Valvular heart disease: symptoms, types, tests and treatment

The NHS lists shortness of breath, tiredness or weakness, dizziness, palpitations, swollen ankles and feet, and chest pain or discomfort. Some people have no symptoms at all, and the condition is sometimes found by chance when a doctor hears a murmur.

These symptoms have many possible causes. Having them does not mean you definitely have valve disease, but the NHS says it is important to have them checked. See a GP if you are regularly short of breath, feel tired, weak or dizzy during normal activities, have palpitations that keep returning, have swollen ankles or feet, or have chest pain that comes and goes.

• Call 999 or go to A&E if you cannot breathe, or if you have sudden chest pain that spreads to the arms, back, neck or jaw or lasts more than 15 minutes (NHS).

• The BHF also advises 999 for chest pain that does not settle with rest, or fainting and loss of consciousness.

• Seek an urgent appointment for worsening symptoms, a temperature with no obvious cause, night sweats, unexplained weight loss, or feeling unwell for two to three weeks.

The heart has four valves. Each has small flaps, called leaflets or cusps, that open and close with every heartbeat. The British Heart Foundation compares them to a one-way traffic system that keeps blood moving in the right direction.

Valve disease arises when one of these valves does not open fully, which is stenosis, or does not close properly, which allows blood to leak backwards. The BHF also describes valve prolapse, where the valve becomes floppy and does not close properly. In each case the heart has to work harder to move blood around the body.

The NHS says the aortic and mitral valves on the left side are most commonly affected, and the tricuspid and pulmonary valves on the right side less often.

Valve problems are named by what the valve does wrong. The BHF explains that either can make the heart work harder, and over time can increase the risk of heart attack or stroke.

The NHS lists congenital heart disease, where a person is born with the problem, changes to the heart with age, especially with smoking, high blood pressure or high cholesterol, conditions such as rheumatic fever, cardiomyopathy or endocarditis, and damage from a heart attack.

The BHF gives a similar list. The most common congenital valve problem it names is bicuspid aortic valve, where the aortic valve has two leaflets instead of the usual three. It advises that anyone diagnosed with a bicuspid aortic valve should be referred to a specialist.

A GP will listen to your heart and may arrange tests or refer you to a cardiologist. The NHS lists an echocardiogram, a chest X-ray and an electrocardiogram (ECG). The BHF adds blood tests, cardiac CT, cardiac MRI and angiogram as other possible tests.

Doctors describe valve disease as mild, moderate or severe, and this grading shapes the plan. If tests show valve disease, you will usually be referred to a cardiology team. NICE guideline NG208 covers investigation and management of heart valve disease presenting in adults, including referral for echocardiography and specialist assessment.

If the disease is mild and causes no symptoms, you may need no treatment but will have regular check-ups. The BHF says this usually includes an echocardiogram every 3 to 5 years. If it is moderate or severe without symptoms, the check-up and echocardiogram interval shortens to every 6 to 12 months.

Medicines do not repair a valve, but the NHS says they can lower blood pressure and protect the heart, reduce fluid build-up, slow the heart rate and lower the risk of clots. It names ACE inhibitors, diuretics, beta blockers and anticoagulants.

The NHS says severe disease usually needs surgery to repair the valve if it is not seriously damaged, or to replace it with an artificial valve or one made from human or animal tissue if it cannot be repaired. The BHF says the type of operation depends on the cause, the effect on the heart and your quality of life.

The BHF links the schedule to how severe the disease is. If your valve disease is mild and you have no symptoms, you might not need treatment and your doctor will usually suggest check-ups including an echocardiogram every 3 to 5 years. Moderate or severe disease with no symptoms needs a check-up and echocardiogram every 6 to 12 months. Make an appointment if you have new or worsening symptoms, which could mean the disease is getting worse.

Valve disease affects people differently, and mild disease is common. The NHS lists possible complications as heart failure, atrial fibrillation, stroke and endocarditis, a serious heart infection. The BHF adds that over time valve disease can raise the risk of heart attack or stroke and can lead to arrhythmias.

Pregnancy can make symptoms worse. The NHS says advice from a heart specialist is important if you are pregnant or want to be, and that you can usually have a safe pregnancy but may need extra monitoring and treatment.

The BHF says many people live well with valve disease. It recommends exercising safely, keeping to a healthy weight, eating a balanced diet, stopping smoking and cutting down on alcohol. Your care team may advise avoiding strenuous exercise depending on your condition.

The BHF suggests questions to ask your doctor or specialist nurse, such as what to do about exercise, work, flying, contraception, driving, having children, antibiotics and visits to the dentist. Feeling anxious after a diagnosis is common. Hospitals often have a specialist valve service, usually with a nurse contact.

The NHS says to see a GP if you are regularly short of breath, feel tired, weak or dizzy during normal activities, have palpitations that keep coming back, last longer than a few minutes or are getting worse, have swollen ankles or feet, or have chest pain that comes and goes.

The NHS says to call 999 or go to A&E if you are struggling to breathe, have sudden chest pain that spreads to your arms, back, neck or jaw or lasts more than 15 minutes, or chest pain with shortness of breath or palpitations. The BHF says to call 999 for chest pain that does not go away when you rest, if you feel you cannot breathe even at rest, or if you faint and lose consciousness. It advises an urgent appointment for worsening or new symptoms, a temperature with no obvious cause, sweating especially at night, unexplained weight loss, or feeling unwell for two to three weeks. Do not drive to A&E.

The NHS pathway runs from GP examination to echocardiography and a cardiology team, and then to a surgical team if intervention is needed. The BHF notes it can take a while to get an appointment for treatment and surgery.

Some people choose a private cardiologist for faster echocardiography and specialist opinion. The same grading and the same options apply. Ask what grade of valve disease you have, when the next scan is due, and which symptoms should prompt earlier review.