- Heart Disease: Heart Valve Disease Center
- A Visual Guide to Heart Disease
- Medical Illustrations of the Heart Image Collection
- Take the Heart Disease Quiz!
- Patient Comments: Heart Valve Disease - Symptoms
- Find a local Cardiologist in your town
What Is Valvular Heart Disease?
Heart valve disease occurs when your heart's valves do not work the way they should.
How Do Heart Valves Work?
Your heart valves lie at the exit of each of your four heart chambers and maintain one-way blood flow through your heart. The four heart valves make sure that blood always flows freely in a forward direction and that there is no backward leakage.
Blood flows from your right and left atria into your ventricles through the open mitral and tricuspid valves.
When the ventricles are full, the mitral and tricuspid valves shut. This prevents blood from flowing backward into the atria while the ventricles contract (squeeze).
As the ventricles begin to contract, the pulmonic and aortic valves are forced open and blood is pumped out of the ventricles through the open valves into the pulmonary artery toward the lungs, the aorta, and the body.
When the ventricles finish contracting and begin to relax, the aortic and pulmonic valves snap shut. These valves prevent blood from flowing back into the ventricles.
This pattern is repeated over and over, causing blood to flow continuously to the heart, lungs and body.
What Are the Types of Valve Disease?
There are several types of valve disease:
- Valvular stenosis. This occurs when a valve opening is smaller than normal due to stiff or fused leaflets. The narrowed opening may make the heart work very hard to pump blood through it. This can lead to heart failure and other symptoms (see below). All four valves can be stenotic (hardened, restricting blood flow); the conditions are called tricuspid stenosis, pulmonic stenosis, mitral stenosis or aortic stenosis.
- Valvular insufficiency. Also called regurgitation, incompetence or "leaky valve", this occurs when a valve does not close tightly. If the valves do not seal, some blood will leak backwards across the valve. As the leak worsens, the heart has to work harder to make up for the leaky valve, and less blood may flow to the rest of the body. Depending on which valve is affected, the conditioned is called tricuspid regurgitation, pulmonary regurgitation, mitral regurgitation or aortic regurgitation.
What Causes Valvular Heart Disease?
Valve disease can develop before birth (congenital) or can be acquired sometime during one's lifetime. Sometimes the cause of valve disease is unknown.
Congenital valve disease. Most often affects the aortic or pulmonic valve. Valves may be the wrong size, have malformed leaflets, or have leaflets that are not attached to the annulus correctly.
Bicuspid aortic valve disease is a congenital valve disease that affects the aortic valve. Instead of the normal three leaflets or cusps, the bicuspid aortic valve has only two. Without the third leaflet, the valve may be stiff (unable to open or close properly) or leaky (not able close tightly).
Acquired valve disease. This includes problems that develop with valves that were once normal. These may involve changes in the structure or your valve due to a variety of diseases or infections, including rheumatic fever or endocarditis.
- Rheumatic fever is caused by an untreated bacterial infection (usually strep. throat). Luckily, the introduction of antibiotics to treat this infection has dramatically reduced the numbers of this infection. The initial infection usually occurs in children, but the heart problems associated with the infection may not be seen until 20-40 years later. At that time, the heart valves become inflamed, the leaflets stick together and become scarred, rigid, thickened and shortened. This leads to mitral regurgitation.
- Endocarditis occurs when germs, especially bacteria, enter the bloodstream and attack the heart valves, causing growths and holes in the valves and scarring. This can lead to leaky valves. The germs that cause endocarditis enter the blood during dental procedures, surgery, IV drug use, or with severe infections. People with valve disease (except mitral valve prolapse without thickening or regurgitation/leaking) are at increased risk for developing this life-threatening infection.
There are many changes that can occur to the valves of the heart. The chordae tendinea or papillary muscles can stretch or tear; the annulus of the valve can dilate (become wide); or the valve leaflets can become fibrotic (stiff) and calcified.
Mitral valve prolapse (MVP) is a very common condition, affecting 1 to 2 percent of the population. MVP causes the leaflets of the mitral valve to flop back into the left atrium during the heart's contraction. MVP also causes the tissues of the valve to become abnormal and stretchy, causing the valve to leak. The condition rarely causes symptoms and usually doesn't require treatment.
Other causes of valve disease include: coronary artery disease, heart attack, cardiomyopathy (heart muscle disease), syphilis (a sexually transmitted disease), hypertension, aortic aneurysms, and connective tissue diseases. Less common causes of valve disease include tumors, some types of drugs and radiation.
What Are the Symptoms of Valve Disease?
- Shortness of breath and/or difficulty catching your breath. You may notice this most when you are active (doing your normal daily activities) or when you lie down flat in bed. You may need to sleep propped up on a few pillows to breathe easier.
- Weakness or dizziness. You may feel too weak to carry out your normal daily activities. Dizziness can also occur, and in some cases, passing out may be a symptom.
- Discomfort in your chest. You may feel a pressure or weight in your chest with activity or when going out in cold air.
- Palpitations. This may feel like a rapid heart rhythm, irregular heartbeat, skipped beats or a flip-flop feeling in your chest.
- Swelling of your ankles, feet or abdomen. This is called edema. Swelling may occur in your belly, which may cause you to feel bloated.
- Rapid weight gain. A weight gain of two or three pounds in one day is possible.
Symptoms do not always relate to the seriousness of your valve disease. You may have no symptoms at all and have severe valve disease, requiring prompt treatment. Or, as with mitral valve prolapse, you may have severe symptoms, yet tests may show your valve leak is not significant.
Latest Heart News
Daily Health News
How Are Valve Diseases Diagnosed?
Your heart doctor can tell if you have valve disease by talking to you about your symptoms, performing a physical exam, and giving you other tests.
During a physical exam, your doctor will listen to your heart to hear the sounds the heart makes as the valves open and close. A murmur is a swishing sound made by blood flowing through a stenotic or leaky valve. Your doctor can also tell if your heart is enlarged or if your heart rhythm is irregular.
The doctor will listen to your lungs to hear if you are retaining fluid in your lungs, which shows your heart is not able to pump as well as it should.
By examining your body, the doctor can find clues about your circulation and the functioning of your other organs.
After the physical exam, the doctor may order diagnostic tests. These may include:
- Transesophageal echocardiography
- Cardiac catheterization (also called an angiogram)
- Radionuclide scans
- Magnetic resonance imaging (MRI)
By looking at the results, repeated over time, your doctor can also see the progress of your valve disease. This will help him or her make decisions about your treatment.
How Is Heart Valve Disease Treated?
Treatment for heart valve disease depends on the type and severity of valve disease. There are three goals of treatment for heart valve disease: protecting your valve from further damage; lessening symptoms; and repairing or replacing valves.
Protecting your valve from further damage.
If you have valve disease, you are at risk for developing endocarditis, a serious condition. People who have mitral valve prolapse without thickening or regurgitation/leaking are not at risk of developing endocarditis.
You are still at risk for endocarditis, even if your valve is repaired or replaced through surgery. To protect yourself:
- Tell your doctors and dentist you have valve disease. You may want to carry an identification card with this information. The American Heart Association website (www.americanheart.org) has a bacterial endocarditis wallet card that you may download; or call your local American Heart Association office or the national office at 1-800-AHA-USA1.
- Call your doctor if you have symptoms of an infection (sore throat, general body aches, fever).
- Take good care of your teeth and gums to prevent infections. See your dentist for regular visits.
- Take antibiotics before you undergo any procedure that may cause bleeding, such as any dental work (even a basic teeth cleaning), invasive tests (any test that may involve blood or bleeding), and most major or minor surgery. Your doctor can provide you with a card that provides specific antibiotic guidelines.
Medications. You may be prescribed medications to treat your symptoms and to lessen the chance of further valve damage. Some medications may be stopped after you have had valve surgery to correct your problem. Other medications may need to be taken all your life. Medications may include:
|Common Types of Medications||What They Do|
|Diuretics ("water pills")||Remove extra fluid from the tissues and bloodstream; lessen the symptoms of heart failure|
|Antiarrhythmic medications||Control the heart's rhythm|
|Vasodilators||Lessen the heart's work. Also encourages blood to flow in a forward direction, rather than backwards through a leaky valve.|
|ACE inhibitors||A type of vasodilator used to treat high blood pressure and heart failure|
|Beta blockers||Treat high blood pressure and lessen the heart's work by helping the heart beat slower and less forcefully. Used to decrease palpitations in some patients.|
|Anticoagulants ("blood thinners")||Prolong the clotting time of your blood, if you are at risk for developing blood clots on your heart valve.|
Follow your doctor's orders when taking medications. Know the names of your medications, what they are for, and how often to take them.
Surgery and Other Procedures. The diagnostic tests your heart doctor orders help to identify the location, type, and extent of your valve disease. The results of these tests, the structure of your heart, your age, and your lifestyle will help your cardiologist (heart doctor), surgeon, and you decide what type of procedure will be best for you.
Surgical options include heart valve repair or replacement. Valves can be repaired or replaced with traditional heart valve surgery or a minimally invasive heart valve surgical procedure. Heart valves may also be repaired by other procedures such as percutaneous balloon valvotomy.
IMAGESSee a detailed medical illustration of the heart plus our entire medical gallery of human anatomy and physiology See Images
Living With Valve Disease
When you have valve disease, it is important to protect yourself from future heart problems, even if your valve has been repaired or replaced with surgery. Here are some tips to stay healthy:
- Know the type and extent of your valve disease.
- Tell all your doctors and dentist you have valve disease.
- Call your doctor if you have symptoms of an infection.
- Take good care of your teeth and gums.
- Take antibiotics before you undergo any procedure that may cause bleeding.
- Carry a wallet card that may be obtained from the American Heart Association with specific antibiotic guidelines.
- Take your medications. Your medications are used to control your symptoms and help your heart pump blood more efficiently. Follow your doctor's instructions when you take your medications.
- See your heart doctor for regular visits, even if you have no symptoms. Your appointments may be spaced once a year or more often, if your doctor feels you need to be followed more closely.
Reviewed by the doctors at The Cleveland Clinic Heart Center. (2005)
SOURCE: American Heart Association
Edited by David W. Stein, MD on December 01, 2006
Edited on October 1, 2005.
Portions of this page © The Cleveland Clinic 2000-2054
Health Solutions From Our Sponsors
Top Heart Valve Disease Related Articles
Chest X-RayChest X-Ray is a type of X-Ray commonly used to detect abnormalities in the lungs. A chest X-ray can also detect some abnormalities in the heart, aorta, and the bones of the thoracic area. A chest X-ray can be used to define abnormalities of the lungs such as excessive fluid (fluid overload or pulmonary edema), fluid around the lung (pleural effusion), pneumonia, bronchitis, asthma, cysts, and cancers. Normal chest X-ray shows normal size and shape of the chest wall and the main structures in the chest
Congestive Heart Failure (CHF) Symptoms, Treatment, and Life ExpectancyCongestive heart failure (CHF) refers to a condition in which the heart loses the ability to function properly. Heart disease, high blood pressure, diabetes, myocarditis, and cardiomyopathies are just a few potential causes of congestive heart failure. Signs and symptoms of congestive heart failure may include fatigue, breathlessness, palpitations, angina, and edema. Physical examination, patient history, blood tests, and imaging tests are used to diagnose congestive heart failure. Treatment of heart failure consists of lifestyle modification and taking medications to decrease fluid in the body and ease the strain on the heart. The prognosis of a patient with congestive heart failure depends on the stage of the heart failure and the overall condition of the individual.
Echocardiogram (Echocardiography, Diagnostic Cardiac Ultrasound)Echocardiogram is a test using ultrasound to provide pictures of the heart's valves and chambers. There are several types of echocardiograms, for example, transthoracic echocardiogram, transesophageal echocardiogram (TEE), stress echocardiogram, dobutamine or adenosine/sestamibi stress echocardiogram, and and intravascular ultrasound.
Electrocardiogram (ECG or EKG)An electrocardiogram is known by the acronyms "ECG" or "EKG" more commonly used for this noninvasive procedure to record the electrical activity of the heart. An EKG generally is performed as part of a routine physical exam, part of a cardiac exercise stress test, or part of the evaluation of symptoms. Symptoms evaluated include palpitations, fainting, shortness of breath, dizziness, fainting, or chest pain.
Fainting (Syncope) Symptoms, Causes, Treatment, and PreventionFainting, also referred to as blacking out, syncope, or temporary loss of consciousness has many causes. Often a person will have signs or symptoms prior to the fainting episode. Diagnosis and treatment depends upon the cause of the fainting or syncope episode.
Heart Catheter PictureCatheter procedures are much easier than surgery on patients because they involve only a needle puncture in the skin where the catheter is inserted into a vein or an artery. See a picture of Heart Catheter and learn more about the health topic.
How the Heart Works: Sides, Chambers, and FunctionThe heart is a very important organ in the body. It is responsible for continuously pumping oxygen and nutrient-rich blood throughout your body to sustain life. It is a fist-sized muscle that beats (expands and contracts) 100,000 times per day, pumping a total of five or six quarts of blood each minute, or about 2,000 gallons per day.
Most Expensive Medical ConditionsWhat are the most expensive medical conditions? Learn about heart conditions, brain disorders, back pain and many more expensive health conditions. Discover the tips that can prevent serious medical problems and protect your financial well-being.
Orthostatic HypotensionOrthostatic hypotension symptoms include:
- Blurred vision
- Syncope or passing out
- Blood loss
- Low blood pressure
- Heat related illnesses
- Parkinson's disease
Pulmonary edema (swelling or fluid in the lungs) can either be caused by cardiogenic causes (congestive heart failure, heart attacks, abnormal heart valves) or noncardiogenic causes such as:
- kidney failure,
- high altitude,
- pleural effusion,
- aspirin overdose,
- pulmonary embolism, and
The treatment of pulmonary edema depends on the cause of the condition.
What Are Three Signs of Cardiac Tamponade?Cardiac tamponade is a life-threatening condition caused by excessive fluid accumulation in the protective sac (pericardium) around the heart. The fluid exerts pressure on the heart and impairs its ability to pump blood. Doctors diagnose this medical emergency by looking for three signs (Beck's triad). They include low arterial pressure, bulging neck veins, and muffled heartbeat.
UltrasoundUltrasound (and ultrasonography) is imaging of the body used in the medical diagnosis and screening of diseases and conditions such as:
- heart valve irregularities,
- carotid artery disease,
- heart disease,
- kidney stones,
- liver disease,
- diseases of the female reproductive, and
- diseases of the male reproductive organs.