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What is Heart Valve disease?

Heart valve disease is caused by either wear, disease or damage of one or more of the heart’s valves, affecting the flow of blood through the heart. This can cause such symptoms as breathlessness, chest pain, dizziness and fainting. However, if it is diagnosed and treated early, patients can be returned to a good quality of life.

The human heart is a highly efficient pump with four chambers – two upper (the atria) and two lower (the ventricles). Each of those chambers is closed off by a one-way valve. As the heart expands and contracts 100,000 times a day, the four valves open and close in sequence to keep the blood flowing the right way. When the heart valves are diseased, the pumping action of the heart is impeded.

The main types of heart valve disease are:

Valve Stenosis or obstruction: This is primarily due to age-related hardening (calcification) of the aortic valve leading to progressive narrowing . The valve can either be exceptionally narrow (therefore having a “stenosis”) or have a blockage which limits the blood flow through the valve. This may result in a “back-up” of blood behind the valve as if behind a dam, causing the heart to pump inefficiently or building up blood pressure in the lungs. This is most commonly associated with aortic stenosis or mitral stenosis.

Valve Regurgitation or insufficiency: When a valve fails to close completely, the valve itself can become “leaky,” allowing blood to backwash down through the valve (called “regurgitation”). In addition, the valve may not ever completely move the volume of blood to the next appropriate chamber. This condition includes mitral regurgitation and aortic regurgitation.

Symptoms and Diagnosis

Symptoms

Aortic stenosis, the most common form of valve disease, may not always have obvious symptoms (asymptomatic) or may be put down to ‘just feeling old’. Yet at the age of 70 plus, being breathless, having chest pains or feeling dizzy are not necessarily part of ageing or from smoking – they could be a sign of heart valve disease so should be checked out by a GP.

The symptoms of aortic stenosis include shortness of breath, chest tightness and / or pain, fatigue, light-headedness, dizziness, fainting and difficulty exercising.

The symptoms of mitral valve disease occur earlier, generally when patients are in their 40s and 50s, and include fatigue, short of breath and cough.


Diagnosis

Heart valve disease is a treatable condition if diagnosed early. If you are over 65 or think you may have any of the symptoms of heart valve disease, ask your GP for a check-up.

Stethoscope check

Diagnosis starts with a simple step – listening to the heart with a stethoscope. To diagnose heart valve disease, the doctor needs to use a stethoscope to listen for the characteristic heart “murmur” or “click-murmur” which is usually the first indication of a heart valve disorder.

Further investigation

Further diagnostic tests can then be undertaken, ranging from electrocardiography (recording the heart’s electrical activity), through to echocardiography (ultrasound of the heart). These and other more sophisticated diagnostic tests allow doctors to make a more accurate diagnosis of heart valve disease and determine the level of severity.

Help the patient prepare for their trip to the GP or healthcare professional. They may be asked:

When they first noticed their symptoms of breathlessness, chest pains, dizziness, fainting or difficulty exercising. Have they come on suddenly or gradually? Have they worsened since first experienced?

About the impact of the symptoms on the patient’s lifestyle. They may have overlooked signs and symptoms, or believe they are due to the natural ageing process, especially if the valve disease is slowly progressive and only gradually limits their daily activities.

About past medical history of cardiovascular disease, rheumatic fever, connective tissue disorders and any other co-morbidities.

Examination

The healthcare professional will usually:

Check the patient’s pulse rate and rhythm

Take the blood pressure

Auscultate (listen to) the heart for abnormal cardiac murmur using a stethoscope

Treatment options

In the early stages of heart valve disease, when it is less severe and not causing any significant symptoms, it may be best to simply monitor your condition and see how things develop. However, the earlier the diagnosis and treatment of heart valve disease, the better the patient prognosis. Heart valve disease is a very treatable condition if patients suffering from symptoms such as breathlessness, tight chest and dizziness are diagnosed early. So it is important that if you have any of the symptoms or are over 65 years, you ask your GP for a quick stethoscope check. With treatment, people can return to a good quality of life with their friends and family.

Treatment for heart valve disease varies according to how severe the disease, but ultimately the effective ways of overcoming the disease are valve repair or replacement. Great progress has been made recently in less invasive procedures.

A diseased valve can either be repaired or replaced by a surgical procedure which has been proven to be very successful over many decades. More recently, a less invasive procedure called TAVI has become available for those who are considered to be at too high-risk for surgery. Your doctor will be able to advise which is the most appropriate in your case.

Surgical Valve Repair and Replacement

Heart valve surgery has proven to be a very successful method of valve repair or replacement for more than 50 years. The diseased valve may be repaired using a ring to support the damaged valve. This method is more often used for the mitral or tricuspid valves.

Alternatively, the entire valve may be removed and replaced. This procedure can last a few hours. Patients usually remain in hospital for a few weeks and recovery can take around three months. The replacement valve can be either mechanical or made of animal tissue.

There are pros and cons of each type depending on your age and lifestyle. You should discuss with your physicians which valve is most appropriate for you.

Transcatheter aortic valve implantation (TAVI)

Transcatheter aortic valve implantation (TAVI) is a less invasive approach which allows the replacement aortic valve to be inserted via a catheter usually through a small incision in the groin. The valve is positioned in place either through a balloon-inflation or self-expanding method.

TAVI is suitable for patients who are considered inoperable or at higher risk for valve surgery.

The procedure typically lasts up to one hour, and patients are up and walking 24 - 48 hours after the procedure. The typical hospital stay is 3 to 5 days. Because the replacement valve is placed using minimally invasive techniques, patients usually experience a much more rapid recovery than from surgical valve replacement.

For further information on heart valve disease, please see our heart valve disease fact sheet here.


Heart valve disease recovery

Patients will need the support of friends, family or carers during the first few months following surgical valve repair or valve replacement. Patients of a working age who have had surgical procedure usually need to be off work for 12 weeks. Some very elderly patients may need slightly longer to recover.

You may need to ensure that the patient has additional help with routine tasks for a few weeks after treatment. Recovery times are likely to be much shorter following the less-invasive Transcatheter Aortic Valve Implantation (TAVI) procedure, which is for patients who are high surgical risk.

Find out more about the role you play in helping the patient on their recovery pathway in the ‘How will I be involved…’ section!