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 Heart Valve Disease? Heart valve disease can develop before birth (congenital) or can be acquired sometime during one's lifetime. Sometimes the cause of valve disease is unknown. Congenital valve disease. This form of valve disease most often affects the aortic or pulmonic valve. Valves may be the wrong size, have malformed leaflets, or have leaflets that are not attached correctly. Bicuspid aortic valve disease is a congenital valve disease that affects the aortic valve. Instead of the normal three leaflets or cusps, the bicuspid aortic valve has only two. Without the third leaflet, the valve may be stiff (unable to open or close properly) or leaky (not able close tightly). Acquired valve disease. This includes problems that develop with valves that were once normal. These may involve changes in the structure or your valve due to a variety of diseases or infections, including rheumatic fever or endocarditis.

Rheumatic fever is caused by an untreated bacterial infection (usually strep throat). Luckily, this infection was much more common before the introduction of antibiotics to treat it in the 1950s. The initial infection usually occurs in children and causes inflammation of the heart valves. However, symptoms associated with the inflammation may not be seen until 20-40 years later. Endocarditis occurs when germs, especially bacteria, enter the bloodstream and attack the heart valves, causing growths and holes in the valves and scarring. This can lead to leaky valves. The germs that cause endocarditis can enter the blood during dental procedures, surgery, IV drug use, or with severe infections. People with valve disease can be at higher risk for developing endocarditis.

There are many changes that can occur to the valves of the heart. The chordae tendinae or papillary muscles can stretch or tear; the annulus of the valve can dilate (become wide); or the valve leaflets can become fibrotic (stiff) and calcified. Mitral valve prolapse (MVP) is a very common condition, affecting 1% to 2% of the population. MVP causes the leaflets of the mitral valve to flop back into the left atrium during the heart's contraction. MVP also causes the tissues of the valve to become abnormal and stretchy, causing the valve to leak. However, the condition rarely causes symptoms and usually doesn't require treatment. Other causes of valve disease include: coronary artery disease, heart attack, cardiomyopathy (heart muscle disease), syphilis (a sexually transmitted disease), high blood pressure, aortic aneurysms, and connective tissue diseases. Less common causes of valve disease include tumors, some types of drugs, and radiation.

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 flipflop 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.

How Are Heart Valve Diseases Diagnosed? Your heart doctor can tell if you have heart valve disease by talking to you about symptoms, performing a physical exam, and performing other tests. During a physical exam, the doctor will listen to your heart to hear sounds the heart makes as the valves open and close. A murmur is a swishing sound made by blood flowing through a stenotic or leaky valve. A doctor can also tell if the heart is enlarged or if your heart rhythm is irregular. The doctor will listen to the lungs to hear if you are retaining fluid there, which shows the heart is not able to pump as well as it should. By examining your body, the doctor can find clues about circulation and the functioning of other organs. After the physical exam, the doctor may order diagnostic tests. These may include:

Echocardiography

Heart Disease and the Echocardiogram

An echocardiogram is a test that uses ultrasound to evaluate your heart muscle, heart valves, and risk for heart disease.

Recommended Related to Heart Disease Acute Myocardial Infarcation (Heart Attack) Patient Education Center Visit WebMD's Heart Disease Health Center Newly Diagnosed? Find out more Heart Attack: Get Information From the Cleveland Clinic Cardiac Rehabilitation: Get Information From the Cleveland Clinic Looking for Clinical Trials? Check here Cholesterol Facts Test Your Heart Attack Knowledge Reach Out: Heart... Read the Acute Myocardial Infarcation (Heart Attack) Patient Education Center article > > Why Do I Need an Echocardiogram? Your doctor may perform an echocardiogram to:

Assess the overall function of your heart. Determine the presence of many types of heart disease. Follow the progress of heart valve disease over time. Evaluate the effectiveness of medical or surgical treatments.

What Are the Types of Echocardiograms? There are several types of echocardiograms. Your doctor will help determine which is best for you.

Transthoracic echocardiogram: This is the standard echocardiogram. It is a painless test similar to X-ray, but without the radiation. The procedure uses the same technology used to evaluate a baby's health before birth. A hand-held device called a transducer is placed on the chest and transmits high frequency sound waves (ultrasound). These sound waves bounce off the heart structures, producing images and sounds that can be used by the doctor to detect heart damage and disease. Transesophageal echocardiogram (TEE): This test requires that the transducer be inserted down the throat into the esophagus (the swallowing tube that connects the mouth to the stomach). Because the esophagus is located close to the heart, clear images of the heart structures can be obtained without the interference of the lungs and chest. Stress echocardiogram: This is an echocardiogram that is performed while the person exercises on a treadmill or stationary bicycle. This test can be used to visualize the motion of the heart's walls and pumping action when the heart is stressed. It may reveal a lack of blood flow that isn't always apparent on other heart tests. The echocardiogram is performed just prior and just after the exercise. Dobutamine stress echocardiogram: This is another form of stress echocardiogram. However, instead of exercising to stress the heart, the stress is obtained by giving a drug that stimulates the heart and makes it "think" it is exercising. The test is used to evaluate your heart and valve function when you are unable to exercise on a treadmill or stationary bike. It is also used to determine how well your heart tolerates activity and your likelihood of having coronary artery disease (blocked arteries), and evaluates the effectiveness of your cardiac treatment plan. Intravascular ultrasound: This is a form of echocardiography performed during cardiac catheterization. During this procedure, the transducer is threaded into the heart blood vessels via a catheter in the groin. It is often used to provide detailed information about the atherosclerosis (blockage) inside the blood vessels.

How Should I Prepare for the Echocardiogram?

On the day of the echocardiogram, eat and drink as you normally would. Take all of your medications at the usual times, as prescribed by your doctor. What Happens During the Echocardiogram? During an echocardiogram, you will be given a hospital gown to wear. You will be asked to remove your clothing from the waist up. A cardiac sonographer will place three electrodes (small, flat, sticky patches) on your chest. The electrodes are attached to an electrocardiograph monitor (ECG or EKG) that charts your heart's electrical activity. The sonographer will ask you to lie on your left side on an exam table. He or she will place a wand (called a sound-wave transducer) on several areas of your chest. The wand will have a small amount of gel on the end, which will not harm your skin. The gel is used to help produce clearer pictures. Sounds are part of the Doppler signal. You may or may not hear the sounds during the test. You may be asked to change positions several times during the exam in order for the sonographer to take pictures of different areas of your heart. You may also be asked to hold your breath at times during the exam. You should feel no major discomfort during the test, although you may feel coolness from the gel on the transducer and a slight pressure of the transducer on your chest. The test will take about 40 minutes. After the test, you can get dressed and go about your daily activities. Your doctor will discuss the test results with you. What Should I Do to Prepare for a Stress Echocardiogram? If you are scheduled for a dobutamine stress echo AND you have a pacemaker, please contact your doctor for specific instructions. Your device may need to be checked before the test. On the day of the stress echocardiogram, do not eat or drink anything except water for four hours before the test. Do not drink or eat caffeinated products (cola, chocolate, coffee, tea) for 24 hours before the test. Caffeine will interfere with the results of your test. Do not take any over-the-counter medications that contain caffeine for 24 hours before the test. Ask your doctor, pharmacist, or nurse if you have questions about medications that may contain caffeine. Do not take the following heart medications for 24 hours before your test unless your doctor tells you otherwise, or unless the medication is needed to treat chest discomfort:

Beta-blockers (for example, Tenormin, Lopressor, Toprol, or Inderal) Isosorbide dinitrate (for example, Isordil, Sorbitrate) Isosorbide mononitrate (for example, Ismo, Indur, Monoket) Nitroglycerin (for example, Deponit, Nitrostat, Nitropatches)

Your doctor may also ask you to stop taking other heart medications on the day of your test. If you have any questions about your medications, ask your doctor. Do not discontinue any medication without first talking with your doctor. If you use an inhaler for your breathing, please bring it with you. What Happens During the Echocardiogram? During an echocardiogram, you will be given a hospital gown to wear. You will be asked to remove your clothing from the waist up. A cardiac sonographer will place three electrodes (small, flat, sticky patches) on your chest. The electrodes are attached to an electrocardiograph monitor (ECG or EKG) that charts your heart's electrical activity. The sonographer will ask you to lie on your left side on an exam table. He or she will place a wand (called a sound-wave transducer) on several areas of your chest. The wand will have a small amount of gel on the end, which will not harm your skin. The gel is used to help produce clearer pictures. Sounds are part of the Doppler signal. You may or may not hear the sounds during the test. You may be asked to change positions several times during the exam in order for the sonographer to take pictures of different areas of your heart. You may also be asked to hold your breath at times during the exam. You should feel no major discomfort during the test, although you may feel coolness from the gel on the transducer and a slight pressure of the transducer on your chest. The test will take about 40 minutes. After the test, you can get dressed and go about your daily activities. Your doctor will discuss the test results with you. What Should I Do to Prepare for a Stress Echocardiogram? If you are scheduled for a dobutamine stress echo AND you have a pacemaker, please contact your doctor for specific instructions. Your device may need to be checked before the test. On the day of the stress echocardiogram, do not eat or drink anything except water for four hours before the test. Do not drink or eat caffeinated products (cola, chocolate, coffee, tea) for 24 hours before the test. Caffeine will interfere with the results of your test. Do not take any over-the-counter medications that contain caffeine for 24 hours before the test. Ask your doctor, pharmacist, or nurse if you have questions about medications that may contain caffeine. Do not take the following heart medications for 24 hours before your test unless your doctor tells you otherwise, or unless the medication is needed to treat chest discomfort:

Beta-blockers (for example, Tenormin, Lopressor, Toprol, or Inderal) Isosorbide dinitrate (for example, Isordil, Sorbitrate) Isosorbide mononitrate (for example, Ismo, Indur, Monoket) Nitroglycerin (for example, Deponit, Nitrostat, Nitropatches)

Your doctor may also ask you to stop taking other heart medications on the day of your test. If you have any questions about your medications, ask your doctor. Do not discontinue any medication without first talking with your doctor. If you use an inhaler for your breathing, please bring it with you.

Transesophageal echocardiography Cardiac catheterization (also called an angiogram)

By by conducting some or all of these tests over time, your doctor can also see the progress of valve disease. This will help him or her make decisions about treatment. How Is Heart Valve Disease Treated? Heart valve disease treatment depends on the type and severity of disease. There are three goals of treatment for heart valve disease: protecting your valve from further damage; lessening symptoms; and repairing or replacing valves. Protecting your valve from further damage. If you have valve disease, you are at higher risk for developing endocarditis, a serious condition. People who have had their valve surgically repaired or replaced are also at risk for endocarditis. To protect yourself:

Tell your doctors and dentist you have heart valve disease. You may want to carry an identification card with this information. The American Heart Association website has a bacterial endocarditis wallet card that you may download; or call your local American Heart Association office or the national office at 1-800-AHA-USA1. Call your doctor if you have symptoms of an infection (sore throat, general body aches, fever). Take good care of your teeth and gums to prevent infections. See your dentist for regular visits. Your doctor may recommend that you take antibiotics before you undergo any procedure that may cause bleeding, such as any dental work (even a basic teeth cleaning), invasive tests (any test that may involve blood or bleeding), and most major or minor surgery. The recommendations for which procedures and which types of valve disease need antibiotics have recently changed, so make sure to ask your doctor about the latest recommendations.

Medications. You may be prescribed medications to treat your symptoms and to lessen the chance of further valve damage. Some drugs may be stopped after you have had heart valve surgery to correct the problem. Other medications may need to be taken all your life. Common heart disease drugs may include: Heart disease drugs Diuretics ("water pills") Anti-arrhythmic medications Vasodilators ACE inhibitors Beta blockers What they do Remove extra fluid from the tissues and bloodstream; lessen the symptoms of heart failure Control the heart's rhythm Lessen the heart's work. Also encourages blood to flow in a forward direction, rather than backwards through a leaky valve. A type of vasodilator used to treat high blood pressure and heart failure. Treat high blood pressure and lessen the heart's work by helping the heart beat slower and less forcefully. Used to decrease palpitations in some patients Prolong the clotting time of your blood, if you are at risk for developing blood clots on your heart valve.

Anticoagulants ("blood thinners")

Follow your doctor's orders when taking these heart disease drugs. Know the names of your medications, what they are for, and how often to take them. Keep a list in your wallet or purse with this information. Surgery and other procedures. The diagnostic tests your heart doctor orders help to identify the location, type, and extent of heart valve disease. The results of these tests, the structure of the heart, and your age and lifestyle will help determine the best treatment for you. Surgical options include heart valve repair or replacement. Valves can be repaired or replaced with traditional heart valve surgery or a minimally invasive heart valve surgery. Heart valves may also be repaired by other procedures such as percutaneous balloon valvotomy. Living With Heart Valve Disease When you have heart valve disease, it is important to protect yourself from future heart problems, even if your valve has been repaired or replaced with surgery. Here are some tips to stay healthy:

Know the type and extent of your heart valve disease. Tell all your doctors and dentist you have valve disease. Call the doctor if you have symptoms of an infection. Take good care of teeth and gums. Take antibiotics before you undergo any procedure that may cause bleeding. Carry a wallet card that may be obtained from the American Heart Association with specific antibiotic guidelines. Take your medications. Drugs are used to control symptoms and help the heart pump blood more efficiently. Follow your doctor's instructions about how and when to take medications. See your heart doctor for regular visits, even if you have no symptoms. Appointments may be scheduled once a year or more often, if your doctor feels you need to be followed more closely.