Heart Valve Disease: Symptoms, Causes & Treatment

Heart valve disease is a condition affecting one or more of the heart's four valves: aortic, mitral, pulmonary, and tricuspid. Each valve allows blood to flow in one direction only; when a valve malfunctions, it either narrows (stenosis), restricting blood flow, or leaks (regurgitation), allowing blood to flow backward, forcing the heart to work harder.

Valve disease can be congenital (present from birth) or acquired (developing over time due to infection, high blood pressure, or atherosclerosis). Symptoms range from mild to severe and may not appear in early stages. In Jordan and the Middle East, rheumatic valve disease (resulting from acute rheumatic fever) affects an estimated 2–3 per 1,000 people in some areas, especially among those who did not receive complete treatment for streptococcal infection.

Diagnosis relies on clinical examination and echocardiography; treatment ranges from medications that relieve symptoms and prevent complications, to medical procedures (balloon or catheter interventions), and possibly surgery to repair or replace the damaged valve.

Symptoms may not appear in early stages of valve disease, especially if the defect is mild. As the condition progresses, patients may experience multiple symptoms that worsen with stress or physical exertion. Symptoms vary slightly depending on which valve is affected, but common signs include:

• Shortness of breath (especially during exertion or when lying down).
• Chest pain or pressure.
• Heart palpitations (irregular, rapid, or skipped heartbeats).
• Extreme fatigue and weakness, even with light activity.
• Swelling in the legs, ankles, and feet.
• Dizziness and fainting in severe cases.
• Fluid accumulation in the lungs (causing dry cough).
• Sudden weight gain (due to fluid retention).
• Abdominal pain (when fluid accumulates in the liver and abdomen).
• Low-grade fever (especially in bacterial inflammation cases).

• Rheumatic Fever: Untreated bacterial infection leading to valve inflammation and scarring over time; the primary cause of valve disease in developing nations.
• Age and Calcification: Calcium deposits accumulate on the aortic valve with age, causing gradual narrowing.
• Heart Attacks: Damage to the heart muscle from coronary artery blockage may affect valve function.
• Chronic High Blood Pressure: Increases heart workload, causing chambers to enlarge gradually and valves to leak.
• Congenital Defects: Some people are born with a bicuspid aortic valve (two leaflets instead of three), increasing disease risk.
• Bacterial Heart Infection (Endocarditis): Bacteria damage valves directly, causing permanent abnormalities.
• Pregnancy and Hormonal Periods: Hormonal changes increase heart workload and may worsen existing valve disease.
• Medications and Treatments: Some weight-loss drugs (especially those containing certain antidepressants) have been linked to valve damage.

• Family history of heart disease and valve disorders.
• Age over 60 years (higher risk for aortic stenosis).
• Existing valve disease or previous treatment for rheumatic fever.
• Uncontrolled high blood pressure.
• Previous heart attack.
• Obesity and sedentary lifestyle.
• Smoking and alcohol abuse.
• Chronic kidney disease or kidney failure.
• High cholesterol and triglyceride levels.
• Previous history of bacterial endocarditis, regardless of treatment outcome.

Diagnosis begins with a thorough clinical examination and listening to the heart with a stethoscope. The doctor may hear abnormal sounds (heart murmurs) indicating abnormal blood flow. Additional tests are then usually ordered to confirm the diagnosis and assess severity:

• Electrocardiogram (ECG): Records the heart's electrical activity; may reveal chamber enlargement or arrhythmias.
• Echocardiography (Ultrasound of the Heart): The gold standard for diagnosing valve disease; shows valve size, movement, and degree of leakage. The doctor measures blood flow velocity across the valve (normal <2.5 m/s for aortic valve; normal pressure gradient between chambers near zero).
• Chest X-ray: Reveals heart enlargement or fluid accumulation in the lungs.
• Cardiac Catheterization: A minimally invasive procedure where a thin tube is threaded through blood vessels to measure pressure and observe blood flow directly; usually in complex cases.
• Stress Test: Assesses heart performance under exertion, especially before surgery.
• Cardiac MRI or CT Scan: May be ordered in certain cases for detailed imaging.

Medications

• Diuretics: Reduce fluid retention and relieve swelling and shortness of breath.
• ACE Inhibitors: Reduce the heart's workload and dilate blood vessels.
• Beta Blockers: Slow heart rate and lower blood pressure.
• Anticoagulants: Such as warfarin or direct oral anticoagulants, prevent blood clots in certain cases (especially with arrhythmias).
• Aspirin and Pain Relievers: May be given in certain cases to reduce inflammation or chest pain.

Procedures / Surgery

• Balloon Valvuloplasty: A minimally invasive procedure where a catheter with a balloon is threaded through blood vessels to the stenotic valve, then inflated to widen it. Particularly useful for mitral stenosis.
• Surgical Valve Replacement: Removal of the damaged valve and replacement with a mechanical valve (durable, lasts long but requires lifelong blood thinners) or a biological valve (from animal or human tissue; safer for blood but may need replacement after 10–15 years).
• Surgical Valve Repair: Attempts to repair the valve rather than replace it; usually the first choice when feasible.
• Commissurotomy: An older procedure to open a stenotic valve by incision; now largely replaced by modern techniques.
• Transcatheter Valve Replacement: A modern procedure using a catheter to insert a new valve through blood vessels without opening the chest; a good option for elderly and high-risk patients.

Lifestyle Changes

• Reduce salt and saturated fats; eat a healthy diet rich in fiber, vegetables, and fruits.
• Exercise regularly with mild-to-moderate activities (such as brisk walking); avoid strenuous sports unless approved by your doctor.
• Regularly control blood pressure, diabetes, and cholesterol.
• Avoid smoking, alcohol, and excessive caffeine.
• Maintain a healthy weight.
• Take medications consistently and keep all appointments.
• Monitor symptoms and see your doctor if any changes occur.
• In cases of bacterial infection, take preventive antibiotics before certain medical procedures.

• Atrial Fibrillation: A dangerous irregular heartbeat that can cause strokes if not treated with anticoagulants.
• Heart Failure: The heart's inability to pump enough blood to supply the body, causing lung congestion and limb swelling.
• Stroke: Blood clots may form in the heart and travel to the brain, especially in cases of atrial fibrillation.
• Bacterial Endocarditis: A bacterial infection of the damaged valve that can be life-threatening if not treated promptly.
• Blood Clots (Thromboembolism): May occur, especially with mechanical valves and atrial fibrillation.
• Sudden Cardiac Death: In severe and advanced cases, sudden heart stoppage can occur.
• Cardiac Hypertrophy: The heart's attempt to compensate for the defect may cause muscle enlargement and progressive weakness.
• Pulmonary Edema (Fluid in Lungs): Fluid accumulation in the lungs causes severe shortness of breath and may be life-threatening.

• Promptly treat bacterial infections (especially streptococcal throat infection) and complete the full course of antibiotics.
• Regularly manage high blood pressure through medications and diet.
• Avoid smoking, alcohol, and drugs, as they are strong risk factors for heart disease.
• Exercise regularly and moderately (150 minutes weekly of light-to-moderate activity).
• Maintain a healthy weight and reduce dietary fat and salt.
• Have periodic heart checkups if you have a family history or risk factors.
• Take preventive antibiotics before certain medical procedures if you have a history of valve disease.
• Control diabetes and high cholesterol.
• Avoid psychological stress and get adequate sleep.
• Stay up-to-date with seasonal flu and pneumonia vaccinations, as they reduce infection risk.