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Heart valve disease

Published by Bupa's health information team, September 2008.

This factsheet is for people who have heart valve disease, or who would like information about it.

Heart valve disease is when one or more valves in your heart aren't working fully and blood doesn't flow through your heart as it should. Heart valve disease is also known as valve disease or valvular heart disease.

About heart valve disease

Heart valve disease can put extra strain on your heart and cause symptoms such as breathlessness and swollen ankles. Severe heart valve disease can cause your heart to pump less efficiently. A number of treatments are available to help you deal with heart valve disease.

The heart

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

There are two chambers on each side of your heart - the ventricles and the atria.

Heart valves

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

You also have valves on each side between your heart and the major blood vessels taking blood away from your heart. On the right is your pulmonary valve. On the left, between the left ventricle and the aorta, is your aortic valve.

Your 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.

Your valves have two functions. They allow your blood to flow through them smoothly and prevent it from leaking back against this flow. Your valves allow blood to flow in one direction only.

Illustration showing the blood flow in the heart and major blood vessels
The blood flow in the heart and major blood vessels

Heart valve disease

There are two problems that can affect your heart valves.

  • If your valve becomes narrowed, your blood can't readily flow into the next chamber or blood vessel. This is called valve stenosis.
  • If your valve doesn't close properly, blood leaks backwards in the wrong direction. This is called valve insufficiency or incompetence.

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

Stenosis

When one of your valves is stenosed or narrowed, there is resistance to your blood flow and so your heart has to work harder to get blood through it.

Incompetence

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

When incompetence occurs in the valves on the left of your heart, it can lead to a build-up of fluid on your lungs. This is called pulmonary oedema. When this happens on the right-hand side, it can lead to a build up of fluid in your body, particularly in your liver and legs - which is likely to cause your ankles to swell. Sometimes incompetence on the left side puts a strain on the right-hand side and can cause fluid in the lungs and the rest of the body.

Symptoms of heart valve disease

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

If you have more serious valve disease, you may have:

  • breathlessness, especially when you exert yourself, such as when you exercise
  • tiredness
  • palpitations (irregular, fluttery heartbeat or an awareness of your heart beating)
  • angina (chest pain) because your narrowing valve reduces the blood supply to your heart muscle
  • swollen ankles or feet
  • dizziness or fainting

Complications of heart valve disease

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

If you have heart valve disease you may need to take a short course of antibiotics before you have surgery to prevent infection. Ask your GP for more advice.

Causes of heart valve disease

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 you were born with a defective valve
  • cardiomyopathy - if your heart muscle becomes thickened or dilated, it can obstruct blood flow
  • age - as you get older, your valves become less flexible, and more stretched or torn

Diagnosis of heart valve disease

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. Your GP will listen to your heart with a stethoscope to check for a murmur - an extra noise to the usual heart sounds, 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 doctor specialising in identifying and treating conditions of the heart and blood vessels), who can carry out more specific tests. These may include:

  • an electrocardiogram (ECG), a test that measures the electrical activity of your heart to see how well it is working
  • 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. A dye that shows up on X-rays is injected into your blood stream and X-rays are taken to produce an image of the blood flowing through your heart
  • cardiac CT imaging - a CT scan that uses X-rays to make a three-dimensional image of your heart

Treatment of heart valve disease

Your treatment will depend on what is wrong with your valve and how serious the problem is. You may not need any treatment at all. If this is the case, you will still need regular check-ups with your GP to check that your heart valve doesn't get any worse.

Medicines

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

  • diuretics (eg furosemide, spironolactone) - these help to reduce swelling by encouraging your body to get rid of excess water in your urine
  • ACE inhibitors (eg ramipril, perindopril) - these help your heart work more effectively by relaxing your blood vessels and so improving blood flow
  • digoxin (eg Lanoxin, Lanoxin-PG) - this stabilises your heart rhythm and helps your heart pump harder
  • beta-blockers (eg bisoprolol fumarate) - this controls your heart rhythm and can make your heart beat stronger

Surgery

Balloon valve surgery

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

In this procedure, a small tube (catheter) is threaded up to your heart through an artery, usually in your groin. A guidewire, with a deflated balloon at the end, is passed up the catheter. When it reaches your narrowed valve, the balloon is gently inflated to stretch the valve. The balloon is then deflated and removed, leaving a widened valve that your 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 - your faulty heart valve is replaced with a prosthetic (artificial) valve
  • valve repair - your valve may be repaired if possible

Heart valve surgery is carried out under general anaesthesia, which means that you will be asleep during the operation.

Special considerations

If you're pregnant

During pregnancy, your blood volume and heart rate increase and your resistance to blood flow decreases.

If you have mild or moderate heart valve disease and become pregnant, there is a low risk of heart problems during pregnancy, and careful medical supervision is advised.

If you have severe heart valve disease and are keen to have a baby, your GP may advise you to have valve surgery before you become pregnant. Severe valve disease is sometimes only identified during pregnancy. If this happens, it's usually possible to continue with the pregnancy under careful medical supervision.

Living with heart valve disease

If you have heart valve disease, you may have a yearly check-up with your cardiologist. This check-up is very important, even if you feel completely well. You might not need treatment for many years, if ever, but a careful, regular watch will make sure that you get any treatment you need at the right time.

Help and support

Contacting other people who have heart valve disease through charities and patient groups can be a good way to obtain support and advice.

Further information

Related topics

Sources

  • Valvular heart disease. British Heart Foundation, 2005, Heart Information Series no. 11. www.bhf.org.uk
  • Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2007:354-355
  • Preventing infective endocarditis. National Institute of Health and Clinical Excellence (NICE), 2008, Information about NICE clinical guideline 64. www.nice.org.uk
  • Lung B, Gohlke-Barwolf C, Tornos P et al (on behalf of the Working Group on Valvular Heart Disease). Recommendations on the management of the asymptomatic patient with valvular heart disease. Eur Heart J 2002; 23:1253. http://eurheartj.oxfordjournals.org
  • Joint Formulary Committee, British National Formulary. 54th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2007; 70-73, 100-102
  • Balloon valvuloplasty for aortic valve stenosis in adults and children. National Institute of Health and Clinical Excellence (NICE), 2004, Interventional Procedure Guidance 78. www.nice.org.uk
  • Balloon dilatation of pulmonary valve stenosis. National Institute of Health and Clinical Excellence (NICE), 2004, Interventional Procedure Guidance 67. www.nice.org.uk
  • Vahanian A, Baumgartner H, Bax J, et al. Guidelines on the management of valvular heart disease. Eur Heart J 2007; 28:230-268. http://eurheartj.oxfordjournals.org
  • Manghat NE, Rachapalli V, Van Lingen R et al. Imaging the heart valves using ECG-gated 64-detector row cardiac CT. Br J Radiol 2008; 81:275-290. http://bjr.birjournals.org

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: September 2008

 

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