Heart valve disease presenting in adults: investigation and management

Context

The heart has 4 valves (aortic, mitral, tricuspid and pulmonary) that control blood flow.

In heart valve disease, valve function can be impaired by:

There can be stenosis and regurgitation of the same valve (mixed valve disease) or disease may affect more than one valve (multiple valve disease).

Mitral and tricuspid heart valve disease can be primary or secondary. Primary disease affects the valve structure, whereas secondary disease results from enlargement or dysfunction of the heart chambers (atria or ventricles) with otherwise normal mitral or tricuspid valve structure.

Heart valve disease can be congenital or acquired. Acquired valve degeneration is currently the main cause of heart valve disease, leading to the most common types of heart valve disease, as for example calcific aortic stenosis and myxomatous or calcific degeneration of the mitral valve.

Secondary heart valve disease can be classified as:

Among people aged 65 years or over the prevalence of asymptomatic heart valve disease may be more than 50%, whereas the prevalence of clinically significant heart valve disease is around 11%. It is predicted that for people over 65, the prevalence of heart valve disease will increase, from 1.5 million people currently to more than 3 million in 2046.

People with heart valve disease may have no symptoms or may have symptoms that can depend on the affected valve. Associated heart rhythm problems, such as atrial fibrillation or heart block, may cause palpitations and breathlessness, or dizziness and light‑headedness, respectively. Untreated severe disease can lead to valvular heart failure, with symptoms including breathlessness, reduced exercise capacity, tiredness and swollen ankles. Heart valves stiffen as part of the ageing process, making dysfunction more likely in older people. We hope that this guideline will raise awareness of heart valve disease and improve diagnosis and management.