Heart valve disease

In heart valve disease, one or more of the valves in your heart doesn't work properly.

Your heart has four valves that keep blood flowing in the correct direction. In some cases, one or more of the valves don't open or close properly. This can cause the blood flow through your heart to your body to be disrupted.

Your heart valve disease treatment depends on the heart valve affected and the type and severity of the disease. Sometimes heart valve disease requires surgery to repair or replace the heart valve.

Symptoms

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

• Whooshing sound (heart murmur) when a doctor is listening to the heart with a stethoscope
• Chest pain
• Abdominal swelling (more common with advanced tricuspid regurgitation)
• Fatigue
• Shortness of breath, particularly when active or lying down
• Swelling of your ankles and feet
• Dizziness
• Fainting
• Irregular heartbeat

When to see a doctor

If you have symptoms that might suggest heart valve disease, see your doctor. If you have a heart murmur, your doctor might suggest that you see a cardiologist.

Causes

The four heart valves, which keep blood flowing in the right direction, are the mitral, tricuspid, pulmonary and aortic valves. Each valve has flaps (leaflets) that open and close once per heartbeat. If one or more of the valves fail to open or close properly, the blood flow through your heart to your body is disrupted.

Heart valve disease may be present at birth (congenital). It can also occur in adults due to many causes and conditions, such as infections and other heart conditions.

Heart valve problems include:

• Regurgitation. The valve flaps don't close properly, causing blood to leak backward in your heart. This commonly occurs due to valve flaps bulging back, a condition called prolapse.
• Stenosis. The valve flaps become thick or stiff and possibly fuse together. This results in a narrowed valve opening and reduced blood flow through the valve.
• Atresia. The valve isn't formed, and a solid sheet of tissue blocks the blood flow between the heart chambers.

Risk factors

Several factors can increase your risk of heart valve disease, including:

• Older age
• History of certain infections that can affect the heart
• History of certain forms of heart disease or heart attack
• High blood pressure, high cholesterol, diabetes and other heart disease risk factors
• Heart conditions present at birth (congenital heart disease)

Complications

Heart valve disease can cause many complications, including:

• Heart failure
• Stroke
• Blood clots
• Heart rhythm abnormalities
• Death

Diagnosis

Your doctor will conduct a physical examination and listen for a heart murmur, a possible sign of a heart valve condition. You might have several tests to diagnose your condition.

Tests might include:

• Echocardiography. Sound waves directed at your heart from a wandlike device (transducer) produce video images of your heart in motion. This test assesses the structure of your heart, the heart valves and the blood flow through your heart. An echocardiogram helps your doctor get a close look at the heart valves and how well they're working. Doctors may also use a 3D echocardiogram.

  In another type of echocardiogram called a transesophageal echocardiogram, a small transducer attached to the end of a tube is inserted down the tube leading from your mouth to your stomach (esophagus). This test helps your doctor get a closer look at the heart valves than is possible with a regular echocardiogram.

• Electrocardiogram (ECG). Wires (electrodes) attached to pads on your skin measure electrical impulses from your heart. An ECG can detect enlarged chambers of your heart, heart disease and abnormal heart rhythms.
• Chest X-ray. A chest X-ray can help your doctor determine whether the heart is enlarged, which can indicate certain types of heart valve disease. A chest X-ray can also help doctors determine the condition of your lungs.
• Cardiac MRI. A cardiac MRI uses magnetic fields and radio waves to create detailed images of your heart. It can determine the severity of your condition and assess the size and function of your lower heart chambers.
• Exercise tests or stress tests. Different exercise tests help measure your activity tolerance and monitor your heart's response to physical exertion. If you can't exercise, you might be given medications that mimic the effect of exercise on your heart.

• Cardiac catheterization. This test isn't often used to diagnose heart valve disease, but it may be used if other tests aren't able to diagnose the condition or to determine its severity.

  A doctor threads a thin tube (catheter) through a blood vessel in your arm or groin, guides it to an artery in your heart and injects dye through the catheter to make the artery visible on an X-ray. This provides your doctor with a detailed picture of your heart arteries and how your heart functions. It can also measure the pressure inside the heart chambers.

Treatment

Heart valve disease treatment depends on your symptoms, the severity of the condition, and whether your condition is worsening.

A doctor trained in heart disease (cardiologist) will provide your care. Treatment might include monitoring your condition with regular follow-up visits. You might be asked to:

• Make healthy lifestyle changes
• Take medications to treat symptoms
• Take blood thinners to reduce the risk of blood clots if you have a certain irregular heart rhythm called atrial fibrillation

Surgery or other procedures

You might eventually need heart valve surgery to repair or replace the diseased heart valve even if you don't have symptoms. If you need surgery for another heart condition, your doctor might repair or replace the diseased valve at the same time.

Heart valve surgery is usually performed through a cut (incision) in the chest. Doctors sometimes do minimally invasive heart surgery, which involves smaller incisions than those made for open-heart surgery. In some medical centers, doctors perform robot-assisted heart surgery, a type of minimally invasive heart surgery in which surgeons use robotic instruments to conduct the procedure.

Surgery options include valve repair or replacement.

Heart valve repair

Your doctor might recommend heart valve repair to preserve your heart valve. To repair a heart valve, surgeons might:

• Patch holes in a valve
• Separate valve leaflets that have fused
• Replace the cords that support the valve
• Remove excess valve tissue so that the valve can close tightly

Surgeons often tighten or reinforce the ring around a valve (annulus) by implanting an artificial ring. In some cases, doctors use less invasive procedures to repair certain valves using long, thin tubes (catheters). These procedures can involve the use of clips, plugs or other devices.

Heart valve replacement

If the valve can't be repaired, surgeons might remove the damaged valve and replace it with a mechanical valve or a valve made from cow, pig or human heart tissue (biological or tissue valve).

If you had valve replacement with a mechanical valve, you'll need to take blood thinners for the rest of your life to prevent blood clots. Biological tissue valves break down over time and usually need to be replaced.

A minimally invasive procedure called transcatheter aortic valve replacement (TAVR) may be used to replace a damaged aortic valve. In this procedure, the doctor inserts a long, thin tube (catheter) into an artery in your leg or chest and guides it to the heart valve. A replacement valve is moved through this catheter to the correct position.

Lifestyle and home remedies

You'll have regular follow-up appointments with your doctor to monitor your condition.

It's a good idea to make several heart-healthy lifestyle changes, including:

• Eating a heart-healthy diet. Eat 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.
• Maintaining a healthy weight. Aim to keep a healthy weight. If you're overweight or obese, your doctor may recommend losing weight.
• Getting regular physical activity. Aim to include about 30 minutes of physical activity, such as brisk walks, in your daily fitness routine.
• Managing stress. Try relaxation activities, such as meditation and deep breathing; stay physically active; and spend time with family and friends.
• Avoiding tobacco. If you smoke, quit. Ask your doctor about resources to help you quit smoking. Joining a support group may be helpful.

For women with heart valve disease, talk with your doctor before you become pregnant. Your doctor can discuss with you which medications you can safely take, and whether you need a procedure to treat your valve condition before pregnancy.

You'll likely require close monitoring by your doctor during pregnancy. If you have a severe valve condition, your doctor might recommend against pregnancy to reduce the risk of complications.

Coping and support

If you have heart valve disease, here are some steps that may help you cope:

• Take medications as prescribed. Take your medications as directed by your doctor.
• Get support. Having support from your family and friends can help you cope with your condition. Ask your doctor about support groups that may be helpful.
• Stay active. It's a good idea to stay physically active. Your doctor may give you recommendations about how much and what type of exercise is appropriate for you.

Preparing for an appointment

If you think you have heart valve disease, make an appointment to see your doctor. Here's some information to help you prepare for your appointment.

What you can do

• Be aware of pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do beforehand.
• Write down your symptoms, including any that seem unrelated to heart valve disease.
• Write down key personal information, including a family history of heart disease, and any major stresses or recent life changes.
• Make a list of all medications, vitamins and supplements you take.
• Take a family member or friend along, if possible. Someone who accompanies you can help you remember information you receive.
• Be prepared to discuss your diet and exercise habits. If you don't already eat well and exercise, be ready to talk to your doctor about challenges you might face in getting started.
• Write down questions to ask your doctor.

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

• What is likely causing my symptoms or condition?
• What are other possible causes for my symptoms or condition?
• What tests will I need?
• What's the best treatment?
• What are the alternatives to the primary approach you're suggesting?
• I have other health conditions. How can I best manage them together?
• Are there restrictions I need to follow?
• Should I see a specialist?
• If I need surgery, which surgeon do you recommend for heart valve surgery?
• Is there a generic alternative to the medicine you're prescribing?
• Are there brochures or other printed material I can take with me? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

• When did your symptoms begin?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

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