Heart valve disease

What is heart valve disease?

Your heart has four valves, the aortic, mitral, tricuspid and pulmonary valves, which act as one-way doors keeping blood moving in the right direction through the heart. Heart valve disease means one or more of these valves is not working properly, forcing the heart to work harder to pump the same amount of blood.

Valve problems take two main forms. Stenosis means a valve has become stiff or narrowed and does not open fully, restricting blood flow. Regurgitation (also called a leaky valve or valve incompetence) means the valve does not close properly, allowing blood to leak backwards. Some valves can be both narrowed and leaky at the same time.

Valve disease is common and becomes more so with age; significant disease affects around one in eight people over 75. Many valve conditions progress slowly over years, which is precisely why expert assessment and structured monitoring matter: they allow treatment at the right moment, before the heart suffers lasting strain.

Heart murmurs

A heart murmur is an extra sound made by turbulent blood flow, often heard through a stethoscope during a routine examination. Murmurs are frequently innocent, particularly in young people, but they can be the first clue to a valve problem, and a new murmur in an adult should always be properly investigated. An echocardiogram can quickly and painlessly show whether a murmur reflects a genuine valve abnormality or is nothing to worry about, giving you a clear answer and peace of mind.

Types of valve disease

Aortic valve disease

The aortic valve controls blood flow from the main pumping chamber to the body. Aortic stenosis, a progressive stiffening and narrowing of the valve, is the most common significant valve condition in the UK and can cause breathlessness, chest tightness, dizziness or blackouts, typically on exertion. Aortic regurgitation, a leaking aortic valve, places a volume load on the heart and may progress silently for years.

Mitral valve disease

The mitral valve sits between the heart's left-sided chambers. Mitral regurgitation, often caused by mitral valve prolapse where the valve leaflets are floppy, is the most common leaky valve. It can cause breathlessness, fatigue and palpitations, and is a frequent cause of atrial fibrillation. Mitral stenosis is now less common in the UK but still seen, particularly after rheumatic fever earlier in life.

Tricuspid and pulmonary valve disease

The right-sided valves can also leak or narrow, often secondary to other heart or lung conditions. Tricuspid regurgitation commonly causes fluid retention with swelling of the legs and ankles, and is increasingly treatable.

Symptoms

Mild valve disease usually causes no symptoms at all. As a valve problem becomes more significant, you may notice:

• Shortness of breath on exertion or when lying flat
• Fatigue and reduced exercise capacity
• Palpitations or an irregular heartbeat
• Chest tightness, dizziness or fainting on exertion
• Swollen ankles or legs

Because valve disease often progresses gradually, many people unconsciously slow down and attribute their symptoms to age or fitness. A step-change in what you can comfortably do is always worth investigating. If you experience exertional chest pain or blackouts, seek medical assessment urgently; if severe symptoms occur at rest, call 999.

Causes

Valve disease may result from age-related degeneration and calcification, congenital abnormalities such as a bicuspid aortic valve, mitral valve prolapse, infection of a valve (endocarditis), rheumatic fever, a previous heart attack affecting the valve's supporting structures, or enlargement of the heart from high blood pressure or cardiomyopathy. Some cancer treatments and radiotherapy can also affect the valves years later.

Diagnosis

Assessment starts with a careful history and examination. The central investigation is an echocardiogram, an ultrasound scan that shows each valve in motion, measures how narrowed or leaky it is, and assesses the effect on the heart's chambers and pressures. An ECG checks the heart rhythm, and blood tests including NT-proBNP help gauge strain on the heart.

Where more detail is needed, a cardiac MRI scan, Dr Assomull's specialist field, precisely quantifies leaking valves and the heart's response to them, which is often pivotal in deciding the timing of intervention. Occasionally a stress echocardiogram is used to see how a valve behaves during exercise.

Treatment

Monitoring

Many valve conditions simply need structured surveillance: a scheduled echocardiogram every six to twenty-four months depending on severity, with prompt review if symptoms change. Good monitoring means intervention happens at the optimal moment, neither too early nor too late.

Medication

No tablet can reverse a valve narrowing, but medication plays an important supporting role: controlling blood pressure to reduce strain on a leaking valve, managing fluid retention, treating atrial fibrillation and protecting against stroke where needed.

Valve repair and replacement

When a valve problem becomes severe or symptomatic, definitive treatment is highly effective. Options include surgical valve repair or replacement and, increasingly, keyhole procedures such as TAVI (transcatheter aortic valve implantation) for aortic stenosis and edge-to-edge repair for mitral regurgitation, which avoid open surgery in suitable patients. We will explain the options relevant to your valve clearly and guide you to the right specialist team at the right time.

Our integrative cardiology approach

At Cardiologist London, valve care means more than measuring a valve. Dr Assomull combines meticulous imaging with attention to everything that influences how well you live with a valve condition: blood pressure control, rhythm management, exercise guidance tailored to your valve, nutrition, sleep and cardiovascular risk. You will always understand what your valve is doing, what the plan is, and exactly when and why any intervention would be recommended.

If you have been told you have a murmur or a valve problem, or you simply want a definitive assessment, book a consultation at our Harley Street clinic.