Heart valve disease occurs when one or more of the heart’s four valves—the mitral, aortic, tricuspid, or pulmonary valve—does not open or close normally. These valves function like one-way gates, ensuring that blood moves efficiently through the heart and into the lungs and body. When a valve becomes narrowed or leaky, the heart may have to work harder to maintain normal circulation.
There are two major forms of valve dysfunction. Stenosis occurs when valve leaflets become thickened, stiff, or fused, reducing the size of the opening and restricting blood flow. Regurgitation, also called insufficiency or incompetence, occurs when a valve fails to close completely, allowing blood to flow backward. Some congenital conditions can also produce atresia, in which a valve opening does not form normally.
The causes of valve disease vary considerably. Age-related degeneration is an important cause, particularly of aortic stenosis. With aging, calcium and other tissue changes can make valve leaflets thicker and less flexible. Congenital abnormalities, including a bicuspid aortic valve, in which the aortic valve has two leaflets rather than the usual three, can also lead to valve dysfunction earlier in life.
Infections and inflammatory diseases are additional causes. Infective endocarditis can damage valve tissue and produce persistent leakage. Rheumatic fever, which can follow an inadequately treated streptococcal infection, may cause scarring and distortion of the valves, producing rheumatic heart disease. Other cardiovascular conditions can also contribute. Heart attacks, cardiomyopathy, heart failure, or enlargement of the heart chambers may alter the structures supporting a valve and interfere with its ability to close properly. Connective-tissue disorders, including Marfan syndrome, may similarly weaken supporting tissues.
Symptoms can develop gradually and may initially be mistaken for normal aging or reduced fitness. Common manifestations include shortness of breath, fatigue, weakness, chest discomfort, dizziness, fainting, palpitations, and swelling of the ankles, legs, or abdomen. Breathlessness may become particularly noticeable during exercise or when lying flat. Reduced blood flow can contribute to dizziness or fainting, while abnormal enlargement of the heart chambers may contribute to irregular rhythms such as atrial fibrillation.
A heart murmur—an unusual sound produced by turbulent blood flow—is sometimes the first indication of valve disease. However, a murmur does not automatically mean that a valve is seriously diseased, and some people with significant valve abnormalities have few or no symptoms.
Diagnosis usually begins with a medical history and physical examination, followed by an echocardiogram, the principal imaging test for evaluating heart valves. Echocardiography uses ultrasound to show valve structure, heart size, pumping function, and the direction and speed of blood flow. Depending on the situation, clinicians may also use an electrocardiogram, exercise testing, chest X-ray, CT, MRI, or cardiac catheterization.
Treatment depends on the affected valve, severity of disease, symptoms, and overall health. Mild disease may require only regular monitoring and heart-healthy habits. Medicines can help control blood pressure, fluid retention, abnormal rhythms, or blood-clot risk, although medication generally cannot repair a severely damaged valve. When disease becomes advanced, valve repair or replacement may be necessary. Traditional surgery remains important, while catheter-based procedures such as transcatheter aortic valve replacement (TAVR/TAVI) provide less invasive treatment for selected patients.
With appropriate monitoring and modern treatment, many people with heart valve disease can maintain an active life. Early recognition is important because untreated advanced disease can contribute to heart failure, arrhythmias, stroke, pulmonary hypertension, and other serious complications.Heart Valve Disease: Causes, Symptoms, Diagnosis, and Treatment
