What Are Heart Valve Diseases?

We can think of the heart valves as the one-way doors of our home: as blood flows from one chamber to another the valve opens, and when the blood tries to leak back it closes and blocks the way. Our heart has four valves that work in this way: the mitral, aortic, tricuspid and pulmonary valves. I have covered, and will continue to cover, the surgical treatment of valve diseases and the methods we use in functional valve insufficiency in separate articles; in this article I will explain what is actually meant by heart valve disease, its causes and how it is recognised.

What Is Meant by Heart Valve Disease?

Imagine a door: either its hinges have stiffened, it cannot open fully and passing through becomes difficult, or it does not close completely and something is constantly leaking through the gap. The situation is the same with the heart valves. If the valve stiffens and cannot open fully, we call this narrowing (stenosis); as the blood struggles to pass through this narrowed opening, the heart is forced to use more energy to push it. If the valve leaflets cannot close completely and blood leaks backwards, we call this insufficiency (leakage, regurgitation); in this case the heart tires unnecessarily because it is trying to pump both the forward- and backward-flowing blood, and it begins to enlarge because of the blood that pools. If left untreated, both conditions can over time tire the heart muscle and lead to heart failure.

What Are the Causes of Heart Valve Diseases?

Age-Related Calcification (Degenerative): Narrowing that develops as a result of calcium build-up on the aortic valve, particularly at an advanced age, is today the most common cause of valve disease we encounter. Congenital Structural Differences: Some people are born with an aortic valve that has two leaflets instead of three (bicuspid aortic valve); over time this structure may predispose to narrowing or insufficiency at an earlier age. Sequelae of Rheumatic Fever: This is the permanent damage caused to the heart valves through the immune system by throat infections contracted in childhood and not adequately treated; it is still an important cause of valve disease in developing countries. Valve Infection (Infective Endocarditis): Microbes that reach the heart through the bloodstream may settle on the valve surface and destroy the leaflets; this condition usually progresses rapidly and requires urgent assessment. Functional Causes: This is the situation in which the valve itself is normal but cannot close completely because the heart chamber has enlarged or weakened; I have addressed this subject in detail in a separate article.

What Are the Symptoms? When Should We Suspect It?

The most challenging aspect of heart valve diseases is that they can progress for a long time without giving any symptoms; in many of our patients the first finding is a murmur heard with the stethoscope during a routine examination. As the disease progresses, shortness of breath (especially on exertion), tiring easily, palpitations, chest pain, swelling of the feet or sudden fainting episodes may be seen. The appearance of these symptoms may be a sign that the valve disease has now begun to affect the function of the heart as well, and it must be assessed without losing time.

How Do We Screen and Diagnose?

The first step is hearing a murmur when we listen with the stethoscope during the examination; however, not every murmur means disease, so we perform echocardiography (imaging the heart with ultrasound) in every patient in whom we have a suspicion. This examination shows us clearly how far the valve opens and closes, whether there is any leakage and the overall function of the heart. We recommend screening echocardiography particularly in the following groups: those in whom a murmur is detected on examination, those with a family history of congenital valve disease (for example bicuspid aortic valve) or of sudden death at a young age, those who had rheumatic fever in childhood, and those with unexplained shortness of breath or palpitations.

Frequently Asked Questions

Does hearing a murmur always mean valve disease? No. Some murmurs are harmless (innocent murmurs) and require no treatment. The distinction is clarified with echocardiography.

Can valve disease be treated with medication? In mild valve disease, regular follow-up is sufficient; in progressive or advanced narrowing and insufficiency, surgical or interventional treatment comes onto the agenda. I address this subject in detail in separate articles.

I had rheumatic fever in childhood, am I at risk? Yes, this history increases the risk of valve disease; for this reason we recommend following up these patients with regular echocardiography.

If bicuspid aortic valve runs in the family, should I be screened too? Yes, congenital valve differences can be familial; we recommend screening echocardiography for first-degree relatives.

In Summary

Heart valve disease is a condition that arises when the valves either cannot open fully (narrowing) or cannot close completely (insufficiency); it often progresses silently but tires the heart over time. It may have many different causes, from age-related calcification to congenital differences, and from rheumatic fever to infection. The way to detect it early is through regular examination and, when necessary, echocardiography.

If a murmur has been detected during your examination, if you have shortness of breath or palpitations, or if there is a history of valve disease in your family, you can make an appointment for a detailed echocardiographic assessment.

References

1. Iung B, Vahanian A. Epidemiology of Acquired Valvular Heart Disease. Can J Cardiol. 2014;30(9):962-970.
2. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease. Circulation. 2021;143(5):e72-e227.
3. Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS Guidelines for the Management of Valvular Heart Disease. Eur Heart J. 2022;43(7):561-632.
4. Marijon E, Ou P, Celermajer DS, et al. Prevalence of Rheumatic Heart Disease Detected by Echocardiographic Screening. N Engl J Med. 2007;357(5):470-476.