Valvular heart disease

Valvular heart disease means that the valves of the heart are not working well. The heart has four valves—the aortic, mitral, pulmonic, and tricuspid valves. These valves help control the flow of blood.

Sometimes valves stop working properly because of aging, being born with a heart condition, or because of certain illnesses like rheumatic heart disease.

When a heart valve doesn’t work right, it can make the heart less efficient. Doctors can often treat these problems with medicine. In more serious cases, they might need to fix or replace the valve during surgery. This can help the heart work better again. Learning about how these valves work is important for keeping the heart healthy.

Classification

Valvular heart disease means there are problems with the heart's valves. These valves help control the flow of blood. The main problems are stenosis, when a valve gets narrow and slows down blood flow, and insufficiency (or regurgitation), when a valve does not close well and lets blood flow backward.

The aortic and mitral valves, on the left side of the heart, are more often affected than the pulmonary and tricuspid valves on the right side. This is because the left side of the heart works with higher pressure. For example, aortic stenosis happens when the valve gets thicker and makes it hard for blood to leave the heart. This can be due to aging or birth defects. Aortic insufficiency happens when the valve does not close well, sometimes because of diseases that change the heart's structure.

Mitral stenosis, which makes the mitral valve narrower, is often caused by old infections. Mitral insufficiency can happen when the heart stretches and moves the parts that control the valve.

Pulmonary and tricuspid valve problems are less common, especially in adults. Pulmonary valve stenosis is usually there from birth and may get worse with age. Pulmonary insufficiency is often mild and not a problem unless it is caused by medical procedures or other diseases. Tricuspid stenosis is rare and usually linked to birth defects or other conditions, while tricuspid insufficiency can happen when the right side of the heart stretches.

Signs and symptoms

People with aortic stenosis might feel short of breath when doing things, feel pressure in their chest, or suddenly lose consciousness. Doctors might hear certain sounds in the heart when listening with a stethoscope.

Those with aortic regurgitation can also feel short of breath and pressure in their chest. In sudden cases, they might look pale and feel weak.

People with mitral stenosis may get short of breath, feel fluttering in their chest, or have pain. Doctors often hear loud sounds in the heart when listening with a stethoscope.

Those with mitral regurgitation might feel short of breath and have fluid build-up in their lungs. Doctors might hear specific sounds in the heart when listening with a stethoscope.

People with tricuspid regurgitation often have swelling in their legs, belly, or liver area and might feel pressure in their neck veins. Doctors might hear certain sounds in the heart when listening with a stethoscope.

Causes

Calcification of the aortic valve leaflets is common as people get older. This happens because of extra fats and inflammation, not just from aging. It is the main reason for aortic stenosis, especially in people with a certain type of aortic valve. Conditions like high blood pressure, diabetes, high cholesterol, and kidney problems can make this happen faster.

Some heart valve problems are present from birth. For example, tetralogy of Fallot is a birth defect that affects the pulmonary valve, and Ebstein's anomaly affects the tricuspid valve. Having a bicuspid aortic valve, which has two pieces instead of three, is also a birth condition that can cause problems later in life.

Certain diseases of the body's connective tissues, like Marfan's Syndrome, can cause heart valve issues. Inflammation of the heart valves, known as valvular endocarditis, can be due to infections, cancer, or autoimmune diseases. One major cause of valve problems is rheumatic heart disease, which follows a throat infection caused by bacteria. This can damage the mitral valve, and sometimes the aortic valve too. While this was common in the past, better medicine and living conditions have reduced it in many places. However, it still affects people in some developing countries.

Diagnosis

Aortic stenosis

People with aortic stenosis might sometimes have changes on a chest X-ray, like more space around the heart, but often the X-ray looks normal. Special tests like an ECG can show changes in the heart’s muscles. The best test is an echocardiogram. This test shows details like calcium build-up and how the heart valves are working.

Aortic regurgitation

A chest X-ray might not always show problems, but sometimes it can show changes in the heart’s structure. An ECG can show changes in the heart’s muscles, and an echocardiogram is helpful to see what is causing the problem. This test shows how well the heart is pumping and can detect backward flow of blood.

Mitral stenosis

A chest X-ray often shows a larger left atrium and sometimes bigger blood vessels in the lungs. An ECG can show changes in the left atrium. An echocardiogram helps to measure how narrow the valve is and can show calcium build-up and pressure differences across the valve.

Mitral regurgitation

A chest X-ray might show a larger left atrium and congestion in the lung’s blood vessels. It can also show calcium build-up in some cases. An ECG often shows changes in the left atrium and sometimes the right atrium. An echocardiogram is useful to see the backward flow of blood and to check the valve’s condition. Severe cases need closer monitoring with echocardiograms every few months.

Epidemiology

In the United States, about 2.5% of people have problems with their heart valves. These problems become more common as people get older. For example, about 13% of people who are 75 years old or older have such issues.

In some parts of the world, a heart condition called rheumatic heart disease is the main reason for valve problems. It can cause many of these issues in those areas.

Mitral stenosis is mainly caused by rheumatic heart disease and happens in about 0.1% of people in the United States. It is also the most common valve problem during pregnancy.

Special populations

Pregnancy

When someone with heart valve problems becomes pregnant, doctors need to watch closely. Pregnancy makes the body work harder, with more blood flowing through the heart. This can be tough on the heart, especially if there are problems with the valves.

Doctors pay special attention to certain heart valve issues during pregnancy because they can be risky. Careful planning and monitoring help keep everyone safe.