Heart valve disease
There are four valves inside the heart, and every one of them works like a one-way door: it opens, lets blood through and shuts tight so that none comes back.
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Medicines commonly prescribed for Heart valve disease
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 100 mgActive substance: metoprololManufacturer: Aurovitas Spain, S.A.U.Prescription requiredDosage form: TABLET, 20 mgActive substance: rivaroxabanManufacturer: Teva GmbhPrescription requiredDosage form: TABLET, 15 mgActive substance: rivaroxabanManufacturer: Teva GmbhPrescription required
There are four valves inside the heart, and every one of them works like a one-way door: it opens, lets blood through and shuts tight so that none comes back. Valve disease is what happens when that door either fails to open fully or fails to close properly. The heart then works under an extra load, and for years it does so in silence. Plenty of people learn about their valve by chance, because a doctor heard a murmur, and never need any intervention at all. But some of these lesions eventually reach a point where surgery stops being optional, and catching that moment matters more than anything else.
How the valves work and what goes wrong
Between the atria and the ventricles sit the mitral valve on the left and the tricuspid on the right. At the outlets of the ventricles sit the aortic and the pulmonary. The left-sided pair, aortic and mitral, run into trouble most often, because the blood passing through them is under the highest pressure.
There are two kinds of fault, and they are opposites:
- Stenosis. The leaflets thicken, fuse and gather calcium deposits, and the opening narrows. The heart has to force blood through a slit, the wall thickens and the flow beyond the valve drops.
- Regurgitation, also called incompetence. The leaflets do not meet, and with every beat some blood leaks back. The chamber sitting in front of the valve gradually stretches, because it keeps pumping the same volume twice over.
Mitral valve prolapse deserves its own mention: a leaflet bulges back towards the atrium. On its own it is common and harmless in most people; it starts to matter when that bulging produces appreciable leakage.
The signs that give it away
For years the lesion announces nothing, because the heart compensates for the extra load. Once that compensation runs out, you get:
- breathlessness on exertion and, later, at rest as well, sometimes with an inability to sleep without a high pillow;
- tiring quickly and feeling weak even on the usual chores;
- dizziness, vision greying out and fainting, especially during physical effort;
- pressing chest pain with exercise;
- palpitations, skipped beats, a sense of an uneven rhythm;
- swelling of the ankles and feet, and a distended abdomen;
- in children and teenagers with a congenital defect, poor growth and getting worn out quickly at play.
Fainting on exertion, chest pain and breathlessness together in someone with a murmur make an alarming trio. That combination belongs to severe narrowing of the aortic valve, and it is not the sort of thing that waits for the holidays: the assessment happens within days.
When an ambulance is needed
Call an ambulance (in Spain, Italy, Portugal, Poland and Ukraine the single European number 112 applies) if:
- breathing has suddenly become very hard, the person is gasping and cannot finish a sentence;
- chest pain appears that presses or burns, spreads to the arm, neck or jaw and lasts more than a few minutes;
- the person has lost consciousness;
- the face has suddenly dropped on one side, an arm has gone weak or speech has failed — with a diseased valve a clot can travel to the brain;
- the lips and fingers have turned blue, the breathing bubbles and frothy sputum is coughed up.
Same-day medical attention, though without an ambulance, is warranted if breathlessness is building up, if swelling has risen above the ankles, if the beat has turned irregular, or if someone with known valve disease has had a fever for several days with no obvious cause: that is how an infection of the valve can begin.
Why valves go wrong
The causes depend heavily on the age at which the problem shows up:
- congenital variants, the commonest being a bicuspid aortic valve instead of a three-leaflet one; it works for years but wears out earlier than usual;
- age-related change with calcium laid down on the leaflets, the leading cause of aortic stenosis in older people;
- rheumatic fever after a streptococcal throat infection, which damages the mitral valve years later; worldwide it remains one of the main causes;
- a heart attack that has damaged the structures holding the leaflets;
- cardiomyopathies and enlargement of the chambers: the valve itself is intact, but the ring it sits in has stretched;
- dilatation of the aorta, which stops the aortic valve from closing;
- infective endocarditis, an inflammation of the heart lining in which microbes destroy the leaflets;
- past radiotherapy to the chest.
Smoking, high blood pressure and high cholesterol speed up the calcification of the leaflets — in other words, they act on the valves in much the same way as they act on the arteries.
How the diagnosis is confirmed
The first step is the ordinary stethoscope. A murmur already says a good deal: where it is loudest, which part of the cardiac cycle it falls in, where it radiates. The definitive answer, though, comes from the echocardiogram. It shows which valve is involved, whether the problem is narrowing or leakage, how severe it is, how the chambers are coping and what the pressure is in the pulmonary artery.
An electrocardiogram, a chest radiograph and blood tests are added. If the standard scan leaves the picture unclear, a transoesophageal echocardiogram follows: the probe goes down the gullet and the valves come into close view. That same study is indispensable when endocarditis is suspected. Before an operation, computed tomography and coronary angiography complete the work-up.
Where the lesion is mild, repeat scans are scheduled at intervals ranging from six months to several years. The point of follow-up is not the appointments themselves but catching the moment the valve crosses into the severe range — which can happen before the person feels anything at all.
Watching, medicines, surgery
No tablet repairs a leaflet. Medicines do other jobs: they lower blood pressure and unload the heart, clear retained fluid, slow a rhythm that has become too fast and, in atrial fibrillation or after a mechanical valve replacement, prevent clots from forming. The regimen is chosen by the doctor and depends on which valve is affected: what helps in one lesion can do harm in another.
When the lesion is severe, the decision is made by a team of cardiologists and cardiac surgeons. The options are:
- valve repair — the patient's own leaflets are preserved and reconstructed; wherever it is feasible, this is the preferred route;
- a mechanical prosthesis — it lasts for decades but requires lifelong anticoagulation and regular clotting checks;
- a biological prosthesis — no permanent anticoagulant is needed, but the lifespan of the valve is limited;
- catheter techniques: the valve is delivered through a blood vessel, usually in the groin, with no opening of the chest. This route is chosen when open surgery would be too risky and, as experience accumulates, in a steadily widening range of situations.
After the procedure, review appointments and follow-up scans are needed and, with a mechanical prosthesis, regular clotting tests. Rehabilitation programmes with graded exercise speed up the return to ordinary life.
What is at stake if it goes unwatched
Severe valve disease left alone leads to predictable consequences: heart failure, atrial fibrillation with the stroke risk that comes with it, pulmonary hypertension and, in some people, sudden faints during exertion.
Infective endocarditis stands apart. Microbes circulating in the blood settle on an already abnormal valve and destroy it within weeks. Suspect it when someone with known valve disease or a prosthesis has a persistent fever, shivers, feels weak and sweats without a cold to explain it. Blood cultures in that situation are taken before antibiotics are started, and that point is not negotiable. Prevention is straightforward: do not let your teeth go, see the dentist, clean up cuts properly, and ask your doctor whether an antibiotic is advisable before certain dental procedures.
Pregnancy and the valves
In pregnancy the circulating blood volume and the workload on the heart rise appreciably, and a lesion that had stayed quiet can start to declare itself. That is why, with a known valve problem, pregnancy is planned together with a cardiologist: some things are more sensibly settled before conception, including swapping medicines that are unsuitable in pregnancy and discussing whether the valve should be dealt with first.
Most women with a mild lesion carry a pregnancy and give birth without trouble, given closer monitoring and a birth plan agreed in advance. Special attention goes to anyone with a mechanical prosthesis: adjusting anticoagulation through pregnancy is a specialist's job.
Online consultation
In an online consultation an Oladoctor doctor goes through your situation: asks about your symptoms and how you tolerate exertion, reviews the echocardiogram report you send and translates it into plain language — which valve, stenosis or regurgitation, how severe, and what the numbers in it mean.
It suits the questions that can be planned: how often to repeat the scan, what lies behind the breathlessness that has appeared, what exercise is reasonable, what to ask the cardiac surgeon, how to prepare for dental treatment with a valve problem, how to plan a pregnancy. For a faint, chest pain, sudden severe breathlessness or signs of a stroke, an online appointment is the wrong route — that needs urgent care.
This material is for information only and does not replace medical advice.
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