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Heart valve disease

Overview

In heart valve disease, one or more of the valves in your heart doesn't work properly.

Your heart has four valves that keep blood flowing in the correct direction. In some cases, one or more of the valves don't open or close properly. This can cause the blood flow through your heart to your body to be disrupted.

Your heart valve disease treatment depends on the heart valve affected and the type and severity of the valve disease. Sometimes heart valve disease requires surgery to repair or replace the heart valve.

Symptoms

Some people with heart valve disease might not experience symptoms for many years. Signs and symptoms of heart valve disease may include:

  • Abnormal sound (heart murmur) when a doctor is listening to the heart beating with a stethoscope
  • Fatigue
  • Shortness of breath, particularly when you have been very active or when you lie down
  • Swelling of your ankles and feet
  • Dizziness
  • Fainting
  • Irregular heartbeat

When to see a doctor

If you have a heart murmur, your doctor may recommend you visit a cardiologist. If you develop any symptoms that may suggest heart valve disease, see your doctor.

Causes

Your heart has four valves that keep blood flowing in the correct direction. These valves include the mitral valve, tricuspid valve, pulmonary valve and aortic valve. Each valve has flaps (leaflets or cusps) that open and close once during each heartbeat. Sometimes, the valves don't open or close properly, disrupting the blood flow through your heart to your body.

Heart valve disease may be present at birth (congenital). It can also occur in adults due to many causes and conditions, such as infections and other heart conditions.

Heart valve problems may include:

  • Regurgitation. In this condition, the valve flaps don't close properly, causing blood to leak backward in your heart. This commonly occurs due to valve flaps bulging back, a condition called prolapse.
  • Stenosis. In valve stenosis, the valve flaps become thick or stiff, and they may fuse together. This results in a narrowed valve opening and reduced blood flow through the valve.
  • Atresia. In this condition, the valve isn't formed, and a solid sheet of tissue blocks the blood flow between the heart chambers.
Chambers and valves of the heart

A normal heart has two upper and two lower chambers. The upper chambers, the right and left atria, receive incoming blood. The lower chambers, the more muscular right and left ventricles, pump blood out of your heart. The heart valves, which keep blood flowing in the right direction, are gates at the chamber openings.

Chambers and valves of the heart

A normal heart has two upper and two lower chambers. The upper chambers, the right and left atria, receive incoming blood. The lower chambers, the more muscular right and left ventricles, pump blood out of your heart. The heart valves, which keep blood flowing in the right direction, are gates at the chamber openings.

A normal heart and heart valve problems

Heart valve problems may include a narrowed valve (stenosis), a leaking valve (regurgitation) or a valve with leaflets that are bulging back (prolapse), as shown in the bottom two images. A normal heart and valves is shown in the top image.

Risk factors

Several factors can increase your risk of heart valve disease, including:

  • Older age
  • History of certain infections that can affect the heart
  • History of certain forms of heart disease or heart attack
  • High blood pressure, high cholesterol, diabetes and other heart disease risk factors
  • Heart conditions present at birth (congenital heart disease)

Complications

Heart valve disease can cause many complications, including:

  • Heart failure
  • Stroke
  • Blood clots
  • Heart rhythm abnormalities
  • Death

Diagnosis

Your doctor may evaluate your signs and symptoms and conduct a physical examination. In a physical examination, your doctor will likely listen for a heart murmur, as this can be a sign of a heart valve condition. Your doctor may order several tests to diagnose your condition.

Tests may include:

  • Echocardiography. In this test, sound waves directed at your heart from a wandlike device (transducer) held on your chest produce video images of your heart in motion. This test assesses the structure of your heart, the heart valves and the blood flow through your heart. An echocardiogram helps your doctor get a close look at the heart valves and how well they're working. Doctors may also use a 3-D echocardiogram.

    Doctors may conduct another type of echocardiogram called a transesophageal echocardiogram. In this test, a small transducer attached to the end of a tube is inserted down the tube leading from your mouth to your stomach (esophagus). This test allows doctors to have a closer look at the heart valves than is possible with a regular echocardiogram.

  • Electrocardiogram (ECG). In this test, wires (electrodes) attached to pads on your skin measure electrical impulses from your heart. An ECG can detect enlarged chambers of your heart, heart disease and abnormal heart rhythms.
  • Chest X-ray. A chest X-ray can help your doctor to determine whether the heart is enlarged, which can indicate certain types of heart valve disease. A chest X-ray can also help doctors determine the condition of your lungs.
  • Cardiac MRI. A cardiac MRI uses magnetic fields and radio waves to create detailed images of your heart. This test may be used to determine the severity of your condition and assess the size and function of your lower heart chambers (ventricles).
  • Exercise tests or stress tests. Different exercise tests help measure your activity tolerance and monitor your heart's response to physical exertion. If you are unable to exercise, medications to mimic the effect of exercise on your heart may be used.
  • Cardiac catheterization. This test isn't often used to diagnose heart valve disease, but it may be used if other tests aren't able to diagnose the condition or to determine its severity.

    In this procedure, a doctor threads a thin tube (catheter) through a blood vessel in your arm or groin to an artery in your heart and injects dye through the catheter to make the artery visible on an X-ray. This provides your doctor with a detailed picture of your heart arteries and how your heart functions. It can also measure the pressure inside the heart chambers.

Treatment

Heart valve disease treatment depends on how severe your condition is, if you're experiencing signs and symptoms, and if your condition is getting worse.

A doctor trained in heart disease (cardiologist) will provide your care. If you have heart valve disease, consider being evaluated and treated at a medical center with a multidisciplinary team of doctors and medical staff trained and experienced in evaluating and treating heart valve disease. This team can work closely with you to determine the most appropriate treatment for your condition.

Your doctor may suggest monitoring your condition with regular follow-up appointments. Your doctor may also recommend making healthy lifestyle changes and taking medications to treat symptoms.

You may eventually need heart valve surgery to repair or replace the diseased heart valve. Doctors may suggest heart valve surgery even if you aren't experiencing symptoms, as this may prevent complications and improve outcomes. If you need surgery for another heart condition, your doctor may repair or replace the diseased valve at the same time.

Heart valve surgery is usually performed through a cut (incision) in the chest. Doctors may sometimes conduct minimally invasive heart surgery, which involves the use of smaller incisions than those used in open-heart surgery. In some medical centers, doctors may perform robot-assisted heart surgery, a type of minimally invasive heart surgery in which surgeons use robotic instruments to conduct the procedure.

Doctors may also use less invasive procedures to repair certain valves using long, thin tubes (catheters) in some people. These procedures can involve the use of clips, plugs or other devices. In some cases, valves can be replaced during a catheter procedure. Doctors continue to study catheter procedures to repair or replace heart valves.

Surgery options include:

Heart valve repair

Your doctor may often recommend heart valve repair when possible, as it preserves your heart valve and may preserve heart function. To repair a valve, surgeons may separate valve flaps (leaflets or cusps) that have fused, replace the cords that support the valve, remove excess valve tissue so that the leaflets or cusps can close tightly or patch holes in a valve. Surgeons may often tighten or reinforce the ring around a valve (annulus) by implanting an artificial ring.

Doctors may conduct a procedure using a long, thin tube (catheter) to repair a valve with a narrowed opening. In this procedure, a doctor inserts a catheter with a balloon on the tip into an artery in your arm or groin and guides it to the valve.

A doctor then inflates the balloon, which expands the opening of the valve. The balloon is then deflated, and the catheter and balloon are removed. You may need additional procedures to treat the narrowed valve over time.

Heart valve replacement

In some cases, the valve can't be repaired, and surgeons may perform heart valve replacement. In heart valve replacement, your surgeon removes the damaged valve and replaces it with a mechanical valve or a valve made from cow, pig or human heart tissue (biological tissue valve).

Biological tissue valves degenerate over time, and often eventually need to be replaced. People with mechanical valves will need to take blood-thinning medications for life to prevent blood clots. Your doctor will discuss with you the benefits and risks of each type of valve and discuss which valve may be appropriate for you.

Biological valve replacement

In a biological valve replacement, a biological or tissue valve replaces the damaged valve.

Biological valve replacement

In a biological valve replacement, a biological or tissue valve replaces the damaged valve.

Mechanical valve replacement

In a mechanical valve replacement, a mechanical valve replaces the damaged valve.

Preparing for an appointment

If you think you have heart valve disease, make an appointment to see your doctor. Here's some information to help you prepare for your appointment.

What you can do

  • Be aware of pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do beforehand.
  • Write down your symptoms, including any that seem unrelated to heart valve disease.
  • Write down key personal information, including a family history of heart disease, and any major stresses or recent life changes.
  • Make a list of all medications, vitamins and supplements you take.
  • Take a family member or friend along, if possible. Someone who accompanies you can help you remember information you receive.
  • Be prepared to discuss your diet and exercise habits. If you don't already eat well and exercise, be ready to talk to your doctor about challenges you might face in getting started.
  • Write down a list of questions to ask your doctor.

For heart valve disease, some basic questions to ask your doctor include:

  • What is likely causing my symptoms or condition?
  • What are other possible causes for my symptoms or condition?
  • What tests will I need?
  • What's the best treatment?
  • What are the alternatives to the primary approach you're suggesting?
  • I have other health conditions. How can I best manage them together?
  • Are there restrictions I need to follow?
  • Should I see a specialist?
  • If I need surgery, which surgeon do you recommend for heart valve surgery?
  • Is there a generic alternative to the medicine you're prescribing?
  • Are there brochures or other printed material I can take with me? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Questions your doctor is likely to ask include:

  • When did your symptoms begin?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

Lifestyle and home remedies

You'll have regular follow-up appointments with your doctor to monitor your condition.

Your doctor may suggest you incorporate several heart-healthy lifestyle changes into your life, including:

  • Eating a heart-healthy diet. Eat a variety of fruits and vegetables, low-fat or fat-free dairy products, poultry, fish and whole grains. Avoid saturated and trans fat, and excess salt and sugar.
  • Maintaining a healthy weight. Aim to keep a healthy weight. If you're overweight or obese, your doctor may recommend losing weight.
  • Getting regular physical activity. Aim to include about 30 minutes of physical activity, such as brisk walks, into your daily fitness routine.
  • Managing stress. Find ways to help manage your stress, such as through relaxation activities, meditation, physical activity, and spending time with family and friends.
  • Avoiding tobacco. If you smoke, quit. Ask your doctor about resources to help you quit smoking. Joining a support group may be helpful.

For women with heart valve disease, it's important to talk with your doctor before you become pregnant. Your doctor can discuss with you which medications you can safely take, and whether you may need a procedure to treat your valve condition prior to pregnancy.

You'll likely require close monitoring by your doctor during pregnancy. Doctors may recommend women with severe valve conditions avoid pregnancy to reduce the risk of complications.

Coping and support

If you have heart valve disease, here are some steps that may help you cope:

  • Take medications as prescribed. Take your medications as directed by your doctor.
  • Get support. Having support from your family and friends can help you cope with your condition. Ask your doctor about support groups that may be helpful.
  • Stay active. It's a good idea to stay physically active. Your doctor may give you recommendations about how much and what type of exercise is appropriate for you.

Last updated: March 3rd, 2017

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