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Heart valve disease

This factsheet is for people who have heart disease or for people who want more information about heart valve disease.

Heart valve disease is when one or more valves in the heart are not working fully and blood does not flow through the heart as it should. This can put an extra strain on the heart and cause symptoms such as breathlessness and swollen ankles. Severe heart valve disease can cause the heart to pump less efficiently. There are a number of treatments to help deal with heart valve disease.

The heart

The heart is a muscular pump that is divided into two sides. The right side of the heart pumps blood to the lungs to get oxygen, and the left side pumps oxygenated blood around the body.

On each side of the heart there are two chambers - the ventricle and the atrium.

Heart valves

Heart valves separate the ventricle and the atrium chambers. On the right side of the heart, the valve is called the tricuspid valve, and on the left, the mitral valve.

There are also valves on each side between the heart and the major blood vessel taking blood away from the heart. On the right this is the pulmonary valve. On the left, between the left ventricle and the aorta, is the aortic valve.

Heart valves are made up of flaps of thin, strong, tissue attached to the heart with fibrous cords. They can only open in one direction.

The valves have two functions. They allow blood to flow through them smoothly and they prevent blood from leaking back against the flow.

Illustration showing the heart

Heart valve disease

There are two problems that can affect the heart valves.

• The valve may become narrowed, so blood cannot readily flow into the next chamber or blood vessel. This is called valve stenosis.
• The valve may not close properly, so blood leaks backwards in the wrong direction. This is called valve insufficiency or incompetence.

Both valve stenosis and valve incompetence put extra strain on the heart.

Stenosis

When a valve is "stenosed" or narrowed, the heart has to work harder to get blood through it. There is "resistance" to blood flow.

Incompetence

When a valve is incompetent, the heart has to work harder as it has to pump more blood than before because a proportion leaks back into the heart and has to be pumped out again. The blood behind the valve may also be under more pressure.

When this happens with the aortic valve (on the left), this can lead to a build-up of fluid on the lungs (pulmonary oedema). When this happens on the right-hand side, this can lead to a build up of fluid in the body, particularly in the liver and legs, which is why the ankles swell.

Symptoms

The symptoms of valve disease depend on which valve is affected, and how severely. If there is only mild damage, you may not have any symptoms.

If you have more serious valve disease, symptoms can include:

• breathlessness especially when you exert yourself, such as when exercising
• tiredness
• palpitations (irregular, fluttery heartbeat or an awareness of your heart beating)
• angina (chest pain) because the valve narrowing means that the blood vessels supplying your heart muscle are not getting enough blood
• swollen ankles or feet
• dizziness or fainting

Cause

There are a number of possible causes of heart valve disease. These include:

• rheumatic fever during childhood - this disease is no longer common in the UK but still affects people in developing countries
• a "congenital deformity" which means that you were born with an abnormal valve
• coronary artery disease - when a blockage occurs in the arteries that supply blood to your heart it can damage the valve
• a disease called cardiomyopathy - when the heart muscle becomes thickened or dilated it can obstruct blood flow
• age - as you get older, the valves become less flexible, stretched or torn

Diagnosis

If you experience any symptoms, consult your GP. He or she will ask you about your symptoms and examine you. Your GP will listen to your heart with a stethoscope to listen for a murmur, an extra noise to the usual heart sound, which can be caused by blood passing through a damaged valve.

If your GP thinks there may be a problem with your heart, he or she may refer you to a cardiologist (a specialist heart doctor), who can carry out more specific tests. These may include:

• an electrocardiogram (ECG), which records the electrical changes happening in your heart
• an echocardiogram, an ultrasound scan that produces a picture of the inside of your heart
• a chest X-ray
• an angiogram, where a small tube (catheter) is threaded up to your heart through an artery - usually in your groin - and a dye that shows up on X-rays is injected and X-rays taken to produce an image of the blood flowing through your heart

Treatment

The treatment you will need will depend on what is wrong with the valve and how serious the problem is. You may not need any treatment at all. If this is the case, you will still need to have regular check ups with your doctor to check that your heart valve does not get any worse.

Drug treatments

You may be prescribed medicines to relieve your symptoms. These include:

• diuretics, which help to reduce swelling by encouraging the body to get rid of excess water in the urine
• ACE-inhibitors, which help the heart work more effectively by relaxing blood vessels and so improving blood flow
• digoxin, which stabilises the heart rhythm and helps the heart pump harder

Balloon valve surgery

If your valve has narrowed (stenosis) your doctor may recommend balloon valve surgery - also called balloon valvoplasty.

In this procedure, a small tube (catheter) is threaded up to your heart through an artery, usually in the groin. A guidewire, with a tiny deflated balloon at the end, is passed down the catheter. When it reaches the valve, the balloon is gently inflated to stretch the valve. The balloon is then deflated and removed, leaving a widened valve that blood can flow through more efficiently.

Heart valve surgery

If you have serious valve disease, you may need heart valve surgery to prevent permanent damage to your heart.

The two types of surgery are:

• valve replacement - the faulty heart valve is replaced with a prosthetic (artificial) valve
• valve repair - if a valve is not seriously damaged it may be repaired

For more information about heart valve surgery, please see the separate BUPA factsheet, Heart valve surgery

Endocarditis

If you have heart valve disease, regardless of how severe it is, the valve is more susceptible to infection. A valve infection is called endocarditis and it can be very serious.

If you have heart valve disease you should take a short course of antibiotics before you have any dental treatment or surgery as a preventive measure. Ask your doctor for more advice.

Further information

• The British Heart Foundation
  08450 70 80 70
  www.bhf.org.uk

Sources

• Valvular heart disease. British Heart Foundation. Heart Information Series Number 11. May 2005.
  www.bhf.org.uk
• Simon C, Everitt H, Birtwistle J, Stevenson B. Oxford Handbook of General Practice. Oxford: Oxford University Press, 2002:262-263.
• Lung B, Gohlke-Barwolf C, Tornos P, Tribouilloy C, Hall R, Butchart E, Vahanian A (on behalf of the Working Group on Valvular Heart Disease. Recommendations on the management of the asymptomatic patient with valvular heart disease. European Heart Journal 2002; 23 (16): 1253.
  www.oxfordjournals.org
• BNF British National Formulary 50, September 2005.
• Balloon valvuloplasty for aortic valve stenosis in adults and children. National Institute of Clinical Excellence (NICE). July 2004. Interventional procedure Guidance 78. www.nice.org.uk.
• Balloon dilatation of pulmonary valve stenosis. National Institute of Clinical Excellence (NICE). June 2004. Interventional procedure Guidance 67.
  www.nice.org.uk
• Prophylaxis and treatment of infective endocarditis in adults : concise guidelines. Royal College of Physicians, 1 December 2004.
  www.rcplondon.ac.uk

Reviewed by Dr James Quekett, BSc. MB Ch.B MRCGP DRCOG DFFP, partner/principal general practitioner at Rowcroft Medical Centre.

Published by BUPA's health information team, healthinfo@bupa.com, July 2006.

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