fever or chills.
• Feeling sick to your stomach, throwing up or having diarrhea.
• Chest pain.
• Heart rate of more than 150 beats a minute.
• Severe headache or arm/leg weakness/numbness without warning.
• Shortness of breath that doesn’t get better with rest.
• Bright red blood in what you cough.
• Dark black stool or bright red blood in your stool.

What questions should I ask my doctor?

• Would lifestyle changes help me?
• What kinds of exercise are safe for me to do?
• How soon after surgery can I exercise?

A note from Cleveland Clinic

Although heart valve disease is a lifelong condition, you can manage it with medications and/or surgery. Your healthcare provider can talk with you about the best option for your situation. Regardless of what your provider does, you can do your part, too. You can get more exercise, eat heart-healthy foods and avoid using tobacco products. Be sure to keep taking any prescribed medicines and go to all of your follow-up appointments.