Health condition · Clinically reviewed
Valvular heart disease, from murmur to TAVI.
From an incidental murmur to a symptomatic valve — a modern pathway of echo, TOE, cardiac MRI and TAVI or surgery when needed.
Why trust this guide
- 01
Clinically reviewed
Written by our editorial team and reviewed by a registered UK clinician before publication.
- 02
Sourced, not summarised
Every claim is checked against NICE, ESC or a peer-reviewed source you can see at the end.
- 03
Updated for 2026
Reflects current UK and European guidance on echo surveillance, TAVI and surgery.
Key facts
Valvular heart disease at a glance.
The essentials, in plain English — what it is, which valves are most often affected, and how the UK now decides between TAVI and surgery.
-
What it is
Structural or functional disease of the heart valves — narrowing (stenosis) or leaking (regurgitation).
-
Most common in older adults
Aortic stenosis is the most common valve disease of ageing in the UK.
-
Mitral regurgitation
Common with age and after myocardial infarction; often coexists with atrial fibrillation.
-
Bicuspid aortic valve
A common congenital variant — affects around 1–2% of the population and predisposes to early stenosis.
-
TAVI vs surgery
Modern MDT decision — TAVI is now first-line for many older or higher-risk patients with severe aortic stenosis.
-
Endocarditis prophylaxis
Antibiotic prophylaxis before dental work is limited to high-risk cases under current NICE guidance.
Why this guide matters
A quiet murmur, a very different set of choices.
Valve disease has changed. TAVI, MitraClip and structural MDTs mean many patients avoid open-heart surgery — but only if the pathway is followed carefully.
-
Symptoms drive treatment
Severity on echo matters — but the moment symptoms appear, the balance tips towards intervention.
-
One echo is rarely enough
Valve disease evolves over years. Serial imaging is what catches the right moment to act.
-
MDT decisions, not single-doctor calls
TAVI vs surgery is decided jointly by cardiologists, imagers and surgeons.
How the diagnosis is made
From first murmur to a clear plan.
The steps a UK cardiology team will normally follow, in order — so you know what to expect and why.
Phase 1 · Recognising
Murmur, symptoms and first-line tests
Phase 2 · Confirming
Advanced imaging where needed
Phase 3 · Managing
Structural MDT and, if needed, referral
- 01
Recognising
Murmur or symptom triage
A murmur picked up incidentally, or symptoms like breathlessness, syncope or angina prompt referral.
- 02
Recognising
ECG
Looks for left ventricular strain, chamber enlargement or coexisting arrhythmia such as AF.
- 03
Recognising
Transthoracic echocardiogram
The core test — grades valve severity, measures gradients and assesses left ventricular function.
- 04
Confirming
Transoesophageal echo (TOE) if complex
A detailed view of the valve from behind the heart, particularly useful for mitral and prosthetic valves.
- 05
Confirming
Cardiac MRI for LV function and fibrosis
Reserved for borderline cases — quantifies regurgitation, LV volumes and myocardial fibrosis.
- 06
Managing
Structural heart MDT
A joint discussion between cardiologists, imagers and surgeons to weigh TAVI, surgery or medical care.
- 07
Managing
Cardiothoracic surgery referral if indicated
For surgical valve replacement or repair when TAVI is not the right route.
Typical timeline: 4–12 weeks from first echo to a settled MDT plan.
Symptoms
What valve disease actually feels like.
Often nothing for years — then breathlessness, syncope or angina. Here is what to look for and when to seek urgent care.
-
Asymptomatic murmur
An incidental finding on examination — often the first clue, needs an echocardiogram to characterise.
-
Syncope on exertion
A red-flag symptom of severe aortic stenosis — needs urgent echo and cardiology review.
-
Breathlessness
Especially on exertion or lying flat — a sign the valve is starting to strain the heart.
-
Angina symptoms
Chest tightness on exertion in aortic stenosis, even with normal coronary arteries.
-
Palpitations
Often reflects new atrial fibrillation, which commonly develops alongside mitral valve disease.
-
Suspected aortic stenosis
Ejection systolic murmur radiating to the neck, slow-rising pulse — echo confirms severity.
-
Suspected mitral regurgitation
Pansystolic murmur at the apex radiating to the axilla — often with breathlessness or AF.
-
When to seek urgent care
Syncope with exertion or acute pulmonary oedema — call 999. Do not drive yourself.
Treatment
How valve disease is treated in the UK.
Watchful waiting where safe, TAVI or surgery when needed — what each option does and when it is chosen.
-
Watchful waiting
For asymptomatic mild disease — regular review with no active treatment needed.
-
Regular echo surveillance
Serial echocardiograms at intervals matched to severity — yearly for moderate, every 3–5 years for mild.
-
Medical management
Heart-failure medications if left ventricular dysfunction has developed — diuretics, ACE inhibitors, beta blockers.
-
TAVI
Transcatheter aortic valve implantation — now first-line for many older or higher-risk patients with severe aortic stenosis.
-
MitraClip
Transcatheter mitral repair for selected patients with severe mitral regurgitation who are unsuitable for surgery.
-
Aortic valve replacement
Surgical replacement — mechanical or biological — remains the standard for younger, lower-risk patients.
-
Mitral valve repair or replacement
Repair is preferred where feasible, particularly for degenerative mitral regurgitation.
-
Endocarditis prophylaxis
Antibiotics before invasive dental or medical procedures — reserved for high-risk cases under NICE guidance.
What this guide is based on
The sources behind every claim on this page.
UK national guidance and specialist society standards, current at the time of last review.
Key references
Guidelines and standards we relied on.
A quiet reminder
This guide is for information, not medical advice.
Your cardiologist knows your echo and your history. If in doubt, get your valve reviewed by a structural heart team.
-
National Institute for Health and Care Excellence (NICE). Heart valve disease presenting in adults: investigation and management (NG208).
-
European Society of Cardiology. Guidelines for the management of valvular heart disease.
-
British Heart Valve Society. Position statements and clinical resources.
-
British Society of Echocardiography. Guidelines and standards for echocardiography.
Red flags
When valve disease becomes an emergency.
Most valve disease is slow. These are the situations where it stops being slow — and you should act today.
-
Syncope with exertion
A red-flag symptom of severe aortic stenosis — call 999 or attend an emergency department.
-
Acute pulmonary oedema
Sudden severe breathlessness with pink frothy sputum — treat as an emergency.
-
Endocarditis symptoms
Persistent fever with a new or changing murmur — needs blood cultures and echo urgently.
-
Sudden severe MR
Papillary muscle rupture after a heart attack — rapid deterioration, needs emergency surgical review.
-
Prosthetic valve dysfunction
Sudden breathlessness, new murmur or fever in someone with a replacement valve — same-day cardiology review.
-
Post-TAVI complications
New stroke symptoms, heart block or bleeding after a TAVI — return to the implanting centre.
-
Pregnancy with valve disease
Any known valve disease in pregnancy needs specialist joint cardiology and obstetric care.
-
Rapid deterioration on echo
A significant jump in severity between echoes warrants urgent MDT discussion.
-
Rheumatic fever recurrence
New joint pains, fever or rash in someone with prior rheumatic heart disease — needs prompt review.
Living with it
A long-term condition, but a very manageable one.
Four things that make the biggest difference day to day — habits, monitoring, medication and reviews.
A quiet reminder
Consistency beats intensity, every time.
Small, steady steps — kept up for years — do more than one heroic push that does not last.
- 01 Daily habits
Keep the rest of the heart healthy
Blood pressure control, activity within limits and stopping smoking all reduce the strain on a diseased valve.
- 02 Monitoring
Stick to the echo schedule
Regular echocardiograms track severity — do not skip them, even when you feel well.
- 03 Medication
Anticoagulation after valve surgery
Mechanical valves need lifelong warfarin; bioprosthetic valves usually do not. Never stop without cardiology advice.
- 04 Reviews
Structural heart clinic follow-up
Yearly review with a valve specialist — more often around the time of TAVI or surgery.
Frequently asked
Everything we get asked about valve disease.
Quick answers on echo, TAVI, surgery, endocarditis prophylaxis and when to worry.
-
What is valvular heart disease?
Structural or functional disease of one or more of the heart’s four valves — either narrowing (stenosis) that restricts flow, or leaking (regurgitation) that lets blood flow backwards.
-
Which valve disease is most common?
Aortic stenosis is the most common valve disease of ageing in the UK. Mitral regurgitation is also very common, particularly with age and after a heart attack.
-
What is TAVI and who is it for?
TAVI (transcatheter aortic valve implantation) is a keyhole replacement of the aortic valve via an artery in the groin. It is now first-line for many older or higher-risk patients with severe aortic stenosis.
-
When is surgery preferred over TAVI?
Surgical valve replacement is generally preferred for younger, lower-risk patients, for bicuspid valves in some cases, and where other cardiac surgery is needed at the same time.
-
Do I need antibiotics before dental work?
Under current NICE guidance, routine antibiotic prophylaxis is not recommended for most people with valve disease. It is reserved for defined high-risk cases — your cardiologist will tell you if this applies.
-
When should I call 999?
Syncope with exertion, acute severe breathlessness (pulmonary oedema), chest pain, or new stroke symptoms after a TAVI or valve surgery are emergencies.
Related content
Keep reading.
-
Echocardiogram
The core test that grades valve severity and LV function.
Learn more -
Cardiac MRI
A detailed look at heart muscle, valves and fibrosis.
Learn more -
CT coronary angiogram
Assesses the coronary arteries before valve intervention.
Learn more -
All conditions
Browse every clinically reviewed condition guide.
Learn more