What Is Heart Valve Disease?
A healthy heart circulates blood in a one-way loop, controlled by a system of four valves: the mitral, the aortic, the tricuspid, and the pulmonary. If these valves fail to open or close properly, the heart loses its ability to pump blood throughout the body, eventually starving organs of oxygen and nutrients.
Valves can be improperly formed, scarred, stretched, weakened, or thinned. Supportive structures may loosen or tear. If a valve does not fully close, blood can leak through the opening and go in the wrong direction, which is called regurgitation. Stenosis is when the valve is blocked and does not open correctly. Sometimes a valve neither opens nor closes properly.
"Valvular heart disease is actually one of the most common heart problems," says Paul Stelzer, MD, Professor of Cardiothoracic Surgery. Degenerative diseases, birth defects, connective tissue diseases, trauma, and tumors can all cause valvular heart disease. Other contributing factors are coronary artery disease, trouble with the aorta, and pulmonary hypertension, or elevated pressure in the arteries supplying the lungs.
"We have a lot of collective expertise here," Dr. Stelzer says. "Bringing it together to help individual patients is the best thing about the Mount Sinai approach."
Symptoms of Heart Valve Disease
It is common for individuals with valvular heart disease to have no symptoms. If they do, the symptoms are sometimes attributed to other health conditions. Anyone experiencing one or more of the following symptoms should discuss them with a physician:
- Shortness of breath or difficulty breathing
- Swollen ankles or feet
- Palpitations, or unusual awareness of heartbeat
- Chest pain or pressure
Signs of Heart Valve Disease
During a valvular heart disease examination, physicians will screen for the following:
- Heart murmur or other abnormal heart sounds
- Fluid in the lungs
- Enlarged heart size on examination of the chest
- Distended neck veins
- Swollen liver
Types of Valvular Heart Disease
The heart has four valves, each covered with a set of flaps called leaflets: mitral, aortic, tricuspid, and pulmonary. Every valve is subject to its own set of problems.
Mitral Valve Diseases
Faulty mitral valves are extremely common. For most people, this causes few problems. In others it can be life-threatening.
Also known as mitral incompetence or mitral insufficiency, mitral regurgitation is a valvular heart disease in which one of the heart valves fails to close properly, causing blood to leak through the opening and go in the wrong direction.
People with a history of rheumatic fever, coronary artery disease, heart attack, or a hereditary connective tissue disorder, such as Marfan syndrome, are at increased risk of mitral regurgitation. Mitral regurgitation can lead to mitral valve prolapse, left ventricle enlargement, valve and heart muscle infections, such as endocarditis or myocarditits, or heart failure.
When the opening of the mitral valve narrows, blood flow is limited and the atrium has to work harder. This can potentially lead to heart failure. Mitral stenosis is most commonly a consequence of rheumatic fever, hardening of the leaflets with age, or certain congenital heart defects. Patients may not experience symptoms. Sometimes they may develop an abnormal heart rhythm such as atrial fibrillation.
Mitral Valve Prolapse (MVP)
This common condition can be caused by Barlow's disease, which is an abnormality in the structure of the leaflets of the valves. It can also occur as an occasional consequence of aging, as the leaflets become less elastic. People with certain connective tissue diseases experience fibroelastic deficiency, a condition that affects valve function.
Aortic Valve Diseases
As the population ages, Paul Stelzer, MD, Professor of Cardiothoracic Surgery, is seeing more cases of aortic valve disease in older people.
"Aortic valves are kind of like car valves," he says. "Eventually, they just wear out."
Aortic valve diseases fall within two categories:
When the aortic valve opening narrows, it is harder for blood to push through to the aorta. The ventricle becomes overworked, its walls thicken, and the risk of heart attack or heart failure increases. The valves also become susceptible to infection. Signs and symptoms include fatigue, difficulty breathing, chest pain, and fainting. People with a history of rheumatic fever and those born with certain valve conditions, such as a bicuspid aortic valve, are at higher risk. In older people, the cause is usually a buildup of calcium on the valve leaflets.
Also known as aortic incompetence or aortic insufficiency, aortic regurgitation occurs when blood flows backwards through the aortic valve. People with heart-damaging infections such as rheumatic fever, high blood pressure, and certain birth defects, such as a bicuspid aortic valve, are at higher risk. If regurgitation becomes severe, heart failure may result.
Tricuspid Valve Diseases
The tricuspid valve is on the right side of the heart, between the right atrium and the right ventricle.
Also known as tricuspid incompetence or tricuspid insufficiency, tricuspid regurgitation is a condition in which a leaky tricuspid valve causes blood to move backwards into the right atrium. This puts undue pressure on the atrium walls and the nearby veins, causing them to enlarge. An enlarged atrium can cause abnormal heart rhythms, such as atrial fibrillation. Untreated, tricuspid regurgitation can lead to symptoms of heart failure, including fatigue and swollen legs.
Tricuspid regurgitation is often seen in conjunction with problems on the opposite side of the heart, such as mitral valve disease or left ventricular dysfunction.
Pulmonary Valve Diseases
The pulmonary valve lies between the right ventricle and the pulmonary artery.
When the pulmonary valve leaks, the right side of the heart has to work harder, which can lead to heart failure. Causes include pulmonary hypertension, heart infections such as endocarditis and rheumatic fever, or congenital valvular heart disease.
This valvular heart disease, which obstructs the flow of blood to the heart, is often discovered shortly after birth, but it can also be diagnosed in adults. Doctors listen for a prominent heart sound called a murmur. Children born with the congenital disorders Tetralogy of Fallot and Noonan's syndrome are at increased risk of pulmonary stenosis.