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Heart Valve Diseases
What is heart valve disease?
Heart valve disease is when 1 or more heart valves don’t work
right. The valves normally keep blood flow moving forward in one direction. And they
prevent the backward flow of blood as it leaves each chamber of the heart. The heart
has 4 chambers: 2 upper chambers (atria) and 2 lower chambers (ventricles). The
heart also has 4 valves. They are:
Tricuspid valve. Located
between the right atrium and the right ventricle.
Pulmonary valve. Located
between the right ventricle and the pulmonary artery.
Mitral valve. Located
between the left atrium and the left ventricle.
Aortic valve. Located
between the left ventricle and the aorta.
As the heart muscle contracts and relaxes, the valves open and
close, letting blood flow into the ventricles and out to the body at alternate
times. The following is a step-by-step explanation of blood flow through the
The left and right atrium contract once they are filled with
blood. This pushes open the mitral and tricuspid valves. Blood is then pumped
into the ventricles.
The left and right ventricles contract. This closes the
mitral and tricuspid valves, preventing backward blood flow. At the same time,
the aortic and pulmonic valves open to let blood be pumped out of the
The left and right ventricles relax. The aortic and pulmonic
valves close, preventing backward blood flow into the heart. The mitral and
tricuspid valves then open to allow forward blood flow within the heart to fill
the ventricles again.
Heart valve disease can occur from 2 main types of problems:
Leakage of the valve
(regurgitation). When the valve does not close completely, it causes
blood to flow backward through the valve. This reduces forward blood flow and
can lead to volume overload in the heart.
Narrowing of the valve
(stenosis). When the valve opening becomes narrowed, it limits the blood
flow out of the ventricles or atria. The heart is forced to pump blood with more
force to move blood through the narrowed or stiff (stenotic) valve.
Heart valves can develop both regurgitation and stenosis at the
same time. Also, more than 1 heart valve can be affected at the same time. Some of
the more common heart valve diseases are:
Bicuspid aortic valve.
With this birth defect, the aortic valve has only 2 leaflets instead of 3. It is
more likely to narrow over time. If the valve becomes narrowed, it is harder for
the blood to flow through. Often the aortic valve may also develop regurgitation
in addition to stenosis. Symptoms often don’t appear until the adult years.
Mitral valve prolapse.
With this defect, the mitral valve leaflets bulge and don’t close correctly
during the contraction of the heart. This may lead to a lot of regurgitation
Mitral valve stenosis.
With this problem, the mitral valve opening is narrowed. It is often caused by a
past history of rheumatic fever. It increases resistance to blood flow from the
left atrium to the left ventricle.
Aortic valve stenosis.
This valve disease occurs mainly in older adults. It causes the aortic valve
opening to narrow. This increases resistance to blood flow from the left
ventricle to the aorta.
Pulmonary stenosis. With
this valve disease, the pulmonary valve does not open enough. This forces the
right ventricle to pump harder and enlarge. This is often a condition that is
present at birth (congenital).
What causes heart valve disease?
The causes of heart valve disease include:
Changes in the heart valve structure because of aging
Coronary heart disease and heart attack
Heart valve infection (endocarditis)
A sexually transmitted infection (syphilis)
An inherited connective tissue disorder that weakens the
heart valve tissue (myxomatous degeneration)
Radiation such as radiation therapy aimed at the chest wall
to treat lymphoma
Medicines such as the now-banned diet pill Phen-Fen
What are the symptoms of heart valve disease?
You may not have any symptoms if you have mild to moderate heart
valve disease. The most common symptoms are:
Fluttering heartbeat (palpitations)
Severe tiredness (fatigue)
Dizziness or fainting
Low or high blood pressure, depending on the type of valve
Shortness of breath with activity or rest
Belly pain because of an enlarged liver (if the tricuspid
valve isn’t working correctly)
Symptoms of heart valve disease may look like other health
problems. Always see your healthcare provider for a diagnosis.
How is heart valve disease diagnosed?
Your healthcare provider may think you have heart valve disease if
your heart doesn’t sound right through a stethoscope. He or she may hear abnormal
sounds because of turbulent blood flow across a valve. This is called a heart
murmur. It can often mean valve regurgitation or stenosis.
To further define the type of valve disease and extent of the
valve damage, your healthcare provider may use any of the following tests:
(ECG). This test records the
electrical activity of the heart and shows abnormal rhythms (arrhythmias).
It can also sometimes detect heart muscle damage.
This test uses sound waves to evaluate the heart’s chambers and valves. An
image on a screen is created as an ultrasound probe (transducer) is passed
over the heart. This is the best test for looking at heart valve
echocardiogram (TEE). A small ultrasound probe is passed down into
the esophagus. The sound waves create an image of the valves and chambers of
the heart on a computer screen without the ribs or lungs getting in the
Chest X-ray. This test
makes images of internal tissues, bones, and organs on film. An X-ray can
show enlargement in any area of the heart.
catheterization. A tiny, hollow tube (catheter) is put through a
large artery in the leg or arm leading to the heart. It measures heart
pressures. Contrast dye is injected so the healthcare provider can see
images of the heart and blood vessels.
MRI. This test uses a
combination of large magnets, radio waves, and a computer to make images of
organs and structures in the body.
CT scan. This test
uses X-rays and a computer to make images of organs and structures within
the body. Contrast dye is often used to help make out the structures of the
heart, including the heart valves.
How is heart valve disease treated?
In some cases, your healthcare provider may want only to closely
watch the heart valve problem for a period of time. If you need treatment, it
depends on the type of heart valve disease. Treatment may include:
These are not a cure for heart valve disease. But they can
often ease symptoms. Beta-blockers, digoxin, and calcium channel blockers help
to control heart rate and stop abnormal heart rhythms. Other medicines such as
diuretics or vasodilators can help control blood pressure. These medicines may
not work if you have a narrowed heart valve. Sometimes they can make symptoms
worse. If the valve won’t open, you may need surgery, valvuloplasty, or
You may need surgery to fix or replace the valve that isn’t
working right. In many cases, repair is preferable, because your own tissues are
used. When heart valves are severely malformed or destroyed, they may need to be
replaced with a new valve. Replacement valves may be either tissue (biologic)
valves. These include animal valves and donated human valves. Or they may be
mechanical valves. These are made of metal, plastic, or another artificial
These are minimally invasive procedures. The healthcare
provider repairs or replaces the heart valves. It is done through an artery (for
the aortic valve) or a vein (for the tricuspid, pulmonary, or mitral valve).
This repair is done for the mitral valve. A clip can be used
to reduce the amount blood from leaking through the mitral valve.
For this nonsurgical procedure, a special hollow tube
(catheter) is put into a blood vessel in the groin and guided into the heart. At
the tip of the catheter is a deflated balloon that is inserted into the narrowed
heart valve. Once in place, the balloon is inflated to stretch the valve open,
and then removed. This procedure is only used to treat stenotic valves.
TAVR (transcatheter aortic
For this nonsurgical procedure, a new aortic valve is placed
inside the older narrowed valve. This is done using catheters, balloons, and
wires inserted in the arteries of the groin. Or in some cases, they may be
inserted in the arteries of the arms or the apex of the heart. This procedure is
currently only for aortic stenosis. This procedure can also be used to replace
heart valves that start leaking or narrow over time.
What are the possible complications of heart valve
When heart valves fail to open and close properly, the effects on
the heart can be serious. They may prevent the heart from pumping enough blood
through the body. This may cause heart failure, abnormal heart rhythms, stroke,
heart attack, or even death.
Key points about heart valve disease
Heart valve disease is when 1 or more of the heart’s 4
valves don’t work right.
There are 2 main heart valve problems. A heart valve may
leak (regurgitation). Or it may become narrowed (stenosis).
One cause of heart valve disease is coronary heart disease
and heart attack.
Some common symptoms are chest pain, palpitations from
irregular heartbeats, fatigue, and dizziness.
An echocardiogram is the best test for looking at heart
Medicines may help ease symptoms. You may need heart surgery
to fix or replace a valve.
Tips to help you get the most from a visit to your healthcare
Know the reason for your visit and what you want to
Before your visit, write down questions you want
Bring someone with you to help you ask questions and
remember what your provider tells you.
At the visit, write down the name of a new diagnosis, and
any new medicines, treatments, or tests. Also write down any new instructions
your provider gives you.
Know why a new medicine or treatment is prescribed, and how
it will help you. Also know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the
results could mean.
Know what to expect if you do not take the medicine or have
the test or procedure.
If you have a follow-up appointment, write down the date,
time, and purpose for that visit.
Know how you can contact your provider if you have
Online Medical Reviewer:
Louise Cunningham, RN
Online Medical Reviewer:
Mandy Synder, RN
Online Medical Reviewer:
Stephen Kang, MD
Date Last Reviewed:
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