Valvular heart disease is characterized by damage to or a defect in one of the four heart valves: the mitral, aortic, tricuspid or pulmonary.
The mitral and tricuspid valves control the flow of blood between the atria and the ventricles (the upper and lower chambers of the heart).
The pulmonary valve controls the flow of blood from the heart to the lungs, and the aortic valve governs blood flow between the heart and the aorta, and thereby the blood vessels to the rest of the body. The mitral and aortic valves are the ones most frequently affected by valvular heart disease.
Normally functioning valves ensure that blood flows with proper force in the proper direction at the proper time. In valvular heart disease, the valves become too narrow and hardened (stenotic) to open fully, or are unable to close completely (incompetent).
A stenotic valve forces blood to back up in the adjacent heart chamber, while an incompetent valve allows blood to leak back into the chamber it previously exited. To compensate for poor pumping action, the heart muscle enlarges and thickens, thereby losing elasticity and efficiency.
In addition, in some cases, blood pooling in the chambers of the heart has a greater tendency to clot, increasing the risk of stroke or pulmonary embolism.
The severity of valvular heart disease varies. In mild cases there may be no symptoms, while in advanced cases, valvular heart disease may lead to congestive heart failure and other complications. Treatment depends upon the extent of the disease.
When to Call an Ambulance
Call an ambulance if you experience severe chest pain.
When to Call Your Doctor
Call your physician if you develop persistent shortness of breath, palpitations or dizziness.
Valve disease symptoms can occur suddenly, depending upon how quickly the disease develops. If it advances slowly, then your heart may adjust and you may not notice the onset of any symptoms easily.
Additionally, the severity of the symptoms does not necessarily correlate to the severity of the valve disease. That is, you could have no symptoms at all, but have severe valve disease. Conversely, severe symptoms could arise from even a small valve leak.
Many of the symptoms are similar to those associated with congestive heart failure, such as shortness of breath and wheezing after limited physical exertion and swelling of the feet, ankles, hands or abdomen (edema). Other symptoms include:
- Palpitations, chest pain (may be mild).
- Dizziness or fainting (with aortic stenosis).
- Fever (with bacterial endocarditis).
- Rapid weight gain.
There are many different types of valve disease; some types can be present at birth (congenital), while others may be acquired later in life.
- Heart valve tissue may degenerate with age.
- Rheumatic fever may cause valvular heart disease.
- Bacterial endocarditis, an infection of the inner lining of the heart muscle and heart valves (endocardium), is a cause of valvular heart disease.
- High blood pressure and atherosclerosis may damage the aortic valve.
- A heart attack may damage the muscles that control the heart valves.
- Other disorders such as carcinoid tumors, rheumatoid arthritis, systemic lupus erythematosus, or syphilis may damage one or more heart valves.
- Methysergide, a medication used to treat migraine headaches, and some diet drugs may promote valvular heart disease.
- Radiation therapy (used to treat cancer) may be associated with valvular heart disease.
Get prompt treatment for a sore throat that lasts longer than 48 hours, especially if accompanied by a fever. Timely administration of antibiotics may prevent the development of rheumatic fever which can cause valvular heart disease.
A heart-healthy lifestyle is also advised to reduce the risks of high blood pressure, atherosclerosis and heart attack.
- Don’t smoke.
- Consume no more than two alcoholic beverages a day.
- Eat a healthy, balanced diet low in salt and fat, exercise regularly and lose weight if you are overweight.
- Adhere to a prescribed treatment program for other forms of heart disease.
- If you are diabetic, maintain careful control of your blood sugar.
During your examination, the doctor listens for distinctive heart sounds, known as heart murmurs, which indicate valvular heart disease. As part of your diagnosis, you may undergo one or more of the following tests:
- An electrocardiogram, also called an ECG or EKG, to measure the electrical activity of the heart, regularity of heartbeats, thickening of heart muscle (hypertrophy) and heart-muscle damage from coronary artery disease.
- Stress testing, also known as treadmill tests, to measure blood pressure, heart rate, ECG changes and breathing rates during exercise. During this test, the heart’s electrical activity is monitored through small metal sensors applied to your skin while you exercise on a treadmill.
- Chest X-rays.
- Echocardiogram to evaluate heart function. During this test, sound waves bounced off the heart are recorded and translated into images. The pictures can reveal abnormal heart size, shape and movement. Echocardiography also can be used to calculate the ejection fraction, or volume of blood pumped out to the body when the heart contracts.
- Cardiac catheterization, which is the threading of a catheter into the heart chambers to measure pressure irregularities across the valves (to detect stenosis) or to observe backflow of an injected dye on an X-ray (to detect incompetence).
The following provides an overview of the treatment options for valvular heart disease:
- Don’t smoke; follow prevention tips for a heart-healthy lifestyle. Avoid excessive alcohol consumption, excessive salt intake and diet pills—all of which may raise blood pressure.
- Your doctor may adopt a “watch and wait” policy for mild or asymptomatic cases.
- A course of antibiotics is prescribed prior to surgery or dental work for those with valvular heart disease, to prevent bacterial endocarditis.
- Long-term antibiotic therapy is recommended to prevent a recurrence of streptococcal infection in those who have had rheumatic fever.
- Antithrombotic (clot-preventing) medications such as aspirin or ticlopidine may be prescribed for those with valvular heart disease who have experienced unexplained transient ischemic attacks, also known as TIAs (see this disorder for more information).
- More potent anticoagulants, such as warfarin, may be prescribed for those who have atrial fibrillation (a common complication of mitral valve disease) or who continue to experience TIAs despite initial treatment. Long-term administration of anticoagulants may be necessary following valve replacement surgery, because prosthetic valves are associated with a higher risk of blood clots.
- Balloon dilatation (a surgical technique involving insertion into a blood vessel of a small balloon that is led via catheter to the narrowed site and then inflated) may be done to widen a stenotic valve.
- Valve Surgery to repair or replace a damaged valve may be necessary. Replacement valves may be artificial (prosthetic valves) or made from animal tissue (bioprosthetic valves). The type of replacement valve selected depends on the patient’s age, condition, and the specific valve affected.
How Is Heart Valve Disease Treated?
Currently, no medicines can cure heart valve disease. However, lifestyle changes and medicines often can successfully treat symptoms and delay problems for many years. Eventually, though, you may need surgery to repair or replace a faulty heart valve.
The goals of treating heart valve disease might include:
- Preventing, treating, or relieving the symptoms of other related heart conditions.
- Protecting heart valves from further damage.
- Repairing or replacing faulty valves when they cause severe symptoms or become life threatening. Replacement valves can be man-made or biological.
- Preventing, Treating, or Relieving the Symptoms of Other Related Heart Conditions
To relieve the symptoms of heart conditions related to heart valve disease, your doctor may advise you to quit smoking and follow a healthy diet.
A healthy diet includes a variety of vegetables and fruits. It also includes whole grains, fat-free or low-fat dairy products, and protein foods, such as lean meats, poultry without skin, seafood, processed soy products, nuts, seeds, beans, and peas.
A healthy diet is low in sodium (salt), added sugars, solid fats, and refined grains. Solid fats are saturated fat and trans fatty acids. Refined grains come from processing whole grains, which results in a loss of nutrients (such as dietary fiber).
For more information about following a healthy diet, go to the National Heart, Lung, and Blood Institute’s “Your Guide to Lowering Your Blood Pressure With DASH” and the U.S. Department of Agriculture’s ChooseMyPlate.gov Web site. Both resources provide general information about healthy eating.
Your doctor may ask you to limit physical activities that make you short of breath and tired. He or she also may ask that you limit competitive athletic activity, even if the activity doesn’t leave you unusually short of breath or tired.
Your doctor may prescribe medicines to:
- Treat heart failure. Heart failure medicines widen blood vessels and rid the body of excess fluid.
- Lower high blood pressure or high blood cholesterol.
- Treat coronary heart disease (CHD). CHD medicines can reduce your heart’s workload and relieve symptoms.
- Prevent arrhythmias (irregular heartbeats).
- Thin the blood and prevent clots (if you have a man-made replacement valve). These medicines also are prescribed for mitral stenosis or other valve defects that raise the risk of blood clots.
- Protecting Heart Valves From Further Damage
If you’ve had previous heart valve disease and now have a man-made valve, you may be at risk for a heart infection called infective endocarditis (IE). This infection can worsen your heart valve disease.
One of the most common causes of IE is poor dental hygiene. To prevent this serious infection, floss and brush your teeth and regularly see a dentist. Gum infections and tooth decay can increase the risk of IE.
Let your doctors and dentists know if you have a man-made valve or if you’ve had IE before. They may give you antibiotics before dental procedures (such as dental cleanings) that could allow bacteria to enter your bloodstream. Talk to your doctor about whether you need to take antibiotics before such procedures.
Repairing or Replacing Heart Valves
Your doctor may recommend repairing or replacing your heart valve(s), even if your heart valve disease isn’t causing symptoms. Repairing or replacing a valve can prevent lasting damage to your heart and sudden death.
Having heart valve repair or replacement depends on many factors, including:
- The severity of your valve disease.
- Your age and general health.
Whether you need heart surgery for other conditions, such as bypass surgery to treat CHD. Bypass surgery and valve surgery can be done at the same time.
When possible, heart valve repair is preferred over heart valve replacement. Valve repair preserves the strength and function of the heart muscle. People who have valve repair also have a lower risk of IE after the surgery, and they don’t need to take blood-thinning medicines for the rest of their lives.
However, heart valve repair surgery is harder to do than valve replacement. Also, not all valves can be repaired. Mitral valves often can be repaired. Aortic and pulmonary valves often have to be replaced.
How Can Heart Valve Disease Be Prevented?
To prevent heart valve disease caused by rheumatic fever, see your doctor if you have signs of a strep infection. These signs include a painful sore throat, fever, and white spots on your tonsils.
If you do have a strep infection, be sure to take all medicines prescribed to treat it. Prompt treatment of strep infections can prevent rheumatic fever, which damages the heart valves.
It’s possible that exercise, a healthy diet, and medicines that lower cholesterol might prevent aortic stenosis (thickening and stiffening of the aortic valve). Researchers continue to study this possibility.
A healthy diet, physical activity, other lifestyle changes, and medicines aimed at preventing a heart attack, high blood pressure, or heart failure also may help prevent heart valve disease.
If you’ve had previous heart valve disease and now have a man-made valve, you’re at risk for a heart infection called infective endocarditis (IE).
One of the most common causes of IE is poor dental hygiene. Thus, to prevent this serious infection, floss and brush your teeth and regularly see a dentist. Gum infections and tooth decay can increase the risk of IE.
Let your doctors and dentists know if you have a man-made valve or if you’ve had IE before. They may give you antibiotics before dental procedures (such as dental cleanings) that could allow bacteria to enter your bloodstream.
Talk to your doctor about whether you need to take antibiotics before such procedures.