Heart Valve Diseases

What Is Heart Valve Disease?

Heart valve disease occurs when the heart valves do not work the way they should.

How Do Heart Valves Work?

Your heart valves lie at the exit of each of your four heart chambers and maintain one-way blood flow through your heart. The four heart valves make sure that blood always flows freely in a forward direction and that there is no backward leakage.

Blood flows from your right and left atria into your ventricles through the open tricuspid and mitral valves.

When the ventricles are full, the tricuspid and mitral valves shut. This prevents blood from flowing backward into the atria while the ventricles contract.

As the ventricles begin to contract, the pulmonic and aortic valves are forced open and blood is pumped out of the ventricles. Blood from the right ventricle passes through the open pulmonic valve into the pulmonary artery, and blood from the left ventricle passes through the open aortic valve into the aorta and the rest of the body.

When the ventricles finish contracting and begin to relax, the aortic and pulmonic valves shut. These valves prevent blood from flowing back into the ventricles.

This pattern is repeated over and over with each heartbeat, causing blood to flow continuously to the heart, lungs, and body.

What Are the Types of Heart Valve Disease?

There are several types of heart valve disease:

Valvular stenosis. This occurs when a heart valve doesn't fully open due to stiff or fused leaflets. The narrowed opening may make the heart work very hard to pump blood through it. This can lead to heart failure and other symptoms (see below). All four valves can develop stenosis; the conditions are called tricuspid stenosis, pulmonic stenosis, mitral stenosis, or aortic stenosis.

Valvular insufficiency. Also called regurgitation, incompetence, or "leaky valve," this occurs when a valve does not close tightly. If the valves do not seal, some blood will leak backwards across the valve. As the leak worsens, the heart has to work harder to make up for the leaky valve, and less blood may flow to the rest of the body. Depending on which valve is affected, the condition is called tricuspid regurgitation, pulmonary regurgitation, mitral regurgitation, or aortic regurgitation.

What causes valve disease?

A person can be born with valve disease (congenital) or develop a problem later in life (acquired). Sometimes the cause of valve disease may be unknown.

Congenital valve disease

Congenital valve disease develops before birth. Common problems that cause this type of valve disease are abnormal valve size, leaflets that are not properly formed, and abnormal leaflet attachment. This most often affects the aortic or pulmonic valve.

Bicuspid aortic valve disease is a type of congenital valve disease that affects the aortic valve. The valve has two leaflets (cusps) instead of three. Without the third leaflet, the valve may be:

stenotic - stiff valve leaflets that can not open or close properly

leaky - not able close tightly (regurgitant).

Normal aortic valve

Normal aortic valve - three leaflets

Bicuspid aortic valve

Bicuspid aortic valve - two leaflets

This occurs more frequently in some family members. At least 25 percent of the patients with this disease have a larger than normal aorta above the valve (aortic root). Bicuspid aortic valve disease affects about 2 percent of the population.

Acquired valve disease

Acquired valve disease includes problems that develop with valves that were once normal. Acquired disease can be the result of infection, such as infective endocarditis and rheumatic fever. It can also be caused by changes in the valve structure, such as stretching or tearing of the chordae tendineae or papillary muscles, fibro-calcific degeneration or diliatation of the valve annulus. Sometimes the cause of acquired valve disease is unknown..

What Are the Symptoms of Heart Valve Disease?

Symptoms of heart valve disease can include:

Shortness of breath and/or difficulty catching your breath. You may notice this most when you are active (doing your normal daily activities) or when you lie down flat in bed. You may need to sleep propped up on a few pillows to breathe easier.

Weakness or dizziness. You may feel too weak to carry out your normal daily activities. Dizziness can also occur, and in some cases, passing out may be a symptom.

Discomfort in your chest. You may feel a pressure or weight in your chest with activity or when going out in cold air.

Palpitations. This may feel like a rapid heart rhythm, irregular heartbeat, skipped beats, or a flip-flop feeling in your chest.

Swelling of your ankles, feet, or abdomen. This is called edema. Swelling in your belly may cause you to feel bloated.

Rapid weight gain. A weight gain of two or three pounds in one day is possible.

Symptoms of heart valve disease do not always relate to the seriousness of your condition. You may have no symptoms at all and have severe valve disease, requiring prompt treatment. Or, as with mitral valve prolapse, you may have noticeable symptoms, yet tests may show the valve leak is not significant.

When to Call Your Doctor

Call your physician if you develop persistent shortness of breath, palpitations or dizziness.