Heart & Stroke Conditions Explained

Definition

Heart Valve Disease

In your heart, there are 4 valves (right and left) separating the top and bottom chambers from each other, and the bottom chambers from the main blood vessels leaving the heart. The valve consists of a set of flaps (also called leaflets or cusps). These flaps open and close fully so that blood can exit a chamber of the heart and not return.

The 2 most common heart valves that develop problems are the aortic valve (between the left lower chamber and the aorta) and the mitral valve (between the left upper and lower chambers).

Symptoms

Heart Valve Disease

Some people with heart valve disease will experience no symptoms for many years.

Some common symptoms people do experience include:

  • shortness of breath particularly after physical activity or when you lie down
  • swelling of the ankles and feet
  • fatigue
  • dizziness or fainting
  • irregular heart beat

Causes

Heart Valve Disease

Sometimes one or more of the heart valves doesn't work properly because it may be damaged.

The damage may lead to two main problems:

a) the valve becomes narrowed called “stenosis”. This can be due to thickening and scarring from just simple wear and tear, known as degenerative valve disease. Other causes include rheumatic fever and infections of the valve.

b) the valve becomes leaky so that blood flows back across the valve. This is called “incompetence” or “regurgitation”. This also can be a result of wear and tear, rheumatic fever or infection, or following a heart attack.

Occasionally people are born with abnormal valves (congenital defects) which are more likely to either become narrowed or leak.

Diagnosis

Heart Valve Disease

When heart valves shut (like a door) they produce a sound which is heard by the doctor as "Lub Dub".

However, if the valves are narrowed or are leaking, an additional sound is heard called a murmur.

This sound is produced by blood being forced across a narrowed valve or by blood leaking back through a gap in the valve as it tries to close.

Murmurs which occur when the heart contracts (squeezes) are called systolic murmurs and those that occur when the heart relaxes are called diastolic murmurs.

The murmur may also occur if blood moves rapidly through normal valves.

This is normal in childhood or in patients with fast heart rates which occur in pregnancy, fever, hyperthyroid states or anaemia.

If you are seeing your doctor because you have noticed some symptoms or your doctor has heard a murmur when examining you, certain heart tests may be arranged to check your valves and your heart function.

These include:  

  • ECHO (echocardiogram)
  • Ecg
  • Chest Xray
  • Exercise stress test
  • Angiography

Treatment

Heart Valve Disease

Sometimes, the murmur is innocent which means it does not signify any major heart problem.

Many people with valve disorders do not require any specific treatment. This is not to say that no treatment will ever be required.

Your doctor will be making clinical judgements as to what is the best time, if any, to fix the problem. People with congenital heart valve defects may need medical treatment with drugs.

Treatment options depend on which valve is affected, what symptoms you are experiencing and how severe the condition of your valve is.

Treatment options include:

• medicines

• valve surgery to repair the valve

• valve surgery to replace the valve

• less invasive procedures using catheters to replace or repair the valve (eg TAVI)

• combination of medicines and either a surgical or catheter procedure

Resources

Heart Valve Disease

Read our resources for further information:

Read our booklet on Step by step through Cardiac Catheterisation and angioplasty

Symptoms