# Heart valve disorders
What is it
The heart valves ensure that blood flows through the heart in one direction. The heart has four chambers and four valves: two between the upper chambers and the lower chambers (mitral and tricuspid valves), and two between the lower chambers and arteries (the aortic and pulmonary valves).
In case of heart valve disease, one or more of these valves do not work properly. This can be done in two ways:
- **Stenosis** (constriction): the valve does not close fully, so it is more difficult for blood to flow through
- **Insufficiency** (insufficiency): the valve does not close properly, so blood runs back
Both problems cause the heart to work harder to pump blood. In the long run, this can be harmful to the heart and the rest of the body.
Heart valve disorders can be congenital (present from birth) or develop later in life. They are among the “neglected cardiac diseases” — diseases that receive less attention worldwide than, for example, a heart attack, although they can indeed be serious.
Causes
The causes vary by valve and by type of disorder.
**Aortic valve stenosis** (narrowing of the aortic valve) is often caused by aging and calcification (calcium deposition) of the valve. This is the most common heart valve disease among the elderly. Sometimes an underlying disease plays a role, such as rheumatic fever (much in countries with less medical care) or a congenital abnormal valve.
**Aortic insufficiency** (aortic valve leakage) can be caused by damage to the valve itself, but also by expansion of the aortic wall (the vessel containing the valve). This can occur due to high blood pressure, inflammation (inflammation), or rare aortic dissection (rupture of the aortic wall).
**Mitral stenosis** (narrowing of the mitral valve) is usually the result of rheumatic fever earlier in life. Rheumatic fever can leave scars in the valve that clot.
**Mitral insufficiency** (mitral valve leakage) can occur due to direct damage to the valve (e.g. rheumatic fever, infection), but also because the heart itself enlarges or weakens, causing the valve to close properly.
**Pulmonary and tricuspid valve diseases** are less frequent and often secondary — due to other heart problems or lung diseases.
**Infectious causes** such as endocarditis (heart inflammation) can affect valves.
Furthermore, factors such as high blood pressure, smoking, certain hereditary disorders and metabolic diseases (such as diabetes) play a role in progression.
How the disease progresses
Heart valve disease is very different, depending on which valve is affected, how severe, and how fast the disease progresses.
**Slowly progressive forms** can remain very stable for years or decades. A person can live without symptoms for a long time, while examinations already show that a valve is not working optimally.
**Faster progressive forms** — for example, aortic valve stenosis in older people, or certain forms of aortic insufficiency — can become serious within months to a few years.
Typically, the disease progresses in stages:
1. **Asymptomatic phase**: the valve does not work properly, but there are no complaints. This can be discovered when checking for something else.
2. **Early symptomatic phase**: the first palpable symptoms occur (shortness of breath during exercise, fatigue).
3. **Advanced phase**: symptoms become stronger, occur even at rest, and the heart begins to adapt (enlarged or weakened).
4. **Severe phase**: Without treatment, the heart can become decompensated — it pumps inadequately, fluid builds up in the lungs and abdomen, and vital organs get too little oxygen.
The moment at which symptoms develop is important: many patients notice in the early phase that their resilience decreases. The heart itself can enlarge (hypertrophy or dilation), which in itself can cause other problems, such as rhythm disorders.
Symptoms by phase
**Asymptomatic phase (no symptoms)**
- No noticeable complaints
- Condition is usually discovered by chance (for example, on an ultrasound for something else)
**Early symptomatic phase**
- Shortness of breath during physical exertion (climbing stairs, running, walking briskly) – going much further than you are used to
- Fatigue or tiredness, even with normal activities
- Mild chest tightness or pressure on the chest during exertion (especially with aortic valve stenosis)
- The feeling that your heart is beating irregularly or pounding (heart palpitations)
- Dizziness when suddenly standing up
**Advanced phase**
- Shortness of breath even at rest, especially when lying down (you have to sit upright to breathe better)
- Fatigue that is noticeable day after day
- Swollen ankles, feet or abdomen due to fluid accumulation
- Decreased appetite, feeling full faster
- Waking up at night due to shortness of breath
**Severe phase (decompensation)**
- Severe shortness of breath with minimal exertion or at rest
- Intense fatigue, almost unable to get out of bed
- Considerable swelling in legs and feet
- Possible confusion or concentration problems (due to insufficient oxygen to the brain)
- Pain in the upper right abdomen (due to liver swollen with fluid)
- In some cases, heart rhythm disorders with rapid pulse
Note: symptoms do not always progress linearly. Some people feel nothing for a long time, until symptoms suddenly appear. Others gradually notice that their capacity becomes smaller.
What it means for daily life
Heart valve disease affects daily life especially through limitation of exercise capacity.
In the asymptomatic phase, much does not change for many people – you simply feel normal. But regular check-ups (ultrasounds, electrocardiograms) are part of life. This can feel like continuous uncertainty: you feel fine, but the doctor tells you that your valve is not working properly.
Once symptoms develop, you need to learn at what level you feel strained. For some, this means climbing stairs more carefully, or a walk becoming shorter. You learn your own limits. Many patients adapt their work and leisure activities.
**Physical activity**: doctors usually advise regular, gentle movement (walking, swimming, cycling at your own pace), but explosive strength exertion or sudden heavy strain can be problematic. This differs per person and per disease stage.
**Work**: lighter work is usually sustainable for longer. Heavy physical occupations can become more difficult. Much depends on when symptoms develop and how quickly the disease progresses.
**Family and social life**: as symptoms worsen, outings, sports or social activities may decrease. This can be emotionally stressful, especially for younger patients.
**Medication**: many patients use multiple medicines, requiring regular monitoring of blood pressure, kidney function and sometimes clotting.
**Infection prevention**: certain valves (especially artificial valves) require precautions against infections (for example at the dentist).
**Psychological burden**: living with a chronic heart condition, especially if you have to make many adjustments, can bring stress and sometimes anxiety. The uncertainty about when you will be better and what will happen plays a role.
Many patients find that life adapts, but it requires awareness of your limits and regular communication with your healthcare provider.
Outlook
The prospects for heart valve disease depend strongly on:
- **Which valve** is affected
- **How severe** the condition is
- **Age** and other health conditions
- **Timing of treatment**: the earlier you get help, the better for the heart
- **Type of treatment**: medication, surgery, or minimally invasive procedures (such as catheter interventions)
**With modern treatment**, things are much better than a few decades ago. Many patients can live at home for years longer and remain active thanks to better medicines, monitoring and surgical options.
For **asymptomatic conditions**, this may involve regular monitoring and medication without immediate intervention – sometimes it remains stable, sometimes we switch to an intervention earlier.
For **symptomatic conditions**: if medication is insufficient, an intervention is usually needed. This can be an operation in which the damaged valve is replaced with an artificial valve (mechanical or biological), or increasingly a minimally invasive procedure via a catheter (for example TAVR – transcatheter aortic valve replacement – for aortic valve stenosis).
After a successful intervention, many patients feel noticeably better – less breathless, more energy. But certain conditions require lifelong monitoring and sometimes also medication.
**Long-term outcomes**: many operated patients have years of good quality of life. Artificial valves have their own requirements (regular monitoring, sometimes anticoagulants). Biological valves wear out faster than natural valves, so in time a second operation may be needed.
It is important to know that **survival rates at population level** say nothing about your personal situation. Age, other conditions, the timing of diagnosis and how well you are treated all play a role. Only your own doctor can say something meaningful about your expectations.
Frequently asked questions
**Q: Can a heart valve condition be cured?**
A: No, a damaged valve does not heal by itself. But symptoms can be treated very well, and progression can be slowed. In severe conditions the valve can be replaced or repaired, which often helps dramatically. This is not 'curing' in the classical sense, but it is a major improvement.
**Q: Does a heart valve condition mean I can no longer exercise?**
A: Not necessarily. Many patients can tolerate regular, gentle physical activity (such as walking, cycling at your own pace, swimming) well. What you can or cannot do depends on how serious your condition is and how your heart responds to it. Your own doctor can best advise you based on tests.
**Q: How quickly does a heart valve condition usually worsen?**
A: This varies enormously. Some patients have a stable condition for decades without symptoms. Others see symptoms appear more quickly. Regular monitoring (usually yearly, sometimes more often) helps to establish how it progresses and when action is needed.
**Q: Can I live and work normally with this condition?**
A: Many people certainly do, especially in the asymptomatic and early symptomatic phases. As symptoms worsen, you may need to adjust your work or activities. This is very individual – what works for you can best be weighed by your own doctor.
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_This information never replaces a doctor's judgment. Always discuss your situation with your own healthcare provider._