Heart valve disease

In heart valve disease, one or more of the valves in the heart doesn't work as it should. There are four heart valves. They keep blood flowing through the heart in the correct direction.

There are different types of heart valve disease. Sometimes a valve isn't formed or it doesn't close all the way. Or a valve opening may get narrow. Heart valve disease can change how blood flows through the heart to the rest of the body.

Heart valve disease treatment depends on the heart valve affected and the type and severity of the disease. Sometimes surgery is needed to fix or replace the heart valve.

Some people with heart valve disease might not have symptoms for many years. When symptoms occur, they might include:

• Shortness of breath at rest or when active or lying down.
• Fatigue.
• Chest pain.
• Dizziness.
• Swelling of the ankles and feet.
• Fainting.
• Irregular heartbeat.

When to see a doctor

If you have symptoms of possible heart valve disease, make an appointment for a health checkup. You may be sent to a doctor trained in heart diseases, called a cardiologist.

To understand the causes of heart valve disease, it may help to know how the heart works.

Four valves in the heart keep blood flowing in the right direction. These valves are:

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

Each valve has flaps, called leaflets or cusps. The flaps open and close once during each heartbeat. If a valve flap doesn't open or close as it should, less blood moves out of the heart to the rest of the body.

There are different types of heart valve disease. They include:

• Stenosis. The valve flaps become thick or stiff. Sometimes the flaps can join together. These changes can make the valve opening narrow. Less blood can flow through the narrowed valve.
• Regurgitation. The valve flaps may not close tightly. So blood may leak backward.
• Prolapse. The valve flaps become stretched out and floppy. They bulge backward like a parachute. This condition can lead to regurgitation.
• Atresia. The valve isn't formed. A solid sheet of tissue blocks the blood flow between the heart chambers. This type usually affects the pulmonary valve.

Some people are born with heart valve disease. This is called congenital heart valve disease. But adults can get heart valve disease too. Causes of heart valve disease in adults may include infections, age-related changes and other heart conditions.

Several things can increase the risk of heart valve disease, including:

• Older age.
• Some infections, such as rheumatic fever or blood infections.
• A heart attack or some types of heart disease.
• High blood pressure, high cholesterol, diabetes and other heart disease risk factors.
• A heart condition that you're born with, called a congenital heart defect.

Complications of heart valve disease may include:

• Blood clots.
• Heart failure.
• Irregular heartbeats.
• Stroke.
• Death.

To diagnose heart valve disease, a healthcare professional examines you and asks questions about your symptoms and health history. The healthcare professional listens to your heart with a tool called a stethoscope. A whooshing sound called a heart murmur may be heard.

Blood and imaging tests may be done to check your heart health.

Tests

Tests to diagnose heart valve disease may include:

• Echocardiogram. This test uses sound waves to make pictures of the beating heart. It shows how blood flows through the heart and heart valves. There are different types of echocardiograms. The type you have depends on the reason for the test and your overall health.
• Electrocardiogram. Also called an ECG or EKG, this quick test shows how the heart is beating. Sticky patches with sensors on them go on the chest and sometimes the legs. Wires connect the sensors to a computer, which displays or prints results.
• Chest X-ray. A chest X-ray shows the heart and lungs. The test can show if the heart is larger than usual or if there is fluid around the lungs. Fluid could be due to some types of heart valve disease.
• Cardiac MRI. Magnetic fields and radio waves make detailed images of the heart. It can help determine the severity of heart valve disease.
• Exercise stress test. You usually walk on a treadmill or pedal a stationary bike while the heart is checked. An exercise stress test shows how the heart responds to physical activity. It can help your healthcare team learn whether valve disease symptoms happen during exercise. If you can't exercise, you might get medicines that affect the heart like exercise does.
• Cardiac catheterization. This test isn't often used to diagnose heart valve disease. But it may be done if other tests don't find changes with the heart valves. Or it might be used to tell how severe heart valve disease is. A healthcare professional places a thin flexible tube called a catheter in a blood vessel, usually in the groin or wrist. It's guided to the heart. Dye flows through the catheter into the arteries in the heart. The dye helps the arteries show up more clearly on X-ray images and video.

Heart valve disease stages

After testing confirms a diagnosis of heart valve disease, your healthcare team may tell you the stage of disease. Staging helps determine the most appropriate treatment.

The stage of heart valve disease depends on many things. These things include symptoms, disease severity, the structure of the valve or valves, and blood flow through the heart and lungs.

Heart valve disease is staged into four basic groups:

• Stage A: At risk. Risk factors for heart valve disease are present.
• Stage B: Progressive. Valve disease is mild or moderate. There are no heart valve symptoms.
• Stage C: Asymptomatic severe. There are no heart valve symptoms but the valve disease is severe.
• Stage D: Symptomatic severe. Heart valve disease is severe and is causing symptoms.

Heart valve disease treatment depends on:

• The symptoms.
• The type of heart valve disease.
• The stage of the disease.
• If the heart valve condition is getting worse.

Treatment may include:

• Regular health checkups.
• Lifestyle and diet changes.
• Medicines.
• Surgery to fix or replace the valve.

Medications

Some people with heart valve disease need medicines to treat their symptoms. Blood thinners may be given to prevent blood clots.

Surgery or other procedures

A diseased or damaged heart valve might eventually need to be repaired or replaced, even if you don't have symptoms.

If you need surgery for another heart condition, a surgeon might do valve repair or replacement at the same time.

Methods to repair or replace heart valves include:

• Open-heart surgery.
• Minimally invasive heart surgery.
• Robot-assisted heart valve surgery.

The type of heart valve surgery done depends on many things, including:

• Age.
• Overall health.
• Type of heart valve disease.
• Stage of heart valve disease.

Heart valve repair

If you have heart valve disease, your healthcare team might suggest surgery to fix the heart valve. Repair surgery saves your heart valve. During heart valve repair, the surgeon might:

• Patch holes in a valve.
• Separate valve flaps that are stuck together.
• Replace torn or ruptured cords that support the valve.
• Remove extra valve tissue so that the valve can close tightly.
• Make the outer size of the valve smaller so the flaps can better contact each other.

Heart valve repair procedures include:

• Annuloplasty. A surgeon tightens or reinforces the outer ring around the valve. This surgery may be done with other treatments to repair a heart valve.
• Valvuloplasty. This surgery is used to fix the valve flaps. It's often done to repair mitral valve prolapse. The surgeon inserts a flexible tube with a balloon on the tip into an artery in the arm or groin area. The surgeon guides the tube to the affected heart valve. The balloon is inflated. This makes the valve opening wider. The balloon is deflated. Then the tube and balloon are removed. Sometimes clips or plugs go through the tube. The surgeon uses them to repair the heart valve.

Heart valve replacement

If a heart valve can't be repaired, surgery may be done to replace it. The most commonly replaced valves are the mitral and aortic valves. A surgeon removes the damaged heart valve and replaces it with one of the following:

• A mechanical valve. This type of artificial heart valve is made of strong material. It also is called a manufactured valve. If you have a mechanical valve, you need blood thinners for life to prevent blood clots.
• A biological valve. This type of artificial heart valve is made from cow, pig or human heart tissue. Biological tissue valves break down over time and eventually need to be replaced.

Sometimes, the aortic valve is replaced with the person's own pulmonary valve. Then the pulmonary valve is replaced with a biological valve. This more complicated surgery is called the Ross procedure.

Valve replacement typically requires open-heart surgery. But less-invasive treatments may be available. It depends on which heart valve is affected. For example, if the aortic valve is narrowed, surgeons may do transcatheter aortic valve replacement (TAVR). It uses smaller incisions than those used in open-heart surgery.

If you have heart valve disease, your healthcare team may suggest making lifestyle changes. Try these steps:

• Eat healthy. Choose a variety of fruits and vegetables, low-fat or fat-free dairy products, poultry, fish, and whole grains. Avoid saturated and trans fats and excess salt and sugar.
• Get regular exercise. Try to get at least 30 minutes of moderate physical activity every day. Talk to your healthcare team before you start a new exercise routine.
• Keep a healthy weight. Being overweight raises the risk of heart disease. Talk with your care team to set realistic goals for weight.
• Don't smoke or use tobacco. If you smoke or chew tobacco, quit. Smoking is a major risk factor for heart disease. Quitting is the best way to reduce the risk. If you need help quitting, talk with a healthcare professional.
• Practice good sleep habits. Poor sleep may increase the risk of heart disease. Adults should try to get 7 to 9 hours of sleep daily. Go to bed and wake at the same time every day, including on weekends. If you have trouble sleeping, talk to your healthcare team about things that might help.
• Manage blood pressure. Uncontrolled high blood pressure increases the risk of serious health concerns. Get your blood pressure checked at least every two years if you're 18 and older. If you have risk factors for heart disease or are over age 40, you may need more-frequent checks.
• Get a cholesterol test. Get your first cholesterol test when you're in your 20s and then at least every 4 to 6 years. Some people may need to start testing earlier or have more-frequent checks.
• Manage diabetes. If you have diabetes, managing your blood sugar can help keep your heart healthy.

Pregnancy

Careful and regular checkups are needed for those who have heart valve disease during pregnancy. If you have a severe heart valve condition, you might be told not to get pregnant to reduce the risk of complications.

If you have heart valve disease, here are some ways to manage your condition and thrive:

• Get support. Connect with friends and family or join a support group. You may find that talking about your concerns with others in similar situations can help.
• Manage stress. Find ways to help reduce emotional stress. Some ideas are to get more exercise, practice mindfulness, and connect with others in support groups. If you have anxiety or depression, talk with your healthcare team about strategies to help.

If you think you might have symptoms of heart valve disease, make an appointment for a health checkup. Here's some information to help you prepare for your appointment.

What you can do

• Ask if there is anything you need to do before your checkup. For example, you may be told not to eat or drink for a short period before a cholesterol test.
• Write down your symptoms. Include any that seem unrelated to heart valve disease.
• Write down important personal information. Include a family history of heart valve disease. Also include any major stresses or recent life changes.
• Make a list of all medicines, vitamins and supplements you take. Include dosages.
• Take someone with you, if possible. Someone who goes with you can help you remember information you're given.
• Write down questions to ask your healthcare team.

For heart valve disease, some basic questions to ask your care team include:

• What is the likely cause of my symptoms or condition?
• What are other possible causes?
• What tests do I need?
• What's the best treatment?
• I have other health conditions. How can I best manage them together?
• How do I need to change my diet or activities?
• Should I see a specialist?
• If I need heart valve surgery, which surgeon do you recommend?
• Is there any information that I can take with me? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your healthcare team is likely to ask you many questions, including:

• When did your symptoms start?
• Do you always have symptoms or do they come and go?
• On a scale of 1 to 10, with 10 being the worst, how bad are your symptoms?
• What, if anything, makes your symptoms better?
• What, if anything, makes your symptoms worse?