Heart valve disease

Your heart valves

Your blood flows around your heart and the rest of your body in one direction, like a one-way traffic system.

Your heart valves control the direction of your blood flow. They have very small flaps of skin (called leaflets or cusps) that open and close like doors with every heartbeat. They stop the blood flowing backwards. 

There are four valves in your heart:

Stenosis and regurgitation

Heart valve disease is when one or more of your heart valves do not work like they should. There are several types of heart valve disease.

The main problems are caused by the valve not opening fully or the valve not closing properly.

• Valve stenosis or narrowing means the valve does not open fully, it can block or restrict the flow of blood.
• Valve regurgitation, incompetence or leaky valve means the valve does not close fully and the blood can leak back into the heart.
• Valve prolapse means the valve becomes floppy and does not close properly, and blood can leak back into your heart. 

It’s more common to have problems with the aortic and mitral valves.

These problems can put extra strain on your heart and make your heart work harder. Over time, it can increase your risk of having a heart attack or stroke. You may also develop other heart conditions, like arrhythmias.

Causes of heart valve disease

The main causes of heart valve disease are:

• being born with an abnormal valve (congenital heart disease), such as bicuspid aortic valve
• if you’ve had rheumatic fever
• cardiomyopathy, a disease of the heart muscle
• damage to the heart muscle from a heart attack
• getting older
• infection to your heart (endocarditis).

Bicuspid aortic valve

The most common congenital valve problem is bicuspid aortic valve. This is when your aortic valve has only two flaps of skin (called leaflets) that help control blood flow, instead of the usual three.

If you’re diagnosed with a bicuspid aortic valve before or after birth, you should be referred to a specialist.

Symptoms of heart valve disease

Some people with heart valve disease have no symptoms. Other people may have one or more symptoms.

Doctors may hear a heart murmur (a swishing sound) when they listen to your heart with a stethoscope. This could be a sign that you have a heart valve problem.

Common symptoms of heart valve disease are:

• feeling breathless
• chest pain
• feeling weak or dizzy
• discomfort in your chest
• swollen ankles and feet
• being more tired than usual
• a fluttering or pounding feeling in your chest or neck (known as palpitations).

Symptoms can be mild, moderate or severe.

If you have not been diagnosed with heart valve disease and you’re worried about symptoms you have, contact your GP.

When to get help

Call 999 if you:

• have chest pain that does not go away when you rest
• feel like you cannot breathe, even when you rest
• faint and lose consciousness.

Contact your doctor for an urgent appointment if you have:

• symptoms that are getting worse
• new symptoms
• a temperature and there’s no obvious reason why
• sweating, especially at night
• lost weight and there’s no obvious reason why
• been feeling unwell for two to three weeks.

Diagnosing heart valve disease

The most common test to diagnose heart valve disease is an echocardiogram. There are different types of echocardiogram, you may have one or more.

You may also have other tests or scans, such as:

• chest x-ray
• ECG (electrocardiogram)
• blood tests
• cardiac CT scan
• cardiac MRI
• angiogram.

Ask your doctor about the tests they’re recommending you have. They can answer any questions or concerns.

When you’re having a test or scan, ask when and how you’ll get your results.

If the tests show heart valve disease, you will usually be referred to a cardiology team for a specialist assessment.

Support when you’re diagnosed

Many people have good and bad days following a diagnosis. It’s normal to feel anxious, sad or scared about the future.

If you’re feeling anxious or sad more than usual and it’s affecting your daily life, speak to your doctor. You can refer yourself to the NHS for talking therapies, such as cognitive behavioural therapy (CBT) and counselling.

You can also get in touch with Mind, a charity offering support to anyone affected by mental health.

Levels of heart valve disease

When you’re diagnosed with heart valve disease, you may hear your doctor describe it as mild, moderate or severe. Treatment is different for each level.

Mild

Mild heart valve disease is more common.

If your heart valve disease is mild and you have no symptoms, you might not need treatment. Your doctor will usually suggest that you have check-ups, including an echocardiogram, every 3 to 5 years.

Some people with mild heart valve disease will have medicine. This can help your heart work better and improve symptoms.  

Most people with mild heart valve disease have long lives. But it’s important to speak to your doctor if you have any new or worsening symptoms.

Moderate or severe

If your valve disease is moderate or severe with no symptoms, you should have a check-up and echocardiogram every 6 to 12 months.

If you start having new or worsening symptoms, make an appointment with your doctor. This could mean your valve disease is getting worse.

If your heart valve disease is moderate or severe you will usually need treatment. It can feel scary to be diagnosed with severe heart valve disease. Talk to your doctor about what this means for you and your treatment options.

Treating heart valve disease

Your heart valve disease may be treated with medicine, surgery or both.

Medicine

Medicine, also called medical management, can be used to help reduce the workload of your heart. It can help your heart to pump enough blood and oxygen around your body.

They also reduce the risk of your heart being damaged or strained and improve any symptoms you have.

You may be offered medicine if your valve disease is mild, getting worse, or surgery is not an option for you.  

Your doctor will discuss what medicines they’re recommending and why. Find more information on medicines for heart conditions and how to deal with side effects.

Surgery

You may also be offered surgery. There are different types of surgery for heart valve disease.

Surgery will either:

• replace part or all of your heart valve
• repair part or all of your heart valve.

The type of surgery you’re offered will depend on the cause of your valve problem, the effect it’s having on your heart and your quality of life. Your doctor and a specialist team will discuss the possible treatment options with you.

It can take a while to get an appointment for treatment and surgery. It can help to focus on friends and family, or hobbies you enjoy during this time. You can also speak to our cardiac nurses by calling our free Heart Helpline.

Your healthcare team will understand that being diagnosed with heart valve disease and treating it can be hard to deal with. Hospitals usually have a specialist valve service where you can contact somebody, normally a nurse specialist if they have one.

Living with heart valve disease

It’s normal to feel anxious after being diagnosed. You may feel worried about your condition and how it will affect your life. Many people live well with heart valve disease.

You can support your overall health and wellbeing by making healthy lifestyle choices. This can help prevent your condition getting worse and support you to live well.

Healthy lifestyle choices include:

• exercise in a safe way
• maintain a healthy weight
• eat a healthy, balanced diet
• stop smoking
• reduce the amount of alcohol you drink.

Questions to ask your doctor or nurse specialist

It’s important to talk to your doctor and see if there are things you need to avoid. You may want to ask your doctor about:

• exercise
• diet
• school or work
• holidays and flying
• contraception and sex
• driving
• having children
• antibiotics and going to the dentist
• support available to you.

It’s okay to ask questions, even if it feels embarrassing to ask. Healthcare professionals are used to talking about these things and are there to support you.

Exercise

Exercise is important for your overall health and wellbeing. It does not have to be running or going to the gym. Simply adding movement into your day can help keep you healthier for longer. For example, walking or light gardening.

However, there may be some things you cannot or should not do. It’s important to check what exercise is safe for you. You may need to avoid activities where you strain or hold your breath, for example heavy lifting, weight training or swimming.

If you’re having symptoms, like shortness of breath, you may need to change the exercise you do. Be careful when you’re exercising that your symptoms do not get worse.

Speak to your doctor or nurse specialist about your diagnosis. They can explain what you can do or if there is anything you need to avoid.

Pregnancy

If you’re pregnant or planning to have a family, it's important to let your doctor know.

With planning, most people with heart valve disease will not have any complications during pregnancy.

You may need to see a specialist cardiologist if you’re thinking about having children and you have:

• moderate or severe heart valve disease
• bicuspid aortic valve disease
• a prosthetic valve.

If you have valve disease and are considering starting a family, talk to your GP or heart specialist before getting pregnant. They can help make sure you get the care and support you might need.

More information and support

• Read our Heart valve disease booklet for people living with heart valve disease, their family and friends.
• Find information about our heart valve disease research.
• Speak to other people with heart valve disease in our online community.
• Talk to one of our cardiac nurses by calling our Heart Helpline.

Heart Valve Voice is a charity supporting people with heart valve disease. They have information, stories, a symptom tracker and online community.