What Is Heart Valve Disease?
The heart muscle isn't the only part of the organ that can malfunction. Here are the most common heart valve conditions—and how symptoms differ from other types of heart disease.
How heart valves work and why they’re so important
Cardiovascular problems like coronary heart disease and heart attacks are common, but not all heart-related diseases occur within the heart muscles or arteries.
Issues can also arise with the heart valves, which need to be flexible and shaped properly. Over and over, with every beat of your heart, they must open fully to allow blood to flow through, and also close fully to prevent leaks. (Follow these tips on how to prevent heart disease.)
How common are heart valve diseases?
About one in 40 Americans, or 2.5 percent, have a diagnosed heart valve disease, according to the Centers for Disease Control and Prevention (CDC).
Sometimes they can be caused by rheumatic heart disease, which is caused by untreated strep bacteria infections and are relatively rare in the U.S. The cases typically occur earlier in life, before age 25. (There were about 3,000 deaths from rheumatic valvular heart disease in the U.S. in 2017.)
You can also be born with heart valve issues, a condition called congenital heart valve disease, but most heart valve diseases occur in older people. (There were about 25,000 deaths from non-rheumatic valvular heart disease in the same year.)
The longer you live, the higher your risk of developing a heart valve disease. As humans age, heart valves accumulate calcium that makes them stiffer, thicker, and less functional than before.
Those who had cancer earlier in life and received chest radiation also face an increased risk, as do people who have been diagnosed with any other heart disease, including congestive heart failure, heart attack, or an arrhythmia, where your heart beats too slow, too fast, or abnormally.
Inside the heart
The heart consists of four chambers, including two atria on the top and two ventricles on the bottom. Blood passes from chamber to chamber through valves made of leaflets, or flaps, that make the blood flow in a one-way “traffic route.”
All heart valves have three leaflets except for the mitral valve, the “door” between the two chambers on the left side of the heart, which has two.
Tricuspid valve: Connects right atrium and right ventricle
Pulmonary valve: Connects right ventricle and the pulmonary artery
Mitral valve: Connects left atrium and left ventricle
Aortic valve: Connects left ventricle and the aorta, the body’s main artery that carries blood away from the heart
In a properly functioning heart, as the muscle contracts and relaxes, valves open and close to allow blood to circulate through the atria and ventricles. Here’s a quick tour of the blood flow within the heart:
As the left ventricle relaxes, the aortic valve closes. The mitral valve opens and blood moves from the left atrium into the left ventricle.
The left atrium contracts and more blood enters the left ventricle.
The left ventricle contracts and the mitral valve closes as the aortic valve opens.
Blood passes through the aorta to the body beyond the heart.
While the left ventricle relaxes, the right ventricle relaxes and the pulmonary valve closes and the tricuspid valve opens. Blood that has returned to the right atrium (deoxygenated or with low oxygen) from the body enters the right ventricle.
While the left ventricle contracts, the right ventricle contracts. The pulmonary valve opens, the tricuspid valve closes and blood leaves the right ventricle to travel to the lungs to reoxygenate.
Types of heart valve diseases
While that’s how a healthy heart functions, what happens when heart valves encounter problems? It can be extremely serious and life-threatening, as any of the three forms of heart valve disease can impact the body’s ability to pump blood throughout the body. (Here are the surprising signs of an unhealthy heart.)
Two of the most frequently-diagnosed heart valve diseases are aortic stenosis and mitral regurgitation, explains Tsuyoshi Kaneko, MD, assistant professor of surgery at Harvard Medical School and a cardiac surgeon at Brigham and Women’s Hospital, Heart and Vascular Center in Boston.
Before we dive into the types of heart valve disease, here’s a brief explanation of some important terms:
Regurgitation: A valve doesn’t close all the way or allows for two-way blood “traffic.” In other words, regurgitation involves a leaky valve, which causes the chambers to work harder to pump the overflow of blood.
Stenosis: A valve’s opening is too narrow, too stiff, or doesn’t open correctly so blood has a tougher time flowing through. The heart muscle must work harder to pump blood that can pass through the valve.
Atresia: A heart valve develops in a way during childhood or before birth that causes blood to take a different, less optimal path through the heart.
Heart valve diseases include:
Mitral valve prolapse
Also known as Barlow’s syndrome, balloon mitral valve, floppy valve syndrome, or click-murmur syndrome, this heart valve disease occurs when the mitral valve doesn’t fully close. Blood may flow back into the left atrium, as a result. Sometimes symptoms like heart palpitations, chest pain, fatigue, cough, or shortness of breath can begin to interfere with daily activities. If so, surgery to fix or replace the mitral valve may be necessary. (Here’s what chest pain that comes and goes means.)
Bicuspid aortic valve disease
This congenital heart valve disease (meaning someone is born with it) involves an aortic valve that has two instead of three flaps. It can take decades for symptoms to appear, and if they do, they may include chest pain, fainting, dizziness, or shortness of breath during intense activity. About four in every five people diagnosed with bicuspid aortic valve disease needs surgery during adulthood to replace the valve.
This type of heart valve disease occurs when one of the heart valves doesn’t open completely, affecting proper blood flow. Fatigue, fainting, dizziness, chest pain, or shortness of breath are the most common possible symptoms. Depending on the severity of this heart valve disease, treatment might not be necessary. If it is, a valvuloplasty is the most frequent option, which involves the use of a balloon to widen the valve. (Here are the foods that improve circulation.)
Also referred to as a leaky valve, this means one of the heart valves doesn’t close fully so blood flows back in against the normal flow of “traffic.” Shortness of breath, heart palpitations, fatigue, lower body swelling, and a cough may be among the symptoms. If these aren’t severe, doctors often take a “wait and see” approach to treatment. If symptoms become more noticeable, medication can help reduce fluid buildup. In some cases, surgery can fix or replace the leaking heart valve.
Symptoms of heart valve diseases
A major challenge of heart valve disease is that many people have it without even realizing it, according to Satjit Bhusri, MD, founder of Upper East Side Cardiology in New York City.
“Some people have no symptoms, yet they can still have a valve problem that needs treatment. Some people suddenly experience very noticeable symptoms, and symptoms don’t necessarily determine the seriousness of a person’s valve problems,” he says. “Valve disease symptoms can also develop very quickly if the condition is severe, although a valve problem can be severe with no symptoms,” he adds.
Many of the most common heart valve diseases start asymptomatic, then progress into a symptomatic state, Dr. Kaneko adds. That’s why the American Heart Association created a Valve Disease Symptom Tracker so patients can check off heart valve-related symptoms and share them more effectively with their doctors.
The signs and symptoms of heart valve disease (if noticeable) are:
A heart murmur or palpitations
Fatigue, light-headedness, or fainting
Extremity swelling, especially in the abdomen, feet, or ankles
Symptoms often get more prominent and impact quality of life more over time. The AHA suggests thinking in terms of a heart valve health scale rather than a “yes” or “no” symptom check-in.
For example, do you feel like you’re gasping for breath after walking a mile or to the end of the driveway? Are you light-headed more than you used to be, feel chronically tired or notice swollen feet or ankles often?
How heart valve disease is diagnosed
Similar to other types of heart disease, there are several tests a doctor might run to potentially diagnose a heart valve disease. First, they will listen for a heart murmur, which often comes along with a heart valve-related condition.
To officially make the diagnosis, a doctor will typically order either an EKG (electrocardiogram), echocardiogram, stress test, chest x-ray, and/or cardiac MRI to measure the heart’s efficiency, ability to pump properly, and the valves’ blood flow.
Treatment options for heart valve diseases
Some people with heart valve disease can lead long, healthy lives. However, treatment is often necessary if the heart’s ability to pump blood properly is impacted.
There are currently medications being researched (the AHA says no medications are proven to stop a valve from leaking), and lifestyle changes can help reduce the severity of some symptoms. If diagnosed, your doctor may recommend trying to find ways to reduce your overall stress levels, following a heart-healthy diet, getting 30 or more minutes of exercise daily, and steering clear of smoking.
For many severe heart valve diseases, “open-heart surgery through full sternotomy has been the golden standard of many decades,” Dr. Kaneko says. “The newest technique, which has become the primary method, involves a minimally-invasive surgery through the groin and into the upper portion of the sternum or through the ribs. Recovery is dramatically shorter than traditional open-heart surgery,” he says.
Once surgery begins, a cardiologist will generally perform a valve repair or a valve replacement.
Overall, the AHA reports that the goal of heart valve disease treatment is to prevent further damage to the heart, mitigate and manage symptoms through medication, fix any issues with malfunctioning valves, and monitor symptoms throughout your life.
Next, discover 30 ways to reduce your risk for heart disease and stroke.
- Tsuyoshi Kaneko, MD, assistant professor of surgery at Harvard Medical School and a cardiac surgeon at Brigham and Women's Hospital, Heart and Vascular Center in Boston
- Satjit Bhusri, MD, founder of Upper East Side Cardiology in New York City
- American Heart Association: "Roles of Your Four Heart Valves"
- University of Rochester Medical Center: "Anatomy and Function of the Heart Valves"
- Centers for Disease Control and Prevention: "Valvular Heart Disease"
- Cleveland Clinic: "Bicuspid Aortic Valve Disease"
- American Heart Association: "Heart Valve Disease Symptom Tracker"
- American Heart Association: "Symptoms of Heart Valve Disease"
- American Heart Association: "Recognizing the Symptoms of Worsening Heart Valve Disease"
- American Heart Association: "Risks for Heart Valve Problems"
- American Heart Association: "Medications for Heart Valve Symptoms"
- American Heart Association: "Understanding Your Heart Valve Treatment Options"