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Valve disorders


There are several different kinds of valve disorders, and each of them can be classified as mild, moderate or severe. Untreated, they may lead to dizzy spells, shortness of breath, faintness, irregular pulse or serious complications. Fortunately, many valve disorders are treatable with medication, surgery or other medical techniques. Read more about how rheumatic heart disease can damage heart valves or cause them to function improperly.

Types

Valve disorders can be categorized into the following types:

Stenosis (narrowing)

 Sometimes age or disease can prevent heart valves from opening properly. The narrowing of heart valves is known as stenosis. When the opening narrows, the heart cannot push the required amount of blood through the valve. Because stenosis makes the heart work harder to pump the same volume of blood, it may also lead to an increase in the size of the heart muscle. Enlargement of the heart muscle may lead to serious complications.

Pulmonary valve stenosis 

Pulmonary valve stenosis is a narrowing or obstruction that partly or completely blocks the flow of blood. Obstructions can occur in heart valves, arteries or veins. This condition results in the narrowing of the pulmonary valve (which lets blood flow from the right lower chamber of the heart to the lungs).  As a result, the right lower chamber (right ventricle) must pump harder than normal to overcome the obstruction. This may cause stress on, and enlargement of, the right ventricle.

Prolapse (slipping out of place)
In valve prolapse, the valve flaps do not close smoothly or evenly. Instead, they collapse backwards into the heart chamber they are supposed to be sealing off. This sometimes makes a clicking noise and allows a small amount of blood to leak backward through the valve. This group of conditions may be called mitral valve prolapse, click-murmur syndrome, Barlow's syndrome, balloon mitral valve and floppy valve syndrome.

Regurgitation (backward flow)
Another common problem occurs when a heart valve doesn't close securely. This is called regurgitation (or sometimes called valvular insufficiency). This condition reduces the heart's pumping efficiency. When the heart contracts, blood is pumped forward in the proper direction and is also forced backwards through the damaged valve. This not only limits the heart's ability to supply the body with blood, but may also cause lung problems.

Symptoms

Heart valve disorders may cause a variety of symptoms, including

  • Angina (chest pain).  This is often a sign that the heart muscle is not getting enough blood. This may occur because a valve disorder is reducing the heart's ability to pump enough blood to supply the heart muscle. Excessive fatigue can result if the heart isn't able to supply enough blood to meet the needs of the body's cells.
  • Palpitations are irregular heartbeats caused by problems with the heart's electrical system. They can sometimes be the result of heart valve disorders which make the heart work harder and grow larger. As the heart becomes enlarged, its electrical system often begins to malfunction.
  • Shortness of breath is sometimes the result of a narrowing (stenosis) of one of the heart's valves. The heart cannot pump the required amount of blood through the narrowed mitral valve, and this results in a backup of blood in the lungs (similar to a traffic jam caused by a bottleneck). The result is a sensation of breathlessness. If untreated, this may result in a serious medical problem known as heart failure.
  • Swelling can also be a symptom of heart valve disorders. Sometimes valve problems may cause blood to back up in other parts of the body. This may result in fluid buildup and cause swollen hands, wrists, feet and ankles.
Diagnosis

Heart valve disorders can usually be diagnosed based on a description of symptoms and upon physical examination. Often a valve disorder makes a very distinctive murmuring sound, which can be easily heard through a stethoscope. Your doctor may also order some additional tests, including:

Cardiac catheterization
Chest X-ray
Electrocardiogram (ECG/EKG)
Echocardiogram

Treatment

Heart valve problems can be treated in many ways. Your doctor will decide on the best treatment for you based on your age, general health and the severity of your condition. Some patients can be treated with a combination of medications and lifestyle changes. Other patients may need more intensive treatment such as surgical valve repair or replacement.

Medication

Your doctor may prescribe medication to help relieve the symptoms caused by heart-valve disorders.

  • Diuretics
    Diuretics, also known as "water" pills, help lower blood pressure and reduce the workload on your heart.  Read more.

Surgical and other procedures

If your doctor thinks you need surgery for a heart valve disorder, he or she will discuss the operation with you. Then, you can decide whether to go ahead with surgery or not.

Valve repair

  • Valvuloplasty  Surgeons sew the torn flaps of the damaged valve together so that the valve may close properly again.
  • Annuloplasty  Surgeons repair the ring (in medical terms the annulus) which holds the valve in place.
  • Valvulotomy  Surgeons repair a valve flap or annulus.
  • Percutaneous mitral balloon valvotomy  Surgeons insert a catheter into a vein in the right leg and guide it up into the mitral valve. There, a small balloon on the end of the catheter's tip is inflated, opening the blocked valve.

Valve replacement
If heart valves are too badly damaged to be repaired, doctors may recommend surgically replacing the damaged valve. This is a major operation, involving open-heart surgery. The actual operation can last three hours or longer, and patients take several weeks to recover.

Human heart valves may be replaced with mechanical valves, or with specially prepared heart valves from human or animal donors (known as bioprosthetic or tissue valves).

  • Mechanical valves were the first type used in valve replacement surgery. Made of long-lasting metal and plastic, these valves have been refined and improved since their introduction in the 1960s. While mechanical valves are very durable, they do make a clicking noise and they can lead to the formation of blood clots, which may lead to heart attack or stroke. To prevent clot formation, patients with mechanical valves must take blood-thinning medication every day for the rest of their lives. This might have implications for women of childbearing age. Please consult your doctor if this applies to you.
  • Bioprosthetic valves are sometimes called tissue valves and made from specially treated natural valves. These valves come from two sources: human donors and animals. Valves from animal sources (usually cows or pigs) are very similar to those found in the human heart. They are well tolerated by the body, and do not promote clot formation to the same degree as mechanical valves. However, bioprosthetic valves from pigs or cows are usually not as durable as mechanical valves. More than half of patients develop problems within 15 years. In these cases, patients must undergo further surgery. Human heart valves are well tolerated and tend to last longer than animal valves.

Lifestyle

You can lower your risk of heart disease by knowing and controlling your blood pressure, diabetes and blood cholesterol. It is also important to lead a healthy lifestyle by being smoke-free and physically active, eating a healthy diet that is lower in fat, especially saturated and trans fat, achieving and maintaining a healthy weight, limiting alcohol use and reducing your stress.

End-of-life care (palliative care)

Some people living with valve disorders can benefit from end-of-life care (also called palliative care). It can benefit you by offering comfort to you and your family. Learn more about end-of-life care.

If you want to get more information about end-of-life care, talk to your healthcare providers. You can also visit the Public Health Agency of Canada and Health Canada. The Canadian Hospice Palliative Care Association has a directory of end-of-life care services across the country and a caregiver resource list. The Canadian Virtual Hospice has an Ask an Expert Service and a discussion forum where you can talk to end-of-life specialists and people interested in palliative care. The PREPARE website helps you make medical decisions that reflect your values and effectively communicate your wishes with others. TheConversationProject.org has a starter kit to help you and your family to talk about your wishes for end-of-life.

Related information

To find useful services to help you on your journey with heart disease, see our list of government and community agencies.

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