Valvular Heart Disease (VHD) refers to any condition in which one or more of the heart’s valves are damaged or diseased, causing improper blood flow through the heart. The heart has four valves that regulate blood flow between its chambers and to the rest of the body: the mitral valve, aortic valve, tricuspid valve, and pulmonary valve. When these valves don’t work properly, the heart has to work harder to pump blood, and this can lead to various symptoms, including shortness of breath, fatigue, chest pain, or even heart failure if untreated.

Types of Valvular Heart Disease
There are two main types of issues that can occur with heart valves:
- Stenosis: The valve opening becomes narrow, restricting blood flow.
- Regurgitation (or Insufficiency): The valve doesn’t close properly, allowing blood to leak backward.
Each valve can be affected in different ways, leading to various types of valvular heart disease.
1. Mitral Valve Disease
- Mitral Stenosis: The mitral valve, located between the left atrium and left ventricle, becomes thickened and narrowed. This prevents proper blood flow from the left atrium to the left ventricle, causing blood to back up in the lungs, leading to shortness of breath and fatigue.
- Mitral Regurgitation: The mitral valve fails to close properly, causing blood to leak back into the left atrium during ventricular contraction. This can lead to enlargement of the left atrium and increased pressure in the lungs.
2. Aortic Valve Disease
- Aortic Stenosis: The aortic valve, which controls blood flow from the left ventricle to the aorta, becomes narrowed. This limits the amount of blood that can flow to the body, causing the heart to work harder to pump blood. This condition can lead to chest pain, fainting, and eventually heart failure.
- Aortic Regurgitation: The aortic valve doesn’t close completely, causing blood to leak backward into the left ventricle. Over time, this can lead to the enlargement of the left ventricle and reduced heart efficiency.
3. Tricuspid Valve Disease
- Tricuspid Stenosis: The tricuspid valve, between the right atrium and right ventricle, becomes narrowed, which can cause blood to back up in the veins, leading to swelling in the legs and abdomen.
- Tricuspid Regurgitation: The valve doesn’t close properly, leading to the backflow of blood into the right atrium. This can cause symptoms like swelling and fluid retention.
4. Pulmonary Valve Disease
- Pulmonary Stenosis: The pulmonary valve, which controls blood flow from the right ventricle to the lungs, becomes narrowed, leading to reduced blood flow to the lungs and resulting in symptoms like shortness of breath and fatigue.
- Pulmonary Regurgitation: Blood leaks back into the right ventricle from the pulmonary artery, potentially causing right heart enlargement and heart failure over time.
Causes of Valvular Heart Disease
Valvular heart disease can be caused by a variety of factors, both congenital (present at birth) and acquired (developing later in life). Some common causes include:
Congenital Causes:
- Congenital heart defects: Some people are born with heart valve abnormalities, such as bicuspid aortic valve (instead of the normal tricuspid valve), which can lead to aortic stenosis or regurgitation.
Acquired Causes:
- Rheumatic Fever: A complication of untreated strep throat that can cause scarring of the heart valves, particularly the mitral valve. This is less common in developed countries due to antibiotic treatment but still a significant cause of valvular heart disease in some regions.
- Infective Endocarditis: An infection of the inner lining of the heart and valves, typically caused by bacteria. This can damage the heart valves and lead to stenosis or regurgitation.
- Aging: As people age, the heart valves may thicken, stiffen, or calcify, leading to stenosis, particularly the aortic and mitral valves.
- Degenerative Changes: In some cases, the valves may deteriorate or weaken due to other underlying conditions, leading to regurgitation.
- Heart Attack: Damage to the heart muscle during a heart attack can affect the functioning of the valves, particularly the mitral valve.
- Hypertension (High Blood Pressure): Over time, high blood pressure can cause changes in the heart’s structure, including valve abnormalities.
Symptoms of Valvular Heart Disease
The symptoms of VHD depend on the type and severity of the valve dysfunction. In the early stages, many people may not have noticeable symptoms, but as the condition progresses, symptoms can become more pronounced.
Common symptoms include:
- Shortness of breath: Often during exertion or when lying flat (orthopnea).
- Fatigue and weakness: Reduced ability to perform normal activities.
- Swelling in the legs, abdomen, or veins: Caused by fluid buildup.
- Chest pain or discomfort: Particularly in cases of aortic stenosis.
- Palpitations: Irregular heartbeats, often associated with valve regurgitation.
- Fainting or dizziness: Caused by reduced blood flow or arrhythmias.
- Heart murmur: A characteristic sound heard during a physical exam when blood flow through the valves is turbulent.
Diagnosis of Valvular Heart Disease
To diagnose valvular heart disease, doctors will often perform a variety of tests:
- Physical Examination: Listening for heart murmurs or abnormal heart sounds using a stethoscope, which can suggest valve problems.
- Echocardiogram: The primary diagnostic tool, this ultrasound of the heart allows doctors to visualize the heart valves, measure their size and function, and assess blood flow through the heart.
- Electrocardiogram (ECG): This test monitors the heart’s electrical activity and can help detect arrhythmias associated with valvular disease.
- Chest X-ray: A chest X-ray may show signs of valve dysfunction, such as enlargement of the heart or pulmonary congestion.
- Cardiac MRI or CT scan: In some cases, these imaging tests may be used for a more detailed assessment of the valves and heart structure.
- Cardiac Catheterization: Invasive tests may be used to measure blood pressure in the heart and assess the severity of the valve dysfunction.
Treatment of Valvular Heart Disease
The treatment of valvular heart disease depends on the severity of the condition, the valve affected, and the patient’s overall health. Treatment options range from lifestyle changes and medications to surgical interventions.
1. Medications:
- Diuretics: To reduce fluid buildup (edema) and relieve symptoms of heart failure.
- Anticoagulants: Blood thinners to prevent blood clots in cases of valve regurgitation or atrial fibrillation (common in valvular disease).
- Beta-blockers: Used to control heart rate and blood pressure, particularly in cases of aortic stenosis or mitral regurgitation.
- ACE inhibitors or ARBs: These medications help reduce the heart’s workload, especially in heart failure or high blood pressure.
2. Surgical Options:
- Valve Repair: In many cases, surgery can repair a damaged valve. For example, mitral valve repair is commonly performed for mitral regurgitation to restore normal function.
- Valve Replacement: If a valve is too damaged to repair, it may need to be replaced with either a mechanical valve or a biological (tissue) valve. Mechanical valves last longer but require lifelong anticoagulation, while tissue valves may not last as long but do not require long-term blood thinners.
- Percutaneous Valve Procedures: Minimally invasive procedures like transcatheter aortic valve replacement (TAVR) allow doctors to replace or repair valves using catheters, often for patients who are not candidates for traditional open-heart surgery.
3. Lifestyle and Preventive Measures:
- Managing Risk Factors: Control high blood pressure, cholesterol, diabetes, and avoid smoking to prevent further damage to the valves.
- Regular Monitoring: Regular follow-up visits with a cardiologist to monitor the progression of the disease.
- Infection Prevention: For people with valve disease, preventive antibiotics may be prescribed before certain dental or surgical procedures to reduce the risk of infective endocarditis.
Prognosis
The prognosis of valvular heart disease depends on the type and severity of the valve dysfunction, as well as the timing of diagnosis and treatment. In mild cases, many people can live with valvular disease for years without significant symptoms. However, if left untreated, severe valvular disease can lead to heart failure, arrhythmias, and other serious complications. Early detection and appropriate treatment are key to improving outcomes and quality of life.