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Heart valve disease | Mate manawa takirere

Key points about heart valve disease

There are 2 main types of heart valve problems with a variety of causes and treatments.
One is valvular stenosis (narrowing of the valve opening which limits the flow of blood).
The other is valvular insufficiency (also called regurgitation or incompetence) when the valve is leaky and back-flow of blood occurs.
Most valve problems can be treated using medicines or by surgery.
Your treatment will depend on the cause of your problem and the effect it's having on your heart.

Breathless woman sitting with hand on chest

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Your heart has a left and a right side and each side has an upper and a lower chamber (an atrium and a ventricle). There are 4 valves in the heart, 1 between each atrium and ventricle and 1 at the exit of each ventricle. The valves make sure that blood flows in 1 direction through the heart like a one-way traffic system. They open and close at particular times during the normal beat of the heart. They open to let the blood through at the right time and then close to stop the blood flowing backwards.

The image below shows the 4 chambers of the heart and the location of the 4 valves.

Image credit: Bruce Blausen Wikimedia Commons

Video: British Heart Foundation - How does a healthy heart work?

This video shows how the blood flows through the heart. It may take a few moments to load.

(British Heart Foundation, UK, 2014)

If your heart valves become diseased or damaged, they may not fully open or close. This can disrupt the flow of blood through your heart either by:

narrowing the space the blood can flow through – this is known as valvular stenosis, or
allowing the blood to leak back into the chamber it’s come from – this is called valvular regurgitation or insufficiency.

You may have one or both of these valve problems.

The main causes of heart valve disease are:

being born with an abnormal valve or valves (congenital heart disease)
having had rheumatic fever (rheumatic heart disease) after a bout of strep throat
cardiomyopathy (disease of the heart muscle making it become enlarged, thick or rigid)
damage to the heart from heart disease or an infection known as endocarditis
getting older.

You may not have any symptoms, or may have several, depending on how badly the valve is working.

Common signs and symptoms include:

a heart murmur (whooshing sound when somebody listens to your heart with a stethoscope)
shortness of breath or feeling breathless
swollen ankles and feet and sometimes tummy (abdomen)
palpitations (a fluttering or pounding feeling in your chest)
chest pain
feeling light-headed, weak or dizzy
unusual tiredness.

If you’re having any of these symptoms talk to your healthcare provider.

Your healthcare provider will start by talking to you about your symptoms and listening to your chest with a stethoscope. If they think you have problems with a heart valve, there are tests they can arrange for you to see how your heart is working.

These include:

electrocardiogram (ECG) which maps the electrical activity of the heart
echocardiogram (echo) or ultrasound of the heart
chest X-ray
coronary angiography (cardiac catheterisation) which looks at blood flow to the heart.

Your treatment will depend on:

which valve is affected
how many valves are affected
how badly it’s affected
The condition of your heart muscle
your symptoms and overall health.

You may not need any treatment, apart from regular check-ups.

If you do need treatment, it could involve taking cardiovascular medicines or having surgery to widen a narrowed valve opening or to repair or replace a damaged valve (see below).

Valve surgery

If your healthcare team decide that your symptoms and quality of life could be improved by having surgery, there are 2 types.

A valve repair is often done if a valve is leaking but isn’t seriously damaged.
A valve replacement is done when the old valve is too damaged to repair and needs to be replaced with a new one. The replacement can be a mechanical (artificial) valve or a valve from another person or animal.

Your surgeon will discuss the options with you and help you decide what to have done.

Whether or not you have treatment or surgery for your heart valve disease, there may be things you can do to improve your health and lifestyle. These include:

having a heart healthy diet
maintaining a healthy body weight
quitting smoking
doing at least 30 minutes of exercise a day
managing your stress
looking after your teeth – any disease or gum abscess should be treated promptly, to lower the risk of bacteria getting into the bloodstream and possibly damaging the heart valves or endocardium (tissue that lines the inside of the heart chambers).

You may need to take a course of antibiotics when you’re having dental procedures or some medical procedures. Your healthcare provider or dentist can advise you on this.