Heart valve disease: diagnosis and treatment explained

It’s estimated that around 1.5 million people aged 65 or over in the UK have heart valve disease. Early diagnosis is key as the longer a person lives with heart valve disease, the greater their chance of it becoming severe or causing heart failure. 

What is heart valve disease?

Heart valve disease occurs when one or more of the valves in your heart becomes damaged or diseased, affecting the way that blood flows through your heart. 

The valves of your heart make sure that blood flows through its four chambers in one direction. There are also two large blood vessels that leave the heart, which also have valves to stop blood from returning to the heart once it has been pumped out. 

If a valve doesn’t open fully, blood flow is restricted, which is called valve stenosis or narrowing. This means your heart has to pump harder to force blood out, putting extra strain on your heart. 

Alternatively, if the valve won’t close properly, blood can leak backwards into your heart, which is called a leaky valve, valve incompetence or regurgitation. Again, this puts extra strain on your heart as it has to work harder to pump blood. 

What causes heart valve disease?

There are several main causes of heart valve disease, including:

• Ageing
• Congenital heart disease (when you are born with an abnormal valve)
• Cardiomyopathy (a disease affecting heart muscle)
• Damage to the heart from a heart attack
• Previously having had rheumatic fever
• Previously having had endocarditis

What are the symptoms of heart valve disease?

Some common symptoms of heart valve disease include:

• Chest pain or palpitations
• Dizziness
• Difficulty performing physical activities that an average person of your age wouldn’t struggle with
• Shortness of breath
• Swollen ankles, feet or abdomen

Some of these symptoms are associated with other illnesses as well. You should therefore see your GP if you notice any of them so you can get a clear diagnosis. 

What puts you at risk of heart valve disease?

There are several factors that may increase your risk of heart valve disease. The main risk is age, as your heart valves thicken and become stiffer as you get older. This means that regular check-ups with your GP when you are over the age of 65 are important. 

You’re also at greater risk if you have previously had a heart attack or suffered heart failure, or if you have previously been diagnosed with heart valve disease. Intravenous drug use can also increase your risk. 

If you have the risk factors for coronary heart disease you may also be at greater risk of developing heart valve disease. Risk factors include:

• Being overweight and/or having an inactive lifestyle
• Diabetes
• Family history of heart disease
• Insulin resistance
• High cholesterol or high blood pressure
• Smoking

How is heart valve disease diagnosed?

To diagnose heart valve disease, your GP will assess your symptoms and perform an examination, which will include listening to your heart. They will listen for a heart murmur or unusual sounds that could signify a heart valve condition. 

Your doctor may then also order some tests to get a better understanding of what is happening with your heart. Tests can include:

• Blood tests to check for signs of heart problems
• Cardiac MRI scan — this creates a detailed image of your heart
• Chest X-ray to check if your heart is enlarged
• Echocardiogram — this uses sound waves to produce an image of your heart in motion so the structure of your heart and valves can be assessed, as well as the blood flow through your heart
• Electrocardiogram (ECG) — this uses electrodes to measure the electrical impulses from your heart
• Transesophageal echocardiogram — this is similar to an echocardiogram except the doctor will insert a tube down your gullet to get a closer look at your heart valves

Your GP will usually refer you to a cardiologist (a doctor specialising in heart conditions) for these tests as well as any potential treatment. 

How is heart valve disease treated?

Treatment for heart valve disease depends on which valve or valves of the heart are affected, what has caused the damage or disease and how serious your condition is. 

In some cases, treatment will not be needed, although you will have to attend regular check-ups to make sure your condition hasn't worsened. If your condition can be treated with medication, your cardiologist may prescribe you:

• Antiarrhythmics
• Anticoagulants 
• Beta-blockers
• Diuretics

While these medications do not repair your heart valves, they can help control the symptoms of heart valve disease and reduce your chances of complications. 

If your condition is more serious, your cardiologist may suggest surgery to replace or repair the damaged valve, which can include:

• Aortic valve replacement
• Balloon valvuloplasty
• Mitral valve repair
• Mitral valve replacement

It may be possible for you to have a less invasive surgical procedure called a transcatheter aortic valve implantation (TAVI). This is when a new heart valve is fitted by passing it through an artery in the chest or groin and into the heart. This procedure uses only a small cut which reduces the recovery time. 

What happens after treatment?

After treatment, your cardiologist may suggest some lifestyle changes to help support your heart health. This may include:

• Following a healthy diet
• Maintaining a healthy weight and if needed, losing excess weight
• Managing stress
• Quitting smoking
• Regular exercise

You will also need regular follow-up appointments to monitor your recovery and ongoing condition. It’s important that you continue taking medications as prescribed. 

For women, it is important to talk to your doctor before trying for a baby as you may need to change medication, undergo treatment and be monitored closely throughout your pregnancy. In some cases, your doctor may advise against pregnancy due to the risk of complications.