Heart Valve Disease

Overview

Heart valve disease means one or more of the four valves in your heart are not working as they should. Valves act like one-way doors that keep blood flowing in the right direction. A valve may become too narrow (stenosis), so blood struggles to get through. Or it may not close properly (regurgitation or leakage), so blood flows backward. This can make the heart work harder and can affect how well blood reaches the rest of your body.

Heart valve disease becomes more common with age. Some valve problems are present from birth, and others develop later because of wear and tear, infection, or other heart conditions. It is a common reason for heart check-ups, especially in older adults.

It can affect people of any age. It is most often seen in older adults, people born with a heart valve problem, people who have had rheumatic fever, and people with other heart or kidney conditions. Some people have a valve problem without knowing it until a doctor hears a heart murmur or symptoms appear.

Symptoms

Common symptoms

• Shortness of breath, especially with activity or when lying flat
• Feeling very tired or having less energy than usual
• Dizziness, light-headedness, or fainting
• Chest pain or pressure, often with exertion
• A fluttering, pounding, or irregular heartbeat (palpitations)
• Swelling in the ankles, feet, legs, or abdomen
• Trouble doing activities that used to feel easy

Symptoms in children

• Poor feeding or slow weight gain in babies
• Fast breathing or sweating during feeds
• Tiredness or falling behind in growth
• Blue or grey lips or skin (this needs urgent medical help)
• Fainting or near-fainting, especially with exercise

Symptoms in older adults

• Breathlessness with everyday tasks
• Unusual tiredness or weakness
• Swollen ankles or legs
• Dizziness or falls
• Confusion or feeling more muddled than usual, especially if the heart is failing
• A new heart murmur found during a check-up

Causes

Main causes

• Age-related wear and calcium buildup that stiffens or narrows a valve
• Being born with a valve that has an unusual shape or number of leaflets (congenital valve disease)
• Rheumatic fever after an untreated strep throat infection, which can damage valves over time
• Infection of the heart valve (endocarditis)
• Other heart conditions, such as heart attack, heart muscle disease, or heart failure, that stretch or damage the valve
• Radiation treatment to the chest, certain inflammatory conditions, or kidney disease

Risk factors

• Older age
• Family history of heart valve disease or congenital heart problems
• High blood pressure, high cholesterol, diabetes, or smoking
• Previous rheumatic fever or untreated strep throat
• Previous heart infection or an artificial heart valve
• Poor dental health or gum disease
• Intravenous drug use, which raises the risk of heart infection
• Obesity and low physical activity

When to see a doctor

See a doctor urgently if:

• You have new or worsening shortness of breath, chest pain, fainting, or a very fast irregular heartbeat — seek same-day medical advice or call emergency services if severe.
• You have a known valve problem and develop a fever or feel very unwell — get medical help the same day.
• You have swelling that is getting worse quickly, or you are gaining weight rapidly with breathlessness.

Book a routine appointment if:

• You have a heart murmur that has not been checked.
• You feel more tired or breathless than usual with everyday activities.
• You have palpitations, dizziness, or ankle swelling that keeps coming back.
• You have a family history of valve disease or congenital heart problems and want advice.

Diagnosis

A doctor will ask about your symptoms and health history, listen to your heart with a stethoscope, and check your blood pressure and pulse. If they hear a murmur or have other reasons to suspect a valve problem, they may arrange tests. The main test is an echocardiogram, a painless ultrasound scan that shows the valves and how blood flows through the heart.

Tests that may be done

• Physical exam, including listening to your heart and checking for swelling
• Echocardiogram (heart ultrasound) — the key test for valve shape, movement, and leakage
• Electrocardiogram (ECG) to check the heart's rhythm and electrical signals
• Chest X-ray to look at heart size and the lungs
• Blood tests to check general health and strain on the heart
• Stress test, such as walking on a treadmill, if safe and useful
• Cardiac catheterization (a thin tube guided to the heart) in some cases, especially before surgery
• Transesophageal echocardiogram (a scan through the food pipe) if clearer pictures are needed

What to expect at your appointment

Most tests are quick and not painful. An echocardiogram uses gel and a small probe on your chest. A transesophageal echocardiogram may involve numbing your throat and light sedation. Your care team will explain each test and tell you how to prepare. Results help decide whether you need monitoring, medicines, or valve treatment.

Treatment

Treatment depends on which valve is affected, how severe the problem is, your symptoms, your age, and your overall health. Some people only need regular check-ups. Others need medicines to ease symptoms and protect the heart, and some need a procedure to repair or replace a valve. A heart team will discuss the benefits and risks with you.

Self-care at home

• Keep all appointments for check-ups and heart scans.
• Take any prescribed medicines exactly as directed — ask your pharmacist or doctor if unsure.
• Track symptoms such as breathlessness, swelling, and weight changes if your care team advises it.
• Stay physically active within your limits; ask your doctor what activity is safe for you.
• Keep your teeth and gums healthy, and see a dentist regularly.
• Avoid smoking and get help to quit if needed.
• Ask your doctor whether you need antibiotics before dental or other procedures.

Medical treatments

Medicines cannot repair a faulty valve, but they can help the heart work better and reduce symptoms. Your doctor may prescribe medicines to lower blood pressure, remove extra fluid from the body, slow or steady the heart rate, control an irregular rhythm, or reduce the risk of blood clots. Some people with certain valve problems or artificial valves may be advised to take antibiotics before particular dental or medical procedures. You will have regular follow-up to see if treatment needs to change.

When is surgery considered?

A heart team may recommend valve repair or replacement if symptoms are significant, the valve is severely narrowed or leaking, or the heart is becoming enlarged or weaker. Surgery can be traditional open-heart surgery or a less invasive keyhole procedure through a blood vessel, depending on the valve, your age, and your health. Not everyone with valve disease needs surgery, and the decision is made together with you.

Living with this condition

Most people can carry on with daily life, but you may need to pace yourself and plan rest breaks. Keep an eye on new or worsening breathlessness, swelling, or tiredness, and tell your care team. Regular check-ups help catch changes early. Ask your doctor about work, travel, driving, and exercise if you are unsure.

Lifestyle tips

• Eat a balanced diet with plenty of vegetables, fruit, whole grains, and lean protein; limit salt if your doctor advises it.
• Stay active with walking or other gentle exercise unless your doctor tells you to limit activity.
• Reach and keep a healthy weight if possible.
• Do not smoke, and avoid secondhand smoke.
• Limit alcohol and ask your doctor about safe limits.
• Get enough sleep and manage stress where you can.
• Keep up with dental care and tell your dentist about your valve condition.

Diet and exercise

A heart-friendly diet and regular gentle activity can help your overall health and reduce strain on the heart. If you have swelling or heart failure, your doctor may suggest less salt or a fluid limit. Before starting a new vigorous exercise plan, ask your care team what is safe. Cardiac rehabilitation or supervised exercise can help some people build strength and confidence.

Mental health and emotional wellbeing

It is normal to feel worried, anxious, or low when you learn you have a heart valve problem or while waiting for tests or treatment. Talk to your doctor or nurse about these feelings — support is available. If you ever feel in crisis or unsafe, contact your local emergency services or a crisis support line in your area.

Prevention

Not all heart valve disease can be prevented, especially valve problems you are born with or those caused by aging. But you can lower your risk by managing blood pressure, cholesterol, and diabetes, not smoking, staying active, keeping a healthy weight, and treating strep throat properly. Good dental care and avoiding intravenous drug use also help prevent heart infections.

Vaccines

Ask your doctor whether you should have recommended vaccines, such as flu and other routine vaccinations. Vaccines can reduce the risk of infections that may be harder on people with heart conditions.

Screening programmes

There is no routine screening test for all heart valve disease. A doctor may listen to your heart during a normal check-up and arrange an echocardiogram if you have a murmur, symptoms, or a strong family history. If you have a known valve problem, regular echocardiograms are used to monitor it.

Complications

If left untreated

• Heart failure, where the heart cannot pump blood as well as it should
• Irregular heart rhythms, such as atrial fibrillation
• Blood clots and stroke, especially with certain valve problems or irregular rhythms
• Infection of the heart valve (endocarditis)
• Sudden worsening of breathlessness or fainting
• In rare cases, sudden cardiac arrest

Long-term outlook

Many people with heart valve disease live full and active lives, especially when the problem is found and monitored early. Treatment can relieve symptoms and help protect the heart. If valve repair or replacement is needed, outcomes are often good, and your care team will support you through recovery. Regular follow-up is an important part of staying well.

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