Valve leaks on an echo: mild, moderate and severe

The heart has four valves that open and close with every heartbeat to keep blood flowing one way. The British Heart Foundation explains that heart valve disease is when one or more valves do not work as they should, either because they do not open fully (stenosis) or because they do not close properly. When a valve does not close fully, blood can leak back, which is called regurgitation, incompetence or a leaky valve.

The NHS adds that it can affect any of the four valves but is most common in the aortic or mitral valves on the left side of the heart. A report that says “mild mitral regurgitation” therefore describes a small backward leak across the mitral valve.

An echocardiogram uses sound waves to build up a picture of the heart. The BHF says it looks at the structures of the heart, such as the valves, how blood flows through the main arteries and veins, and how well the heart is pumping. The NHS says a standard scan takes around 30 to 40 minutes and that a sonographer moves an ultrasound device over the chest.

The sources cited here do not give numerical thresholds for the grades, and measurement methods differ between departments, so the wording on your report is best taken as a summary, by the person reporting the scan, of how significant the leak appears. Your cardiologist puts that together with your symptoms and the rest of the scan.

The BHF says that when you are diagnosed with heart valve disease you may hear your doctor describe it as mild, moderate or severe, and that treatment is different for each level.

The BHF says most people with mild heart valve disease have long lives, but it is important to speak to your doctor if you have any new or worsening symptoms. The NHS says that with mild disease and no symptoms you may not need treatment and will usually have regular check-ups to see if the condition is getting worse.

If a mild leak was found on a scan done for another reason, ask the clinician who requested it whether any follow-up is intended, since the plan may simply be to review if symptoms develop.

The BHF lists breathlessness, chest pain, feeling weak or dizzy, chest discomfort, swollen ankles and feet, tiredness and palpitations as common symptoms of valve disease, and notes that some people have none. Doctors may hear a murmur with a stethoscope.

The NHS says to see a GP if you are regularly short of breath, feel tired, weak or dizzy with normal activity, have recurring palpitations or swollen ankles, or have chest pain that comes and goes. It says to call 999 or go to A&E if you are struggling to breathe, or have sudden chest pain that spreads to the arms, back, neck or jaw or lasts more than 15 minutes.

The NHS says people with symptoms or severe disease may need medicines to lower blood pressure, reduce fluid build-up, slow the heart rate or reduce the risk of clots, and that severe disease will usually need surgery to repair the valve or replace it with an artificial valve or one made from human or animal tissue. Possible complications include heart failure, atrial fibrillation, stroke and endocarditis, according to the NHS.

Ask your cardiologist which valve is affected, what the heart chambers look like, whether there are symptoms, and when the next scan is due, since timing of surgery depends on all of these rather than the grade alone.