Overview
Heart valve disease occurs when one or more of the four heart valves do not work properly. A valve may be too narrow (stenosis, limiting blood flow) or may leak (regurgitation, allowing blood to flow backwards). Mild valve disease may cause no symptoms for many years; severe disease can cause heart failure.
How common is it?
Heart valve disease affects about 1 in 40 adults over 65 in the UK. Aortic stenosis and mitral regurgitation are the most common types in older adults.
Causes and risk factors
Valve disease can be present from birth (congenital) or develop over a lifetime from degenerative changes, rheumatic fever, infection, or other heart disease.
Common risk factors
- Age-related degenerative calcification (most common cause of aortic stenosis)
- Rheumatic fever in childhood (mitral stenosis)
- Infective endocarditis
- Mitral valve prolapse
- Previous heart attack affecting supporting structures
- Connective tissue disorders (Marfan syndrome)
- Congenital bicuspid aortic valve
Symptoms
- Many are asymptomatic until advanced disease
- Breathlessness on exertion or at rest
- Fatigue
- Palpitations
- Dizziness or fainting (particularly with aortic stenosis)
- Swollen ankles and legs
- Chest pain with exertion
When to see a doctor
See a doctor if you develop breathlessness, dizziness, chest pain, or palpitations and you are known to have heart valve disease. New heart murmurs detected by a doctor should be investigated.
Diagnosis
Echocardiogram (heart ultrasound) is the primary diagnostic test, measuring valve area, gradient, and degree of regurgitation. Cardiac MRI and catheterisation provide additional information before surgery.
Treatments
Surgical valve repair or replacement
Open-heart surgery to repair or replace a valve remains the gold standard for many types of valve disease. Tissue or mechanical valve replacements are used depending on age and circumstances.
TAVI (Transcatheter Aortic Valve Implantation)
Minimally invasive replacement of the aortic valve via catheter through the groin. Now the preferred option for older patients with aortic stenosis who are high surgical risk.
Medical management
Diuretics, beta-blockers, and ACE inhibitors manage symptoms but do not reverse valve disease. Anticoagulation is needed for mechanical valves and for AF complicating valve disease.
Self-care and lifestyle
- Attend regular follow-up appointments as valve disease may progress silently
- Maintain good dental hygiene and report dental procedures to your cardiologist (infective endocarditis prophylaxis may be needed)
- Inform your doctor before any surgical procedure
- Remain active within your symptoms and follow cardiac rehabilitation advice
Prevention
Preventing rheumatic fever with prompt antibiotic treatment of streptococcal throat infections prevents the most common worldwide cause of valve disease. Treating high blood pressure reduces risk of degenerative valve changes.