Your Top Questions About Heart Valve Disease, Answered
Heart valve disease (HVD) isn't as well-known as other types of cardiac disease, so if you or a loved one has just been diagnosed with it, it's likely you have a lot of questions, starting with: “What the heck is a heart valve and what does it do?” We've got the answers to that and many others. Read on for reassuring information about this condition that affects 2.5% of the U.S. population.
What Is a Heart Valve Anyway?
When it comes to heart anatomy, the chambers get all the attention. But your heart's four valves are the gatekeepers between those chambers and the rest of your body, regulating the flow of blood in and out of your heart, says Fayyaz H. Hashmi, M.B.B.S., a cardiac surgeon at Suburban Hospital in Bethesda, MD. The mitral and tricuspid valves allow blood to flow into the heart, while the aortic and pulmonary valves release it to circulate in the body. Any interruption in your valves’ ability to open and close properly can have a big impact on overall cardiac function.
What Can Go Wrong With Your Heart?
There are two primary forms of HVD: regurgitation and stenosis. Regurgitation is when one of your valves doesn't close all the way, allowing blood to leak back to where it came from. Stenosis is when one of your valves is thickened or narrowed, restricting blood flow. In both cases, the heart has to work harder to pump the blood through it. Some people—very few—are born with a heart valve malformation that interrupts the healthy flow of blood (see next slide for more on congenital HVD). Most cases of HVD, however, develop in older age.
Could My Baby Be Born With HVD?
It's very rare. About 40,000 babies—or 1%—are born with a congenital heart defect each year in the United States. Some heart defects are detected during pregnancy and others are caught in newborn screening. About a quarter of infants with a congenital heart defect will need corrective surgery within the first year of their lives, but others will simply need long-term monitoring. The majority of all of these kids will lead long, healthy lives!
Is HVD Always Something You're Born With?
No. The vast majority of HVD cases are what are called “acquired,” says Dr. Hashmi, meaning that they developed over the course of aging. About 13% of people aged 78 or older have HVD. Valves can degenerate over time and calcium deposits can cause the narrowing of a valve. Other cases of HVD are caused by an infection that reaches the heart, says Dr. Hashmi, including rheumatic fever (thankfully, this is extremely rare in the United States) and infective endocarditis (those with existing cardiac conditions and/or a history of illegal drug use are at most risk).
Do All People With HVD Have a Heart Murmur?
A heart murmur is an irregularity in the sound your blood makes as it rushes through the four chambers of your heart—almost all people with valvular issues have one. But “they are not always a sign of trouble,” says Daniel Menees, M.D., an interventional cardiologist at the Michigan Medicine Frankel Cardiovascular Center in Ann Arbor, MI. About 10% of adults (and 30% of children) have a harmless murmur that will simply need to be monitored by your doctor. If your murmur was just detected for the first time, or has changed in sound, further diagnostic testing should be done.
Can I Get HVD From a Dental Procedure?
In some online information about HVD, you may see “dental work” listed as a possible cause. Here's the (very small) connection: When gums bleed, bacteria from dental plaque can enter your bloodstream, causing an infection. If the infection reaches your heart, it's called endocarditis and it can damage the valves. Endocarditis affects about four in 100,000 people each year and only a fraction of those cases are caused by dental work. People with existing heart conditions are most at risk; if that's you, talk to your dentist about prophylactic antibiotics before a procedure.
Are My Symptoms From HVD or Regular Aging?
Shortness of breath, difficulty walking short distances, swollen ankles. For many seniors, these symptoms are commonplace. But they can also be signs of something more serious. The key to knowing the difference? “Noticing changes,” says Amar Krishnaswamy, M.D., an interventional cardiologist at Cleveland Clinic, Cleveland, OH. If you planted a flower bed last month without any problems, for example, but today you're struggling to weed it, that represents a “decline in your functional capacity,” says Dr. Krishnaswamy, and you should see your doctor ASAP. Other signs of HVD to watch for: dizziness, fainting, chest tightness, rapid heartbeat, and difficulty sleeping.
Does Having HVD Mean I Could Have a Heart Attack?
Heart attacks are the direct result of coronary artery disease (CAD), not heart valve disease. Thankfully, HVD is a much slower-moving disease and not known for sudden heart failure. In fact, your doctor may feel comfortable taking a wait-and-see approach with your HVD for many years before deciding on corrective surgery. An important caveat: It's not uncommon, especially in the older population, says Dr. Krishnaswamy, for patients to have both HVD and CAD. In that case, talk to your doctor about your risk for a heart attack.
Will I Have to Change My Lifestyle After an HVD Diagnosis?
Lifestyle is less of a factor in HVD than with CAD, the most common type of heart disease. Sometimes, the valves just degenerate over time. Still, quitting smoking and adopting a heart-healthy diet may help keep your HVD from worsening for longer, and prevent other heart issues from developing. One change to make right now: Cut back on salt, says Dr. Krishnaswamy. More than 2,300 mg of sodium a day can increase your blood pressure, putting more stress on your already fragile valve(s).
Endocarditis Stats: Plos One. (2013.) "Infective Endocarditis in the U.S., 1998–2009: A Nationwide Study." https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0060033
Heart Murmurs: Harvard Health Publishing. (2018.) "Heart Murmur." https://www.health.harvard.edu/a_to_z/heart-murmur-a-to-z
Sodium and Blood Pressure: Cleveland Clinic Health Essentials. (2020.) "How Does Salt Affect Heart Health?" https://health.clevelandclinic.org/how-does-salt-affect-heart-health/
HVD Overview: American Heart Association. (n.d.) "Heart Valve Disease." https://www.heart.org/en/health-topics/heart-valve-problems-and-disease
HVD Statistics: Centers for Disease Control and Prevention. (2020.) https://www.cdc.gov/ncbddd/heartdefects/data.html