heart consists of four chambers—two atria (upper chambers) and two
ventricles (lower chambers). There is a valve through which blood passes
before leaving each chamber of the heart. The valves prevent the
backward flow of blood. They act as one-way inlets of blood on one side
of a ventricle and one-way outlets of blood on the other side of a
ventricle. The four heart valves include the following:
Tricuspid valve. Located between the right atrium and the
Pulmonary valve. Located between the right ventricle and
the pulmonary artery.
Mitral valve. Located between the left atrium and the
Aortic valve. Located between the left ventricle and the
As the heart muscle contracts and relaxes, the valves open and close,
letting blood flow into the ventricles and out to the body at alternate
times. The following is a step-by-step illustration of how the valves
function normally in the left ventricle:
After the left ventricle contracts, the aortic valve closes and
the mitral valve opens to allow blood to flow from the left
atrium into the left ventricle.
The left atrium contracts and more blood flows into the left
When the left ventricle contracts, the mitral valve closes and
the aortic valve opens so blood flows into the aorta and out
into the systemic circulation to the rest of the body.
Heart valve disorders can arise from two main types of malfunctions:
Regurgitation (or leakage of the valve). The valve(s)
does not close completely, causing the blood to flow backward
through the valve. The heart is forced to pump more blood on the
next beat, making it work harder.
Stenosis (or narrowing of the valve). The valve(s)
opening becomes narrowed, limiting the flow of blood out of the
ventricles or atria. The heart is forced to pump blood with
increased force in order to move blood through the narrowed or
stiff (stenotic) valve(s).
Heart valves can develop both malfunctions at the same time
(regurgitation and stenosis). Also, more than one heart valve can be
affected at the same time. When heart valves fail to open and close
properly, the implications for the heart can be serious, possibly
hampering the heart's ability to pump blood adequately through the body.
Heart valve problems are one cause of heart failure.
Mild heart valve disease may not cause any symptoms. The following are
the most common symptoms of heart valve disease. However, each
individual may experience symptoms differently. Symptoms may vary
depending on the type of heart valve disease present and may include:
Palpitations caused by irregular heartbeats
Low or high blood pressure, depending on which valve disease is
Shortness of breath
Abdominal pain due to an enlarged liver (if there is tricuspid
Symptoms of heart valve disease may resemble other medical conditions
and problems. Always consult your physician for a diagnosis.
The causes of heart valve damage vary depending on the type of disease
present, and may include the following:
A history of rheumatic fever, a condition characterized by
painful fever, inflammation, and swelling of the joints.
Rheumatic fever is now rare in North America due to effective
Damage resulting from a heart attack
Damage resulting from an infection
Changes in the heart valve structure due to the aging process
Congenital birth defect
Syphilis, a disease characterized by progressive symptoms if not
treated. Syphilis is a sexually-transmitted infection that is
now rare in North America due to effective treatment. Symptoms
may include small, painless sores that disappear, followed by a
skin rash, enlarged lymph nodes, headache, aching bones, loss of
appetite, fever, and fatigue.
Myxomatous degeneration, an inherited connective tissue disorder
that weakens the heart valve tissue.
The mitral and aortic valves are most often affected by heart valve
disease. Some of the more common heart valve diseases include:
Heart Valve Disease
Symptoms and Causes
Bicuspid aortic valve
This congenital birth defect is characterized by
an aortic valve that has only two flaps (a
normal aortic valve has three flaps). If the
valve becomes narrowed, it is more difficult for
the blood to flow through, and often the blood
leaks backward. Symptoms usually do not develop
during childhood, but are often detected during
the adult years.
Mitral valve prolapse (also known as
click-murmur syndrome, Barlow's syndrome,
balloon mitral valve, or floppy valve syndrome)
This disease is characterized by the bulging of
one or both of the mitral valve flaps during the
contraction of the heart. One or both of the
flaps may not close properly, allowing the blood
to leak backward. This may result in a mitral
Mitral valve stenosis
Often caused by a past history of rheumatic
fever, this condition is characterized by a
narrowing of the mitral valve opening,
increasing resistance to blood flow from the
left atrium to the left ventricle.
Aortic valve stenosis
This type of valve disease occurs primarily in
the elderly and is characterized by a narrowing
of the aortic valve opening, increasing
resistance to blood flow from the left ventricle
to the aorta.
This condition is characterized by a pulmonary
valve that does not open sufficiently, causing
the right ventricle to pump harder and enlarge.
Heart valve disease may be suspected if the heart sounds heard through a
stethoscope are abnormal. This is usually the first step in diagnosing a
heart valve disease. A characteristic heart murmur (abnormal sounds in
the heart due to turbulent blood flow across the valve) can often
indicate valve regurgitation or stenosis. To further define the type of
valve disease and extent of the valve damage, physicians may use any of
the following diagnostic procedures:
Electrocardiogram (ECG or EKG). A test that records the
electrical activity of the heart, shows abnormal rhythms
(arrhythmias or dysrhythmias), and can sometimes detect heart
Echocardiogram (echo). A noninvasive test that uses sound
waves to evaluate the heart's chambers and valves. The echo
sound waves create an image on a monitor as an ultrasound
transducer is passed over the heart.
Chest X-ray. A diagnostic test that uses invisible
electromagnetic energy beams to produce images of internal
tissues, bones, and organs onto film. An X-ray can show
enlargement in any area of the heart.
Cardiac catheterization. This diagnostic procedure
involves the insertion of a tiny, hollow tube (catheter) into an
artery leading to the heart in order to provide images of the
heart and blood vessels. This procedure is helpful in
determining the type and extent of certain valve disorders.
Magnetic resonance imaging (MRI). A diagnostic procedure
that uses a combination of large magnets, radiofrequencies, and
a computer to produce detailed images of organs and structures
within the body.
In some cases, the only treatment for heart valve disease may be careful
medical supervision. However, other treatment options may include
medication, surgery to repair the valve, or surgery to replace the
valve. Specific treatment will be determined by your physician based on:
Your age, overall health, and medical history
Extent of the disease
The location of the valve
Your signs and symptoms
Your tolerance for specific medications, procedures, or
Expectations for the course of the disease
Your opinion or preference
Treatment varies, depending on the type of heart valve disease, and may
include one, or a combination of, the following:
Medication. Medications are not a cure for heart valve disease,
but in many cases are successful in the treatment of symptoms caused by
heart valve disease. These medications may include:
Medications such as beta-blockers, digoxin, and calcium channel
blockers to reduce symptoms of heart valve disease by
controlling the heart rate and helping to prevent abnormal heart
Medications to control blood pressure, such as diuretics
(medications that remove excess water from the body by
increasing urine output) or vasodilators (medications that relax
the blood vessels, decreasing the force against which the heart
must pump) to ease the work of the heart.
Surgery. Surgery may be necessary to repair or replace the
malfunctioning valve(s). Surgery may include:
Heart valve repair. In some cases, surgery on the malfunctioning
valve can help alleviate symptoms. Examples of heart valve
repair surgery include remodeling abnormal valve tissue so that
the valve functions properly, or inserting prosthetic rings to
help narrow a dilated valve. In many cases, heart valve repair
is preferable, because a person's own tissues are used.
Heart valve replacement. When heart valves are severely
malformed or destroyed, they may need to be replaced with an
entirely new replacement valve. Replacement valve mechanisms
fall into two categories: tissue (biologic) valves, which
include animal valves and donated human aortic valves, and
mechanical valves, which can consist of metal, plastic, or
another artificial material.
Another treatment option that is less invasive than valve
repair/replacement surgery is balloon valvuloplasty, a non-surgical
procedure in which a special catheter (hollow tube) is threaded into a
blood vessel in the groin and guided into the heart. The catheter, which
contains a deflated balloon, is inserted into the narrowed heart valve.
Once in place, the balloon is inflated to stretch the valve open, and
then removed. This procedure is often used to treat pulmonary stenosis
and, in some cases, aortic stenosis.
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