Heart valve disease

Heart valve disease affects one or more of the four valves that keep blood flowing through your heart in the same direction. Your heart is divided into four chambers and they are connected by valves. When your heart beats, the valves open one way to let blood flow into the next chamber. They then close to prevent the blood from flowing back again.

• If a valve doesn’t open properly, then not enough blood can get through – this is called narrowing or stenosis
• If a valve doesn’t close properly, because it is floppy or stiffened, then blood will leak backwards – this is called regurgitation, or a leaky heart valve

In both cases, your heart has to work harder to pump the same amount of blood.

Heart valve problems aren't always serious and can often be managed with regular check-ups and maybe medication. However, it sometimes causes more serious heart problems, such as atrial fibrillation or even heart failure, and might need surgery.

Depending on which valve is affected, usual symptoms of heart valve disease are:

• Breathlessness
• Feeling tired
• Swollen feet and ankles
• Feeling dizzy

You may also notice:

• An abnormal heart beat or palpitations
• Chest pain

Sudden pain in your chest can be a symptom of a life-threatening condition such as a heart attack. If you notice any of the following symptoms, call 999 immediately:

• Chest pain that spreads to your arms, back, neck or jaw
• Chest pain that lasts more than 15 minutes
• Your chest feels heavy or tight
• Shortness of breath
• Sweating
• Nausea and/or vomiting

It’s vital that the cause of your chest pain is diagnosed and treated as soon as possible.

Sometimes you won’t notice any symptoms at all and a heart valve problem is only picked up during another examination or because your doctor can hear it when they listen to your heart.

Your doctor may be able to detect heart valve disease by listening to your heart. However, they will usually need to refer you for tests, which could include:

• An echocardiogram – a scan to look at the structures of your heart
• Blood tests – to check for signs of heart problems
• Cardiac CT or MRI scan – to provide a detailed view of your heart
• Chest X-ray – to look for lung conditions
• Electrocardiogram (ECG) – to measure your heart’s rhythm and electrical activity

You will usually be referred to a cardiologist, a doctor specialising in the heart and circulation.

Heart valve disease is more common in older people, but can affect younger people too.

Causes include:

• Ageing - due to thickening, a build-up of calcium deposits, or wear and tear
• Previous infections with bacterial endocarditis or rheumatic fever, which can damage the mitral valve
• Congenital heart conditions
• Coronary heart disease or heart attack
• Certain conditions such as kidney disease

The four main heart valves are called the:

• Mitral valve
• Aortic valve
• Tricuspid valve
• Pulmonary valve

The treatment will depend on which valve is affected, the cause and how serious it is.

Sometimes your doctor will decide that treatment isn’t necessary but will ask you to come back for regular check-ups.

Although medicines can’t repair damaged valves, they can control symptoms and reduce the risk of complications. Common treatments are:

• Diuretics to reduce fluid retention
• Beta blockers to control an irregular heartbeat
• Antiarrhythmics to control atrial fibrillation
• Anticoagulants to reduce clotting and stroke risk

In some cases your doctor may recommend surgery. Surgical options include:

• Mitral valve repair
• Mitral valve replacement
• Balloon valvuloplasty
• Aortic valve replacement
• Transcatheter aortic valve implantation (TAVI)

Depending on your overall health, these surgeries can allow you to resume many everyday activities and enjoy an improved quality of life.