Part B
Heart valve problems: narrowing, leaking and what can be done
A heart valve can fail to open fully or fail to close tightly. This page explains the two patterns, what causes them, how they are found and how they are managed.
Overview
Every heartbeat depends on four small valves opening and closing at the right moment. When one stops doing its job properly, the heart has to work harder, sometimes for years before anyone notices. This page covers the two main kinds of valve problem, common causes, symptoms, how doctors find them and the usual range of treatment.
The four valves and what they do
The NHLBI, part of the US National Institutes of Health, describes heart valve disease as problems affecting one or more of the heart's four valves, which open and close with each heartbeat to keep blood flowing in the correct direction. The NHS names them as the aortic and mitral valves on the left side and the tricuspid and pulmonary valves on the right, and says the left-sided aortic and mitral valves are the ones most often involved. For the wider picture of chambers and blood flow, see how the heart works.
Stenosis and regurgitation
Two patterns account for most valve trouble. In stenosis the valve is too narrow or does not open fully, so blood has trouble getting through. In regurgitation the valve does not close fully and leaks, so some blood flows backward. The NHLBI also mentions atresia, where a valve lacks a proper opening.
Either way, the NHS explains, the heart has to work harder to pump blood.
Common causes
Causes vary from person to person. The NHLBI lists several:
- Problems present from birth (congenital), such as a bicuspid aortic valve, which can be inherited.
- Age, especially when lifestyle factors such as smoking also raise risk.
- Rheumatic fever, which the NHLBI says can damage the heart valves.
- Infection of the heart's lining or valves (endocarditis).
The NHS adds damage from a heart attack, cardiomyopathy, high blood pressure and high cholesterol to its list of causes and risk factors. Valve damage after rheumatic fever is a major topic by itself, covered in rheumatic heart disease, and it starts with a bacterial throat infection described in sore throats and rheumatic fever.
Symptoms
Some people have no symptoms at all, and others develop them gradually. The NHS lists:
- breathlessness
- tiredness or weakness
- dizziness
- palpitations (a pounding, fluttering or uneven heartbeat)
- swollen ankles or feet
- chest pain or discomfort
The NHLBI notes that extreme tiredness is often the first sign and that fainting can occur. Because a valve problem can be silent, it is sometimes found only when a doctor hears a heart murmur during an unrelated check. These symptoms overlap with other conditions, including those on our page about heart failure, which can develop when a valve problem strains the heart over time.
How valve problems are found
Diagnosis usually starts with a conversation and a stethoscope. The NHLBI says a doctor asks about symptoms and family history and listens for a heart murmur or irregular rhythm. A murmur is an extra or unusual sound made by blood moving through the heart.
The test that confirms the picture is an echocardiogram. The NHLBI calls it the most common test to diagnose a problem with the heart valves; it uses sound waves to show the heart's size, shape and pumping, and Doppler ultrasound shows blood flow through the valves. The NHS adds that an ECG and a chest X-ray may also be used, and a GP may refer the person to a cardiologist (a heart specialist).
Management in outline
Treatment depends on which valve is affected, how badly and whether there are symptoms. The NHLBI says most heart valve conditions are treatable.
For mild disease without symptoms, the NHS says treatment is often not needed and regular check-ups are enough; the NHLBI notes that some valve defects stay stable for life. Medicines can ease symptoms or slow progression, for example by lowering blood pressure, controlling the heart rate, reducing fluid build-up or lowering the risk of blood clots. Decisions about which medicine and how much belong with the treating clinician.
When disease is severe or symptoms worsen, a procedure may be considered. Repair can reshape or patch a valve; if that is not possible, the valve may be replaced with a biological (tissue) valve or a mechanical one. The NHLBI explains that mechanical valves last longer but need lifelong blood-thinning medicine, while tissue valves avoid that need but wear out sooner. Replacement can be through open-heart surgery or a catheter-based procedure.
When to see a clinician
The NHS advises seeing a GP for regular breathlessness, tiredness or dizziness during normal activities, repeated or prolonged palpitations, swollen ankles or feet, or chest pain that comes and goes. Struggling to breathe, or sudden chest pain that spreads to the arms, back, neck or jaw, needs emergency help. Emergency numbers differ by country, so use your local emergency number and do not drive yourself.
In short
A heart valve can be too narrow (stenosis) or leaky (regurgitation), and causes range from birth differences to age, rheumatic fever and infection. Symptoms may be absent, or may include breathlessness and tiredness. A stethoscope finds a murmur, an echocardiogram confirms the problem, and care runs from monitoring to medicines to repair or replacement.