Valvular heart disease, sometimes called valvular heart disease, is when one or more of your heart valves don’t work properly. Your heart’s four valves keep blood moving in the right direction, but a malfunctioning valve causes abnormal blood flow in your heart.
In valvular heart disease, the heart works too hard, leading to dizziness, fainting, shortness of breath, and chest pain. This condition can affect any of the four heart valves with valvular stenosis (narrowing) or valvular regurgitation (leakage and backflow).
Valvular heart disease affects about 2.5% of adults in the United States. It may be present at birth or may develop over time due to causes such as aging, infection, and heart attack.
A cardiologist, a doctor who specializes in heart disease, can diagnose and treat valvular heart disease to help you manage your symptoms and prevent complications
Health professionals classify valvular heart disease according to which of the four heart valves is affected and whether there is a narrowing or a leak. They can also rate the condition according to its severity and any symptoms.
Aortic valve disease
The aortic valve is located between the heart’s main pumping chamber (the left ventricle) and the aorta (the large blood vessel that carries blood from the heart to the body). A narrowing of this valve, known as aortic stenosis, affects blood flow from the heart. More than 13% of the elderly have aortic stenosis.
Aortic regurgitation, on the other hand, is the leakage of the aortic valve when it is closed. This causes blood to leak from the aorta into the left ventricle of the heart.
Mitral valve disease
The mitral valve separates the left atrium (upper heart chamber) from the left ventricle (lower heart chamber). The left atrium drains blood into the left ventricle, which then pumps it out into the body.
Mitral regurgitation occurs when blood leaks backwards from the left ventricle into the left atrium when the valve is closed.
Mitral valve stenosis is a narrowing of the mitral valve, which restricts blood flow from the left atrium to the left ventricle. It is often due to rheumatic fever, a complication of an untreated strep infection. Rheumatic fever is uncommon in the US among people born after 1943.
Tricuspid valve disease
The tricuspid valve separates the right chambers of the heart: the right atrium and the right ventricle. It opens to allow blood to flow from the right atrium to the right ventricle, and closes as the heart contracts to push blood into the lungs.
Tricuspid stenosis is a narrowing of the valve that blocks blood flow to the right ventricle.
Tricuspid regurgitation, which leaks blood back through the tricuspid valve, can occur with any condition that enlarges the right side of the heart.
Pulmonary valve disease
The pulmonary valve is located between the right ventricle and the pulmonary artery, the main blood vessel that brings blood from the right side of the heart to the lungs to pick up oxygen.
Pulmonary valve stenosis, or narrowing of the valve, is usually the result of a congenital condition.
Pulmonary valve regurgitation occurs when blood leaks back through a closed pulmonary valve from the pulmonary artery into the heart. It is usually caused by high blood pressure in the blood vessels of the lungs (pulmonary hypertension).
Valvular heart disease may not cause symptoms, especially in the early stages. As the condition progresses, it affects blood flow and heart function. This can disrupt blood flow from the heart and cause fluid to back up into the lungs and throughout the body. The resulting symptoms of valvular heart disease can include:
- Shortness of breath
- Problems with exercise or activities
- Fast or skipped heartbeats
- Dizziness or vertigo
- Fainting or fainting
- Fatigue
- Chest pain
- Rapid weight gain
- Swelling in the abdomen, legs, ankles or around the eyes
- Fever, which can be a sign of a heart infection known as endocarditis
If you develop symptoms of valvular heart disease, see your doctor so they can diagnose or rule out the condition.
Valvular heart disease can be congenital (occurring before birth) or acquired (occurring later in life).
Congenital valve problems occur when the valve does not form properly before birth. According to the Centers for Disease Control and Prevention (CDC), about 1% of babies are born with a congenital heart problem. Certain congenital heart problems can affect the heart valves, including the genetic condition bicuspid aortic valve (BAV), which can lead to aortic stenosis or regurgitation.
Other heart valve problems can happen later in life due to factors such as:
- infection: Rheumatic heart disease or endocarditis can directly affect the valves
- aging: It can lead to calcium deposits that can narrow the valves
- Cardiac Devices: Pacemakers can interfere with valve closure and lead to leakage
- heart attack: It can affect the heart muscles that attach to the valves
- Radiation treatment: May cause valve thickening and scarring
A health care provider may first suspect heart valve disease if they hear a heart murmur during your routine physical exam.
To investigate further, your doctor may order an echocardiogram, an ultrasound test that provides information about the structure and function of your heart. The test shows the heart valves and how well blood is passing through them.
In some cases, the cardiologist may investigate further with other heart tests such as:
- Magnetic resonance imaging (MRI) of the heart: It further visualizes the heart valves and blood flow
- Computed tomography of the heart (CT): It measures the amount of calcium buildup in the valves
- stress tests: It uses an echocardiogram to see how the heart works under stress
- Catheterization of the heart: It directly measures the pressure inside the heart
If a healthcare provider suspects endocarditis along with heart valve disease, they will likely order blood tests to look for bacteria and inflammation.
The goal of treatment is to help you manage your symptoms and prevent or manage potential complications.
If cardiologists diagnose valvular heart disease before it causes symptoms or complications, they can usually track a mild leak or narrowing over time. In this case, the cardiologist may periodically evaluate and perform imaging tests to confirm that your condition is not worsening.
It is important to attend regular check-ups with your doctor. If you develop symptoms or your heart shows signs of weakening due to valve disease, your cardiologist may recommend further treatment. Treatment for valvular heart disease depends on its type, location, and severity, but options may include:
- medicines: Help treat symptoms and related conditions such as high blood pressure, which can help reduce the strain on your heart
- antibiotics: Treating bacterial infections that can inflame the heart or preventing endocarditis
- Minimally invasive procedures: Repair valves or remove calcium build-up
- Heart surgery: Heart valve replacement
It is not always possible to prevent valvular heart disease. Some people are born with it. In other cases, some practices can help you prevent valve disease from developing or worsening:
- Treat underlying conditions like high blood pressure, high cholesterol, and coronary artery disease
- Take good care of your oral health and skin to prevent infections that can lead to endocarditis
- Get the right treatment for your strep throat infection to prevent rheumatic fever
Heart valve disease can be serious. If left untreated, it can lead to life-threatening complications such as:
- heart failure: Valvular disease causes the heart to pump harder to move blood. This can eventually compromise the heart’s ability to pump blood in a way that meets your body’s needs.
- arrhythmias: Irregular heart rhythms can occur with irregular blood flow.
- stroke: If the calcium build-up breaks loose and travels to the brain, it can restrict blood flow to the brain.
- Infection in the heart and bloodstream: An endocarditis infection can also lead to sepsis.
- Problems with the aorta: Blood flow problems can lead to an aneurysm (bulging due to weakness in the wall of the aorta) or rupture.
Valvular heart disease is generally a chronic (long-term) condition, but it can be treated. The outlook for the condition depends on many factors, including the affected valve, the severity of the regurgitation or narrowing, and the symptoms.
Severe and symptomatic valve disease has a worse prognosis and requires more treatment than mild, asymptomatic valve disease. Symptoms can interfere with daily activities, which is often why a cardiologist or surgeon suggests valve repair or replacement.
Your healthcare team can help create an individualized treatment plan for your specific circumstances and provide treatment and support for symptom management.