Heart Valve Diseases: Symptoms, Diagnosis, and Treatment

Heart Valves and Their Functions

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The heart consists of four chambers (two atria, two ventricles) and four valves. Valves act as one-way gates that ensure blood flows in one direction:

Aortic Valve

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• Located between the left ventricle and aorta (main artery)
• Controls blood pumping to the body
• Most commonly affected valve

Mitral Valve

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• Located between the left atrium and left ventricle
• Allows passage of oxygenated blood from the lungs
• Second most commonly affected valve

Tricuspid Valve

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• Located between the right atrium and right ventricle
• Allows passage of deoxygenated blood returning from the body

Pulmonary Valve

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• Located between the right ventricle and pulmonary artery
• Controls blood pumping to the lungs

Types of Heart Valve Diseases

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Valve diseases are examined in two main categories:

Valve Stenosis

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Valve leaflets stiffen or fuse, restricting opening. Blood flow becomes difficult and the heart must work harder.

Aortic Stenosis:

• Most common valve disease
• Due to aging, calcification, or congenital bicuspid valve
• Severe cases cause chest pain, fainting, shortness of breath
• Can be fatal within 2-3 years if untreated

Mitral Stenosis:

• Usually develops after rheumatic fever
• Still common in Turkey
• Shortness of breath, palpitations, atrial fibrillation risk

Valve Regurgitation

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Valve doesn’t close completely, blood leaks backward. Heart must pump both forward and backward.

Mitral Regurgitation:

• Most common valve regurgitation
• Mitral valve prolapse, ischemic heart disease, infective endocarditis
• Fatigue, shortness of breath, palpitations

Aortic Regurgitation:

• Aortic valve doesn’t close completely
• Hypertension, aortic root dilation, infection
• Palpitations, shortness of breath, chest pain

Tricuspid Regurgitation:

• Usually secondary to left heart diseases
• Leg swelling, abdominal swelling, fatigue

Causes of Heart Valve Diseases

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Degenerative (Age-Related)

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• Stiffening and calcification of valve leaflets with age
• Most common cause especially in aortic stenosis
• Frequency increases after age 65

Rheumatic Heart Disease

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• After untreated streptococcal throat infection
• Particularly affects the mitral valve
• Still an important cause in developing countries
• Continues to be seen in Turkey, though decreasing

Congenital

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• Bicuspid aortic valve (two leaflets)
• Two leaflets instead of normal three
• Early aortic stenosis or regurgitation

Infective Endocarditis

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• Bacterial infection on the valve
• Intravenous drug use, dental infections, prosthetic heart valve
• Requires emergency treatment

Myocardial Infarction (Heart Attack)

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• Mitral regurgitation due to papillary muscle damage
• Can be acute or chronic

Other Causes

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• Marfan syndrome
• Systemic lupus erythematosus
• Carcinoid syndrome
• Radiation therapy
• Certain medications

Symptoms

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Valve diseases may not cause symptoms for a long time when progressing slowly. Symptoms usually appear as the disease advances:

Common Symptoms

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• Shortness of breath: During exertion or when lying down
• Fatigue: Unusual weakness
• Palpitations: Irregular or rapid heartbeat
• Chest pain: Especially during exertion
• Dizziness or fainting: Especially in aortic stenosis
• Ankle swelling: Sign of right heart failure

Serious Symptoms (Require Emergency Care)

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• Sudden and severe shortness of breath
• Fainting with chest pain
• Pink frothy sputum (pulmonary edema)
• Fever with new murmur (endocarditis suspicion)

Diagnostic Methods

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Physical Examination

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• Listening to heart sounds with stethoscope
• Detection of murmur
• Location, timing, and intensity of murmur evaluated

Echocardiography (Heart Ultrasound)

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The cornerstone of diagnosis:

• Transthoracic echocardiography (TTE): Done through chest wall
• Transesophageal echocardiography (TEE): Through esophagus, more detailed imaging
• Valve structure, movement, degree of stenosis/regurgitation
• Heart chamber sizes and function
• Pulmonary pressure estimation

Electrocardiogram (ECG)

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• Heart rhythm assessment
• Atrial fibrillation detection
• Left ventricular hypertrophy findings

Chest X-ray

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• Heart size
• Pulmonary congestion
• Valve calcification

Cardiac MRI

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• Detailed heart structure and function
• Precise measurement of regurgitation volume
• Myocardial fibrosis assessment

Cardiac Catheterization

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• Coronary artery disease evaluation (before surgery)
• Pressure measurements
• Definitive determination of stenosis degree

Treatment Approaches

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Treatment is determined based on disease type, severity, and patient condition:

Medical Treatment (Medication)

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Doesn’t treat valve disease but controls symptoms:

• Diuretics: Reduce fluid accumulation
• Beta blockers: Control heart rate
• ACE inhibitors/ARBs: Lower blood pressure
• Anticoagulants: Prevent clot formation (especially in AF)
• Antiarrhythmics: Control rhythm disorders

Surgical Valve Repair

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Preferred when possible, especially for mitral valve:

Advantages:

• Own valve is preserved
• Anticoagulant need is reduced
• Better long-term outcomes

Repair Techniques:

• Valve ring (annuloplasty)
• Leaflet repair
• Chordae repair or transfer

Surgical Valve Replacement

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Valve is replaced when repair isn’t possible:

Mechanical Valves:

• Durable, long-lasting (20-30+ years)
• Requires lifelong anticoagulation (warfarin)
• Preferred in younger patients

Biological (Tissue) Valves:

• From pig or cow tissue
• No anticoagulation required (except first 3-6 months)
• Lasts 10-20 years, may degenerate afterward
• Preferred in elderly or those who can’t take anticoagulants

Transcatheter Aortic Valve Implantation (TAVI/TAVR)

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Aortic valve replacement without open heart surgery:

• Done via catheter through groin or chest
• For high-risk or inoperable patients
• Increasingly used in younger patients
• Short hospital stay (2-5 days)
• Rapid recovery

Indications:

• Severe aortic stenosis
• High surgical risk
• Patients over 75 (expanding)

Transcatheter Mitral Valve Interventions

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• MitraClip: Joining mitral valve leaflets in mitral regurgitation
• Transcatheter mitral valve replacement: Developing technology

Balloon Valvuloplasty

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• Widening narrowed valve with catheter
• Effective in mitral stenosis (especially rheumatic)
• Temporary solution in aortic stenosis (bridge to TAVI)

Post-Operative Care

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Early Period

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• Intensive care monitoring
• Pain control
• Early mobilization
• Breathing exercises
• Wound care

Long-Term Follow-up

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• Regular cardiology check-ups
• Valve function monitoring with echocardiography
• Anticoagulant monitoring (INR control for mechanical valve)
• Endocarditis prophylaxis

Endocarditis Prophylaxis

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Antibiotics before certain procedures in patients with prosthetic valves:

• Dental procedures (those causing gum bleeding)
• Certain surgical procedures
• Always inform your doctor about your prosthetic valve

Lifestyle Recommendations

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Physical Activity

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• Light-moderate exercise generally safe
• Avoid heavy lifting and competitive sports
• Determine exercise program with your doctor

Nutrition

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• Salt restriction (especially if heart failure present)
• Healthy, balanced diet
• Watch vitamin K-containing foods with mechanical valve (warfarin interaction)

Dental Health

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• Regular dental check-ups
• Good oral hygiene
• Consult your doctor before dental procedures

Pregnancy

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• Women with valve disease should be evaluated before pregnancy
• Mechanical valve and anticoagulant management requires special attention
• High-risk pregnancy monitoring

Frequently Asked Questions (FAQ)

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When Should You See a Doctor?

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Cardiology evaluation is recommended in the following situations:

• Shortness of breath with exertion
• Unexplained fatigue
• Palpitations or irregular heartbeat
• Chest pain
• Dizziness or fainting
• Leg swelling
• Murmur detected on examination

Regular cardiology follow-up is critical for early diagnosis and timely treatment of valve diseases.

If you have questions about heart valve diseases or would like to schedule an evaluation, please feel free to contact me.