Heart Valve Diseases: Symptoms, Causes, and Treatment

Heart valve diseases are conditions in which blood flow is disrupted due to the heart valves not functioning properly. These diseases often progress without noticeable symptoms and may lead to serious problems over time. With early diagnosis and treatment, heart function can be preserved and patients’ quality of life can be improved.

What is heart valve disease?

Heart valve disease is a condition in which the heart valves are unable to perform their function properly due to structural defects or loss of function. This condition can prevent the heart from pumping blood properly and may lead to serious health problems over time.

The human heart consists of four chambers: two atria and two ventricles. Between these chambers are four main valves that ensure blood flows correctly. These cavities:

• Mitral Valve: It is located between the left atrium and the left ventricle.
• Aortic valve: It is located between the left ventricle and the aorta.
• Tricuspid valve: It is located between the right atrium and the right ventricle.
• Pulmonary Valve: It is located between the right ventricle and the pulmonary artery (lung artery).

Diseases seen in these cavities are generally classified into two main types of disorders. In some cases, both stenosis and insufficiency can develop together. These disorders include: 

• Stenosis: The valve cannot be opened sufficiently, making it difficult for blood to pass through.
• Regurgitation: The valve cannot close completely, and blood leaks back.

In both cases, the heart's work becomes harder; it has to exert more effort to pump enough blood. As a result, the following types of heart valve disease develop:

• Congenital valve diseases: These are structural abnormalities that are present when the baby is born.
• Acquired valvular diseases: It usually develops due to reasons such as aging, rheumatic fever, and infective endocarditis.
• Degenerative valve diseases: It occurs especially in older age as the heart valves thicken and lose their flexibility.

Over time, these diseases can increase the burden on the heart, leading to symptoms such as fatigue, shortness of breath, palpitations, chest pain, fainting, and swelling in the feet. Therefore, early diagnosis is of great importance.

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What are the symptoms of heart valve disease?

Symptoms of heart valve disease may not be noticeable in the early stages. Symptoms vary depending on the severity of the disease, which valve is affected, the overall health of the heart, and the type of heart valve. The most common symptoms are:

• Shorthness Of Breath
• Easy fatigue
• Fatigue
• Palpitations
• Chest pain and tightness
• Fainting
• Swelling in the ankles and legs.
• Abdominal bloating
• Respiration with wheezing.
• Cough
• Rapid and irregular heartbeat
• Dizziness
• Difficulty concentrating
• Changes in vision or mental function

Heart valve diseases are generally diseases that progress slowly over time. Therefore, symptoms may not be visible initially, or they may become more pronounced due to factors such as old age and fatigue. 

What are heart valve diseases?

The heart is a vital organ that pumps blood throughout the entire body, contracting 60-100 times per minute. Heart valves are one of the vital components that ensure this pumping process occurs regularly and efficiently. The heart has four valves: mitral, tricuspid, aortic, and pulmonary. 

When one or more of the valves fail to function properly, the heart muscle can weaken and cease to perform its function. This condition manifests as narrowing, insufficiency, and structural abnormalities in the heart valves. These diseases vary depending on the position of the flap. Heart valve diseases include the following:

• Mitral valve stenosis
• Mitral valve insufficiency
• Aortic valve stenosis
• Aortic valve insufficiency
• Tricuspid valve stenosis
• Tricuspid valve insufficiency
• Pulmonary valve stenosis
• Pulmonary valve insufficiency
• Mitral valve prolapse (collapse)
• Infection in the heart valves (endocarditis)

Mitral valve stenosis

The mitral valve is located between the left atrium and the left ventricle of the heart. When this valve narrows, sufficient blood cannot pass from the left atrium to the ventricle, and the pressure in the atrium increases. Symptoms include shortness of breath that worsens with exertion, palpitations, fatigue, and difficulty breathing that wakes you up at night.

The most common causes of developmental abnormalities are a history of rheumatic fever and congenital mitral valve abnormalities. Over time, this disease can cause fluid to build up in the lungs and shortness of breath.

Mitral Valve Insufficiency

When the mitral valve does not close completely, some of the blood pumped from the left ventricle of the heart flows back into the left atrium. This leads to an increase in pressure in both the atrium and the ventricle. The most common causes of development are rheumatic diseases, age-related degeneration, and mitral valve prolapse. 

Symptoms include shortness of breath that worsens with exertion, palpitations, weakness, dizziness, and swelling in the legs and ankles. 

Aortic Valve Stenosis

The aortic valve is located at the entrance of the aorta, the main artery that carries blood from the heart. A narrowing of this valve makes it difficult for blood to pass from the heart to the body. The left ventricle has to work harder, and over time the heart muscle thickens.

The most common causes of development are aging, osteoarthritis, and rheumatic valve disease. It can lead to heart failure in advanced stages. Symptoms include chest pain on exercise, dizziness or fainting, and shortness of breath on exertion. 

Aortic Valve Insufficiency

When the aortic valve fails to close, some of the blood pumped to the body returns to the left ventricle. This increases the volumetric load on the heart. The most common causes of development are rheumatic diseases, traumas, aortic root dilation (such as Marfan syndrome), and infective endocarditis. 

Symptoms include feeling your heart beating in your chest, waking up at night with palpitations, shortness of breath during exercise, headache, and fatigue. 

Tricuspid Valve Stenosis

The tricuspid valve is located between the right atrium and the right ventricle of the heart. When narrowing develops, the passage of blood from the right atrium to the ventricle becomes difficult, and the pressure in the right atrium increases. The most common causes of developmental abnormalities are rheumatic diseases and congenital abnormalities. Symptoms include prominent neck veins, fluid accumulation in the abdomen, and edema in the ankles. 

Tricuspid Valve Insufficiency

When the valve does not close completely, some blood from the right ventricle flows back into the right atrium. The right chambers of the heart expand and the pressure increases. The most common causes of development are pulmonary hypertension, heart failure, congenital structural abnormalities, and valvular infections. Symptoms include swelling in the legs, a feeling of fullness in the abdomen, weakness, and easy fatigue. 

Pulmonary Valve Stenosis

The pulmonary valve is located between the right ventricle and the blood vessel leading to the lungs. When there is a narrowing, it becomes difficult for blood to pass to the lungs, increasing the workload on the right heart. It is usually congenital. Symptoms include shortness of breath that worsens with exercise, bruising of the skin, fatigue, and growth retardation in children. 

Pulmonary valve insufficiency

When the pulmonary valve fails to close, blood returning from the lungs leaks back into the right ventricle. It is usually accompanied by other heart problems. The most common causes of development are pulmonary hypertension, congenital valvular diseases, and infections. Mild cases may have no symptoms, but advanced cases can cause shortness of breath and palpitations. 

Mitral Valve Collapse

One or both leaflets of the mitral valve hang down like a balloon towards the left atrium. It is often benign and presents with mild mitral regurgitation. Marfan syndrome, like Ehlers-Danlos syndrome, develops due to connective tissue diseases or congenital structural abnormalities. 

Valve Infection (Infective Endocarditis)

It is a serious and life-threatening infection that develops when bacteria colonize the heart valves. It can develop in normal or artificial (prosthetic) valves. Risk factors include dental treatments, surgeries, catheterization, and weakened immune systems. Symptoms include high fever, chills, night sweats, purple spots on the skin, and a newly developed heart murmur.

What are the treatment options for heart valve diseases?

Treatment for heart valve diseases varies depending on the type of disease, which valve is affected, the severity of the disease, the patient's age, the presence of other comorbidities, and their overall health condition. 

While some mild valvular diseases can be managed with just regular monitoring and lifestyle changes, some advanced cases may require surgery or interventional procedures. The treatment options applied include:

Medical (Drug) Treatment

Structural heart defects cannot be corrected with medication, but drug therapy is used to control symptoms. The goal of drug treatment is to reduce the burden on the heart, control arrhythmias, and prevent blood clots.

Lifestyle Changes and Follow-up

In early-stage or mild valvular heart disease, lifestyle changes are administered. These changes include restricting salt intake, quitting smoking and alcohol, controlling weight, avoiding stress, and protecting against infections.

Interventional (Non-surgical) Procedures

Interventional procedures can be performed on patients who are not suitable for surgery or who are elderly. These procedures are usually performed by accessing the heart through the groin, eliminating the need for large incisions. These processes are as follows:

• TAVI (Transcatheter Aortic Valve Implantation): It is a method used in the treatment of aortic valve stenosis. A new valve is implanted without opening the chest, usually by accessing the valve through a vein in the groin.
• MitraClip (Mitral Valve Clip): It is applied to patients with mitral valve insufficiency who are not candidates for surgery. The leaflets of the mitral valve are brought closer together with a special clip to reduce leakage.
• Balloon Valvuloplasty (Balloon Expansion): It is used especially in young patients with mitral or pulmonary valve stenosis who want non-surgical options. The balloon is used to widen the narrowed valve.

Surgical Treatment

If heart valve disease progresses, open-heart surgery may be necessary to repair or replace the valve. In valve repair (reconstruction), the existing valve stem is preserved and surgically corrected. In valve replacement (prosthetic valve surgery), the existing valve is removed and replaced with an artificial (prosthetic) valve. 

There are two types of valves: mechanical and biological. The mechanical valve is durable and will last a lifetime. However, lifelong blood-thinning medication is necessary to prevent the risk of blood clots. Biological caps, on the other hand, are made from pig or bovine tissue and last for 10-15 years. It is preferred in elderly patients or those at risk of bleeding.

Frequently Asked Questions About Heart Valve Diseases

Where does heart valve pain radiate?

Heart valve diseases do not cause direct pain; however, they can be felt indirectly as chest pain.

What Should Patients with Heart Valve Disease Be Aware Of?

Patients with heart valve disease should limit their salt and fluid intake, avoid strenuous exercise, quit smoking and alcohol, not neglect regular check-ups, and pay attention to their dental health.

How long do heart valve replacements last?

Mechanical valves can last 20-30 years or even longer. The lifespan of biological valves is generally 10-15 years.

What happens if a heart valve deteriorates?

Rottenness refers to the weakening, tearing, or inflammation of the valve tissue. In this situation, the valve loses its function, leakage occurs, the heart has to work harder, and serious complications such as heart failure, arrhythmias, or blood clots can develop.

Which medical specialty deals with heart valve diseases?

Patients with heart valve diseases should consult the cardiology department for diagnosis and treatment.

Is Heart Valve Disease Dangerous?

Yes, it can be life-threatening if left untreated.

What is the most common heart valve disease?

The most common valvular diseases are mitral regurgitation, aortic stenosis, and mitral prolapse. 

Can Heart Valve Disease Be Cured?

Structural heart valve diseases are generally not completely cured with medication; treatment involves valve repair or replacement. 

Can heart valve problems cause shortness of breath?

Yes, due to valve dysfunction, blood circulation in the heart is disrupted, and fluid accumulates in the lungs. This can lead to shortness of breath that worsens with exertion or during sleep at night.