Heart valve disease is a general term for conditions that affect the heart’s efficiency. The four valves within the heart maintain the one-way flow of blood necessary for circulation. When one or more valves become damaged or dysfunctional, the heart must work harder to pump blood, which can lead to significant health issues.
The Role of Heart Valves and Basic Function
The heart functions as a coordinated pump; its four valves act like one-way doors to ensure blood travels in the correct direction through its chambers. These four valves—tricuspid, pulmonary, mitral, and aortic—regulate blood flow. The tricuspid and mitral valves are located between the upper collecting chambers (atria) and the lower pumping chambers (ventricles).
Each valve is composed of thin, strong flaps of tissue called leaflets or cusps that open and close with every heartbeat. When the heart contracts, the valves open fully to allow blood to move forward, and then snap shut to prevent backflow.
The mitral and aortic valves manage oxygenated blood flow to the body. The tricuspid and pulmonary valves manage deoxygenated blood traveling to the lungs for oxygen. When a valve fails, the heart’s pumping efficiency is reduced, placing strain on the muscle and potentially leading to heart failure.
Types of Heart Valve Dysfunction
Heart valve disease primarily involves two mechanical failures that disrupt blood flow. The first is stenosis, where the valve tissue becomes thick, stiff, or fused. This narrowing prevents the valve from opening completely, restricting blood flow. Aortic valve stenosis is a common example, forcing the left ventricle to generate higher pressure to push blood through the narrowed opening.
The second failure is regurgitation, or insufficiency, often described as a “leaky valve.” This occurs when the valve’s leaflets do not close tightly, allowing blood to flow backward into the previous heart chamber. This backflow forces the heart to pump the same blood volume repeatedly, increasing the overall workload.
A specific type of regurgitation, most often seen in the mitral valve, is prolapse, where the valve leaflets are overly flexible and bulge backward. A single valve may exhibit both stenosis and regurgitation, or multiple valves may be affected simultaneously. These failures create turbulent blood flow, detected by a healthcare provider as an abnormal sound called a heart murmur.
Sources of Valve Damage
Heart valve damage can arise from congenital defects (present at birth) or problems acquired later in life. Congenital valve disease develops before birth due to issues in heart formation. The most common congenital defect is a bicuspid aortic valve, which has only two leaflets instead of the usual three.
Acquired valve disease often results from degenerative changes, most commonly age-related calcification. Calcium deposits accumulate on the valve tissue, causing it to stiffen and thicken, frequently leading to aortic stenosis in older adults. Other causes include infectious conditions like endocarditis, an infection of the heart’s inner lining that can severely damage valve tissue.
Past infections, such as untreated strep throat, can lead to rheumatic fever, causing inflammation and scarring of the heart valves. While less common in the United States due to antibiotic use, rheumatic heart disease remains a major cause of valve damage globally. Conditions like high blood pressure, heart attacks, and autoimmune disorders such as lupus also increase the risk of acquired valve disease.
Identifying and Treating the Condition
Many people with heart valve disease do not experience symptoms, especially in the early stages, and the condition may only be discovered when a doctor hears a heart murmur during an exam. When symptoms appear, they are often subtle but can include increasing fatigue, shortness of breath, or swelling in the ankles and feet. Other signs involve dizziness, chest pain, or irregular or rapid heartbeats (palpitations).
The primary diagnostic tool is the echocardiogram, which uses sound waves to create moving images of the heart. This non-invasive test allows doctors to see the valve structure, evaluate how well the leaflets open and close, and determine the extent of any leakage or narrowing. Other tests, such as an electrocardiogram or a chest X-ray, provide additional information about the heart’s electrical activity and overall size.
Treatment is determined by the type and severity of the valve problem, as well as the patient’s overall health. For milder conditions, management involves lifestyle adjustments like adopting a heart-healthy diet and maintaining a healthy weight. Medication can be prescribed to manage symptoms and reduce the heart’s workload, such as diuretics to reduce fluid or vasodilators to lower blood pressure.
When valve dysfunction is severe or symptoms progress, surgical intervention is often necessary to prevent further heart damage. Surgeons first attempt to repair the faulty valve using techniques like patching tears or reshaping the structure. If repair is not possible, the valve must be replaced with a prosthetic one—either a mechanical valve made from durable materials or a biological valve made from animal or human tissue. Minimally invasive procedures, such as transcatheter aortic valve replacement (TAVR), offer replacement options for some patients without traditional open-heart surgery.