Heart Valve Disease

What Is Heart Valve Disease?

Heart valve disease occurs when one or more of the heart’s valves do not open or close properly. This can disrupt normal blood flow through the heart and to the rest of the body. According to the Centers for Disease Control and Prevention, heart valve disease affects approximately 2.5% of the population. 

Heart valve disease may cause the heart to work harder to move blood through the body or cause increased back pressure in the heart and/or to the lungs. Over time, this can weaken the heart or lead to complications such as: 

• Abnormal heart rhythms
• Blood clots
• Heart failure
• Stroke
• Shortness of breath

Types of Heart Valve Disease

Heart valve disease usually involves one of the following problems:

• Regurgitation (insufficiency): The valve does not close tightly and blood leaks backward
• Stenosis: The valve opening becomes narrowed and does not open fully
• Prolapse: Valve leaflets bulge backward, sometimes allowing leakage

Some people are born with valve abnormalities. Others develop heart valve disease later in life.

Causes

Heart valve disease can develop for many reasons, including:

• Age-related degeneration and calcium buildup
• High blood pressure
• Pulmonary hypertension (high blood pressure in the lung arteries)
• Coronary artery disease
• Obesity
• Sleep apnea
• Lung problems
• Endocarditis (infection of the heart lining and valves)
• Rheumatic fever
• Congenital (present at birth) valve defects
• Thyroid disorders

Some cancer treatments and certain medications can also affect valve function.

Signs and Symptoms

The symptoms of heart valve disease depend on the valve affected and how severe the problem is. Some people have no symptoms for years.

Common Heart Valve Disease Symptoms

• Chest pain
• Fatigue
• Irregular heartbeat
• Shortness of breath
• Swelling in the legs, ankles or abdomen

As heart valve disease worsens, symptoms may become more noticeable during activity or even at rest.

Early diagnosis and monitoring can reduce the risk of serious complications.

When to Call 911

Seek emergency care right away if you experience:

• Chest pain
• Fainting
• Severe shortness of breath
• Sudden swelling with rapid weight gain

Diagnosis

Doctors often detect heart valve disease by hearing a heart murmur during a physical exam. A murmur is an unusual sound caused by turbulent blood flow across a narrowed or leaking valve. If a murmur or symptoms raise concern, additional tests are used to confirm the diagnosis and determine how severe the valve problem is.

Imaging Tests

Echocardiogram: This test uses sound waves to show valve structure, blood flow and severity of stenosis or regurgitation. Doppler echocardiography measures the speed and direction of blood flow. This helps doctors calculate how severe a valve problem is and whether treatment is needed.

Electrocardiogram (ECG or EKG): An ECG records the electrical activity of the heart. While it does not show the valves directly, it can reveal irregular heart rhythms, signs that the heart chambers are enlarged and evidence of prior heart damage. Valve disease that progresses over time can cause changes in heart rhythm or chamber size, which may appear on an ECG.

Chest X-ray: A chest X-ray shows the size and shape of the heart and lungs. It can help identify heart enlargement, fluid buildup in the lungs and changes related to long-standing valve disease. Although it does not show the valves themselves, it provides useful information about how valve problems are affecting the heart and lungs.

Cardiac MRI: Cardiac magnetic resonance imaging (MRI) produces detailed, three-dimensional images of the heart. It may be used when echocardiogram results are unclear or when more precise measurements are needed. Cardiac MRI can measure heart chamber size, evaluate heart muscle function, assess the severity of regurgitation and help guide treatment decisions. 

Diagnostic Procedures

Cardiac catheterization: Cardiac catheterization is an invasive procedure used when more detailed information is needed, especially before surgery or valve replacement. A thin tube (catheter) is inserted into a blood vessel and guided to the heart to measure pressures inside the heart chambers and determine the severity of valve narrowing, while also evaluating blood flow. Cardiac catheterization is often used to plan treatment, particularly for severe aortic stenosis or before valve replacement procedures.

Treatment

Treatment depends on the type and severity of heart valve disease.

Medications

Medications do not repair a narrowed or leaking valve. However, they can reduce symptoms, protect the heart and lower the risk of complications while you are being monitored or preparing for a procedure.

Common medication types include:

• Anticoagulants (blood thinners): These reduce the risk of blood clots. They are often prescribed for people with mechanical valve replacements or for patients who develop atrial fibrillation, a common rhythm problem linked to valve disease. Warfarin or other anticoagulants may be used when indicated.
• Blood pressure medications: Lowering blood pressure reduces strain on the heart and may help slow progression in certain types of valve disease. These may include ACE inhibitors, angiotensin receptor blockers or other medications selected by your doctor.
• Diuretics: These help the body remove excess sodium and fluid. Diuretics can reduce swelling in the legs and fluid buildup in the lungs, improving breathing and comfort.
• Medications to manage heart rhythm: Valve disease can increase the risk of irregular heart rhythms. Medicines may be prescribed to slow the heart rate, restore a normal rhythm or prevent rhythm-related complications.
• Medications to reduce heart workload: In some cases, drugs such as beta blockers may be used to decrease how hard the heart works, especially if heart function has begun to weaken.

Your treatment plan depends on the type of valve problem, the severity of disease, your symptoms and your overall health. Some patients require medication long term, while others use medication temporarily before or after valve repair or replacement.

Regular follow-up is important to monitor how well medications are working and to adjust doses as needed.

Procedures

When heart valve disease becomes severe or causes symptoms, procedures may be needed to repair or replace the damaged valve. The choice depends on which valve is affected, how severe the problem is and your overall health.

Catheter-Based Procedures

Catheter-based procedures are less invasive than open-heart surgery. A thin tube (catheter) is inserted through a blood vessel, usually in the groin, and guided to the heart.

These procedures may be recommended for people who are older, have other medical conditions or are considered high risk for surgery.

Common options include:

• Balloon valvuloplasty: A small balloon is inflated inside a narrowed valve to widen the opening. This is most often used for certain cases of mitral stenosis and sometimes for aortic stenosis. In adults, the improvement may be temporary, but it can relieve symptoms or serve as a bridge to valve replacement.
• Transcatheter aortic valve replacement (TAVR or TAVI): A new valve is placed inside a narrowed aortic valve without removing the old valve. This procedure is commonly used to treat severe aortic stenosis. TAVR has become an important option for many patients, including those at low, intermediate or high surgical risk.

Some catheter-based techniques can also repair leaking mitral valves in selected patients.

Surgery

Surgery may be recommended when a valve is severely narrowed or leaking and symptoms are significant, or when heart function begins to decline.

There are two main surgical approaches:

Valve Repair: Whenever possible, surgeons try to repair the existing valve. Repair preserves your own tissue and often avoids the need for long-term anticoagulation. Repair is commonly performed for mitral valve prolapse and some cases of regurgitation.

Valve Replacement: If repair is not possible, the damaged valve is replaced. Replacement valves may be:

• Biological (tissue-based): Made from animal or human tissue. These valves usually do not require lifelong anticoagulation but may wear out over time and eventually need replacement.
• Mechanical: Made from durable materials such as carbon or metal. These valves last longer but require lifelong anticoagulation with warfarin or another blood thinner to reduce the risk of blood clots.

Your doctor will help you decide which option is best based on your age, health history, lifestyle and preferences.

Lifestyle Management

You may lower your risk of heart valve disease or complications by:

• Controlling blood pressure
• Managing diabetes
• Maintaining good dental hygiene to reduce infection risk
• Seeking prompt treatment for infections
• Staying physically active

When to See a Specialist

It’s important to be evaluated by a cardiologist if you or a loved one: 

• Has symptoms of heart valve disease
• Would like strategies to help improve your current treatment of heart valve disease

At National Jewish Health in Denver, Colorado, we have one of the world’s leading cardiology programs. Learn more about our program or use the button below to make an appointment.