Heart Valve Disease

Heart valve disease is a condition where the valves in your heart do not work correctly. When the valves cannot open or close properly, blood flow in the heart is disrupted leading to  breathlessness, fainting, and irregular heartbeats. If left untreated, heart valve disease can worsen and lead to heart failure or death. This article goes into detail some causes, symptoms, and examples of different valve diseases.

What is heart valve disease?

Heart valve disease, also referred to as valvular heart disease, is where one or more of your heart valves do not work correctly. The heart has four valves that are important for blood flowing in and out of the heart in the right direction. Valvular heart disease affects approximately 41 million people worldwide and is increasing due to better diagnostic machinery and increased life expectancy.¹ 

How does the heart work?

The heart is divided into two sides: the right and left. 

The right is responsible for taking in oxygen-poor blood from the body and pumping it into the lungs. The left is responsible for taking in oxygen-rich blood from the lungs and pumping it through the body. This process happens each time your heart beats.

The heart has four valves that divide the different sections of the heart and serve very important functions to properly pump blood into and throughout the body. The valves in the heart  ensure that the proper amount of blood comes in and that it doesn’t flow in the wrong direction. Each valve has ‘leaflets’ or flaps that open and close depending on the pressure within the heart. All the valves have three flaps, except for the mitral valve which only has two. When the valves are damaged or not properly formed, it causes the heart to work harder, weakening it, ultimately leading to heart failure or death.

The four valves and their role in blood circulation are described below.

Tricuspid valve 

Located between the right atrium (top right) and right ventricle (bottom right). 

Oxygen-poor blood enters the right atrium and flows into the right ventricle through the tricuspid valve.

Pulmonary valve 

Located between the right ventricle and the lungs. 

From the right ventricle, when pressure builds, the pulmonary valve opens to allow blood to the lungs to pick up oxygen.

Mitral valve 

Located between the left atrium (top left) and left ventricle (bottom left). 

From the lungs, the now oxygen-rich blood fills the left atrium before passing the mitral valve into the left ventricle.

Aortic valve 

Located between the left ventricle and the aorta. 

The left ventricle fills with this oxygen-rich blood and when pressure builds, the aortic valve opens and pushes blood throughout the body to distribute the blood before coming back to the heart to repeat the cycle.

Symptoms 

Oftentimes, mild cases of valve heart disease do not present with symptoms, only developing later when the valve worsens. 

Some symptoms that you may experience include:

• Shortness of breath
• Chest pain
• Fatigue
• Dizziness or fainting
• Fever
• Irregular heartbeat or extra beats (arrhythmias)

Causes

Heart valve disease can be something that you’re born with, referred to as congenital, or can develop during your life due to a number of different factors.

Some causes are:

• Being born with one or more abnormal valves
• Rheumatic fever 
• Cardiomyopathy
• Previous damage to the heart, such as a heart attack
• Old age
• Previous infections, such as infective endocarditis
• High blood pressure

Rheumatic heart disease

The most common cause of valvular heart disease is rheumatic heart disease. This is a reaction to rheumatic fever from an infection called Streptococcus Pyogenes. This fever causes an immune response of the heart, joints, brain, and skin and most commonly affects the mitral and aortic valves, predisposing them to regurgitation in children and young adults. 

In 2019, it was estimated that rheumatic heart disease affected 40.5 million people worldwide and accounted for an estimated 306,000 deaths with the average age being 28 years old.¹

Types of heart valve disease

Aortic valve disease is the most fatal, accounting for 61% of all valvular heart disease deaths, while mitral valve disease is second, accounting for 15% of valve deaths.¹  Mitral regurgitation is the most common valve defect, followed by aortic stenosis and aortic regurgitation.

The type of heart valve disease you have depends on two factors: 

• Which valve is affected
• How it is affected

There are two main types of problems that can be wrong with your heart valve:

Regurgitation is the leakage of the valves. This indicates that the valve(s) do not close completely and causes blood to flow backwards in the wrong direction through the valve. The reduced blood flow can lead to too much blood volume in one chamber of the heart.

Stenosis is the narrowing of the valve. This limits the amount of blood that can flow into the next chamber and causes increased pressure to push the blood through. 

Other structural problems that could develop into one of the above issues include:

Valve prolapse is when the valve flaps are “floppy” and bulge into the chambers during the heartbeat. While usually harmless on its own, it can eventually develop into regurgitation.

Atresia is a congenital heart defect. It could be that the flaps are missing or are not properly formed.  Bicuspid aortic valve disease is the most common congenital defect occurring in 1-2% of the general population.¹ It is where you are only born with two flaps on the aortic valve instead of the usual three.

Some of the valve diseases are listed below.

Mitral regurgitation

Mitral regurgitation is the most common heart valve disease, affecting approximately 24.2 million people worldwide. It is largely associated with older adults with no prevalence between the sexes. 

Mitral valve prolapse

Mitral valve prolapse often is diagnosed before mitral regurgitation, affecting approximately 3-5% of the general population. This makes an individual more susceptible to heart issues such as mitral regurgitation, irregular heartbeats, endocarditis, and stroke.¹

This is often congenital and is associated with tissue disorders such as Marfan syndrome. It can be made worse with other factors that increase blood flow or pressure.

Aortic valve stenotic disease

Aortic valve stenotic disease is the thickening and narrowing of the aortic valve. It can occasionally be caused by an infection that leads to scar tissue forming, which thickens and stiffens the tissue. It affects approximately 9 million people worldwide, with an increasing number in aging  populations and people with atherosclerosis, the narrowing of the blood vessels.

Without treatment, the outcome of someone with aortic valve disease is poor. A review reported that if proper intervention is not available, the 5-year mortality rate increased to 94%.¹

Aortic regurgitation

Aortic regurgitation is the fourth most common valvular disease. A review reported that aortic regurgitation was detected in 1.6% of UK elders older than 65 years of age.¹

In chronic aortic regurgitation, there is a long period of time where you experience no symptoms followed by slow, progressive development of difficulty breathing or tightness of chest.

Tricuspid regurgitation

Tricuspid regurgitation is one of the less common valvular diseases, however, it is associated with a significant increase in death. It has become more common due to machine implants in the heart such as a cardiac pacemaker. 

Diagnostic of heart valve disease

Your doctor may suspect you have a heart valve disease if your heartbeat sounds abnormal, also known as a heart murmur. From the sound and rhythm of your heart, they may be able to tell the issue with your valve, whether it be regurgitation or stenosis. 

Following this, they may send you for more testing to determine the type and severity of the valve damage. They may recommend any of the following tests:

• Electrocardiogram (ECG). This is the most common test done to diagnose valve disease. An electrocardiogram is able to measure the rhythm and electrical activity of the heart
• Echocardiogram: An echocardiogram uses sound waves to produce an image of the shape and structure of your heart
• Chest-x ray : A chest x-ray uses x-ray waves to show the shape and size of the heart
• Cardiac magnetic resonance imaging (cMRI): An MRI uses magnetic fields and radio waves to determine the shape and structure of your heart in real-time

Risk factors

There are a number of risk factors that could increase your chances of developing a heart valve disease. Some examples include:

• Consuming tobacco products
• Consuming large quantities of alcohol
• Stress
• Unhealthy diets
• Chemotherapy or radiation therapy to the chest

Tobacco, alcohol, and stress are all reported to cause increased blood pressure and puts more work on the heart, eventually weakening the muscle. Unhealthy diets are linked to atherosclerosis, the narrowing of your arteries, and high-salt foods can raise blood pressure.

How is heart valve disease treated?

Depending on the severity of your heart valve disease, your doctor may recommend different routes of treatment. 

There is no medication to cure heart valve disease. The medication that you may be prescribed is to treat or relieve symptoms that you have, such as:

• Beta blockers to control heart rate
• Angiotensin-converting  enzyme (ACE) inhibitors to reduce blood pressure

In more severe cases, your cardiologist may recommend surgical intervention to either repair or replace the valve that is damaged. Surgeons will often use a transcatheter intervention approach where they use a very small thin tube to repair or replace the valve. This is a much less invasive procedure compared to open-heart surgery.

Without proper treatment, heart valve disease can worsen and cause:

• Heart failure
• Stroke
• Blood clots
• Death

If you are diagnosed with progressive valve disease, you should follow up with your cardiologist at least once a year to check the progression and adjust medication as needed.

Prevention

While not all cases of heart valve disease can be prevented, your doctor may recommend certain lifestyle choices if you are at risk. These could include:

• Limiting alcohol intake
• Avoiding tobacco products
• Limiting caffeine consumption
• Reducing stress
• Exercising
• Eating or avoiding certain foods

Your doctor may recommend that your diet includes fruits, vegetables, nuts, and fish as well as reducing intake of processed meats, fast food, or food containing lots of sugar to lower chances of high cholesterol and have an overall healthy heart.

When to seek medical attention?

You should consult your doctor if you experience any of the symptoms listed previously.

If you have a sudden onset of intense chest pain, you should seek immediate medical attention or call the NHS 111 phone line.

Summary

Heart valve disease affects millions of people worldwide and numbers are increasing.  Heart valves are important for the proper function of the heart and when one or more leaks or narrows, it can lead to heart failure or death. Symptoms may include breathlessness, fainting, and chest pain. Cases are often seen in aging populations and in areas where rheumatic heart disease is prevalent. The most common types of heart valve disease are mitral regurgitation and aortic stenosis. Based on the sound and rhythm of your heart, your doctor may be able to identify the valve disease and be sent for further tests, such as an ECG, to confirm a diagnosis. Treatments include treating the symptoms with medication, or in severe settings, surgery to repair or replace the valve. Your doctor may recommend lifestyle changes to maintain a healthy heart to prevent your condition from worsening.