Heart valve disease

Also called Aortic stenosis, Mitral regurgitation, Heart murmur

Often silent for years, then symptoms arrive and the clock starts. Breathlessness, chest tightness or blackouts in an older person deserve a stethoscope.

What it is

Disease of one or more of the four heart valves, which either narrow, called stenosis, or leak, called regurgitation.

The commonest in the UK is aortic stenosis, where the valve stiffens with age and calcium. It is increasingly common over 75, and it is the one to understand, because it follows a specific and important pattern: many years with no symptoms at all, then, once symptoms appear, a sharply worse outlook without treatment.

That is why symptoms matter more than the murmur. Breathlessness, chest tightness or fainting on exertion in somebody with known aortic stenosis is a reason for urgent assessment for valve replacement, not for watchful waiting.

Treatment has changed enormously. TAVI, replacing the valve through a catheter in the groin rather than by open surgery, means many people in their eighties and nineties who would once have been told they were too old are now treated, often going home within days.

Other valves matter too: mitral regurgitation is common and often well tolerated for years, and rheumatic valve disease still occurs, particularly in people who grew up outside the UK.

Damaged valves raise the risk of infective endocarditis, which is why dental health and telling dentists matters.

Signs you might notice

Breathlessness on exertion, gradually reducing what somebody can do.

Chest tightness or pain on exertion.

Fainting, light-headedness or blackouts, particularly on exertion. This is a serious sign in aortic stenosis.

Tiredness, palpitations, swollen ankles.

A heart murmur, often found incidentally.

999: chest pain, collapse, or severe breathlessness.

Urgent: any of breathlessness, chest tightness or fainting in somebody known to have aortic stenosis. These three symptoms change the plan.

Also urgent: fever, night sweats and feeling unwell over weeks in someone with a valve problem or a replacement valve, which may be endocarditis and is easily mistaken for a virus.

How it can affect day-to-day life

The commonest error is attributing gradually reducing exercise tolerance in an older person to age. Somebody who has stopped walking to the shops has a symptom, and it is worth asking what changed and when.

People are frequently told they have a murmur and nothing more, and then never followed up. Anybody with a known valve problem should have a plan for monitoring, usually a repeat echocardiogram at an interval that depends on severity.

Dental health is genuinely protective. Bacteria from the mouth cause endocarditis on damaged valves, and everyone with valve disease should be registered with a dentist and tell them.

After a mechanical valve replacement, lifelong warfarin is needed, with regular monitoring; tissue valves usually do not need it but do not last as long, which is the trade-off people are asked to weigh.

Being told they are too old for treatment should be questioned now; TAVI has changed who is treatable.

Supporting someone well

Report the three symptoms: breathlessness, chest tightness, fainting. They are what triggers action.

Ask what the monitoring plan is, and when the next echocardiogram is due. Do not let follow-up lapse.

Register with a dentist, go regularly, and say there is a valve problem.

Ask about TAVI rather than accepting too old or too frail without a specialist opinion.

For mechanical valves, never stop anticoagulation without advice, and tell every clinician.

Report fever and feeling unwell over weeks; endocarditis is easily missed and needs blood cultures before antibiotics.

Keep active within symptoms, and ask what level is safe.

Where to get help

A GP practice for a murmur or new symptoms; cardiology for assessment and treatment.

999 for chest pain, collapse or severe breathlessness.

Urgent GP for unexplained fever over weeks with a valve problem.

British Heart Foundation on 0808 802 1234.