Heart Valve Disease
Heart Valve Disease: A Complete Patient Guide
Heart valve disease (valvular heart disease) means that one or more of the heart’s four valves is not working properly. The valves are the one-way doors that keep blood moving forwards through the heart: the aortic, mitral, tricuspid and pulmonary valves. A valve can be narrowed (stenosis), so that it does not open fully, or it can leak (regurgitation), so that some blood flows backwards. Some valves have both problems.
Valve disease is common, particularly with increasing age, and the left-sided valves (aortic and mitral) matter most. Many people have no symptoms for years, and the problem is often discovered when a doctor hears a heart murmur. Over time, a significantly narrowed or leaking valve makes the heart work harder and can lead to breathlessness, tiredness, rhythm problems and heart failure.
The key test is an echocardiogram (heart ultrasound), which shows which valve is affected, how severe the problem is and how the heart is coping. Mild disease is simply monitored. Severe disease, or disease that is causing symptoms or changes in the heart, may need a valve repair or replacement, increasingly by keyhole (transcatheter) techniques such as TAVI. Timing matters, which is why regular follow-up is important.
Specific valve problems are covered on their own pages: aortic valve stenosis, aortic valve regurgitation, mitral valve regurgitation, mitral valve prolapse and bicuspid aortic valve.
Valve disease often causes no symptoms at first. Symptoms usually appear gradually, and many people adapt without noticing, putting them down to age or fitness.
Common symptoms
Breathlessness, especially on exertion, climbing stairs or lying flat
Tiredness and reduced stamina
Palpitations or an irregular heartbeat (often atrial fibrillation)
Chest tightness or pain on exertion, particularly with aortic stenosis
Dizziness, light-headedness or fainting, especially during exercise
Ankle swelling and fluid retention in more advanced disease
What a doctor may find
A heart murmur on listening with a stethoscope
An irregular pulse, or signs of fluid on the lungs or in the legs
A change in blood pressure pattern, such as a wide pulse pressure in aortic regurgitation
No symptoms does not mean no disease
Valve disease can progress silently. Mild disease usually stays stable for years, but severe disease can affect the heart muscle before symptoms are obvious, so scheduled monitoring is important.
The cause depends on the valve involved. Often more than one factor is present.
Common causes
Age-related wear and calcification: the most common cause of aortic stenosis in older adults
Congenital valve differences, such as a bicuspid aortic valve, which can narrow or leak earlier in life
Degenerative change of the mitral valve, including mitral valve prolapse, causing mitral regurgitation
Enlargement of the heart or aortic root, which stretches the valve ring and stops the leaflets meeting (a cause of aortic and functional mitral regurgitation)
Rheumatic heart disease, following rheumatic fever in childhood, now uncommon in the UK but still an important cause in people who grew up in parts of the world where it is common
Infective endocarditis, an infection of the heart valves that can damage them suddenly
Factors that raise the risk
Increasing age, high blood pressure, high cholesterol and kidney disease (for calcific aortic stenosis)
Previous valve infection or rheumatic fever
Previous chest radiotherapy
A family history of valve or aortic disease, or a congenital heart condition
A previous heart attack or heart failure, which can distort the mitral valve
Valve disease is diagnosed with a careful examination and imaging. The aim is to name the valve, grade the severity and show the effect on the heart.
1. History and examination
Your symptoms, exercise capacity and medical history are reviewed, and the heart is listened to for a murmur.
2. ECG
Checks the heart rhythm and any strain on the heart chambers, including atrial fibrillation. See our ECG reporting service.
3. Echocardiogram
The key test. An echocardiogram shows how well each valve opens and closes, measures pressure gradients and leak severity, and assesses the size and pumping function of the heart. A bubble or transoesophageal study is occasionally needed for more detail.
4. Exercise testing
A treadmill ECG or stress echocardiogram can reveal limiting symptoms in someone who feels well, or show how the heart responds to effort. It is used only when it is safe for the valve problem in question.
5. Blood tests
NT-proBNP (a marker of heart strain), a blood count and kidney function help assess the effect on the body and plan treatment.
6. CT and cardiac MRI
A CT calcium score can confirm the severity of aortic stenosis when other tests disagree, and CT is used to plan TAVI. Cardiac MRI measures leak severity and heart size precisely when echocardiography is not definitive. CT or invasive angiography checks the coronary arteries before valve surgery.
How often are scans repeated?
It depends on the valve and its severity. As a guide, mild disease may be reviewed every 32to 3 years, moderate disease every 1 to 2 years, and severe disease every 6 to 12 months, or sooner if symptoms change. Your cardiologist will set your interval.
No medicine can repair a damaged valve. Treatment aims to monitor safely, control related conditions and intervene at the right time.
Monitoring and medicines
Regular reviews and echocardiograms for mild to moderate disease
Treating high blood pressure, high cholesterol and atrial fibrillation
Anticoagulation (blood thinners) when atrial fibrillation is present, or lifelong warfarin for a mechanical valve
Water tablets and other heart failure medicines to relieve symptoms when needed
Good dental hygiene, to reduce the risk of valve infection
Valve repair or replacement
Intervention is considered when a valve is severely narrowed or leaking and is causing symptoms, or when the heart is starting to be affected even though you feel well. The decision is made by a Heart Team of cardiologists and cardiac surgeons, taking into account your age, other health problems and what you prefer.
Surgical repair or replacement. Repair is preferred for a leaking mitral valve when possible, because it keeps your own valve. Replacement uses a mechanical valve (long-lasting but needs warfarin for life) or a biological tissue valve (does not usually need warfarin but may wear out over time)
TAVI (transcatheter aortic valve implantation). A new valve is placed inside the narrowed aortic valve through an artery, usually without open-heart surgery, and is an option for many older or higher-risk patients and is recommended in the 2025 ESC/EACTS guideline for suitable patients aged 70 or over
Transcatheter mitral repair (TEER). A clip repairs a leaking mitral valve in selected patients who are not suitable for surgery
Balloon valvuloplasty. Used mainly for rheumatic mitral stenosis
Where I fit in
I can assess your valve with examination, ECG and echocardiography, explain how severe it is, arrange monitoring and, when intervention is needed, refer you to the right surgical or transcatheter team and continue your care afterwards.
Most people with mild to moderate valve disease live normally. Small steps help protect the heart and catch change early.
Staying active
Regular moderate activity is generally encouraged. If you have severe valve disease, ask before doing very strenuous exercise or heavy lifting. Never ignore chest pain, faintness or unusual breathlessness during exercise.
Looking after your heart
Keep your blood pressure and cholesterol under control, and do not smoke
Keep to a healthy weight and limit alcohol
Report new or worsening symptoms promptly rather than waiting for your next review
Attend every scheduled check, even if you feel well
Dental care and infection
See a dentist regularly and keep your teeth and gums healthy. Tell your dentist and other doctors that you have a valve problem. If you develop a fever without a clear cause, especially after dental work or with a prosthetic valve, seek medical advice promptly.
Pregnancy, driving and medicines
If you are planning a pregnancy, seek advice beforehand, because some valve problems and mechanical valves need specialist planning
Driving rules depend on your symptoms and treatment. See our page on DVLA cardiac assessment
If you take warfarin, keep to your blood test schedule and tell every clinician you see
The outlook depends on which valve is affected, how severe it is and when it is treated.
Mild and moderate valve disease often stays stable for many years with monitoring. Mitral valve prolapse is usually benign.
Severe aortic stenosis that is causing symptoms carries a poor outlook without treatment, but valve replacement, including TAVI, restores life expectancy close to normal in many people.
Leaking valves can be tolerated for a long time, but treatment at the right moment prevents lasting damage to the heart muscle.
Timely intervention before the heart is badly affected gives the best results, which is why monitoring matters.
Do not put new breathlessness or tiredness down to age without having it checked. Valve disease is treatable.
Arrange an assessment if you have:
A heart murmur that has not been investigated
New or worsening breathlessness, reduced stamina or chest tightness on exertion
Palpitations, dizziness or fainting
Ankle swelling or unexplained weight gain
A known valve problem and no recent echocardiogram
A bicuspid valve, previous rheumatic fever or endocarditis, or a family history of valve or aortic disease
If you are unsure
A cardiology assessment with an ECG and echocardiogram quickly shows whether a valve is responsible and how significant it is. It often provides reassurance.
These features in someone with a known or suspected valve problem need prompt assessment.
Red flags
Breathlessness that has become worse over days or weeks
Chest pain or pressure on exertion
Fainting or near-fainting, especially during or after exercise
Breathlessness lying flat or waking at night
Rapid weight gain or increasing leg swelling
A fast or irregular heartbeat that does not settle
Fever, sweats or flu-like illness in someone with a valve problem or a prosthetic valve
What to do
Contact your GP, cardiologist or NHS 111 the same day. If the symptoms are severe, call 999.
Valve disease can occasionally cause an emergency.
Call 999 immediately if you have:
Severe breathlessness at rest, or you cannot speak in full sentences
Chest pain or pressure, especially with sweating or pain spreading to the arm or jaw
Fainting or collapse
Coughing up pink frothy phlegm
Sudden weakness of the face, arm or leg, or speech difficulty (possible stroke)
While waiting
Sit upright, loosen tight clothing and stay as calm as you can. Do not drive yourself.
Heart valve disease means a valve is narrowed, leaking or both.
It is common with age, and many people have no symptoms at first.
The aortic and mitral valves are the most important.
An echocardiogram is the key test and shows severity and effect on the heart.
Mild disease is monitored. Severe disease may need repair or replacement.
TAVI and transcatheter repair allow treatment without open-heart surgery for many patients.
Treating severe disease at the right time gives the best outcome.
New breathlessness, chest pain or fainting needs urgent assessment.
Guidelines and sources
This page follows current UK and international guidance:
NICE NG208: Heart valve disease presentation and management.
Praz F et al. 2025 ESC/EACTS Guidelines for the management of valvular heart disease. European Heart Journal 2025.
Otto CM et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease. Circulation 2021;143:e72-e227.
These are the questions patients most often ask about heart valve disease.
What is heart valve disease?
A condition in which one of the four heart valves is narrowed, leaks, or both, making the heart work harder.
What are the symptoms of heart valve disease?
Breathlessness, tiredness, palpitations, chest tightness, dizziness or fainting and ankle swelling. Many people have no symptoms at first.
What causes heart valve problems?
Age-related wear, a congenital valve difference such as a bicuspid aortic valve, mitral valve degeneration, rheumatic fever, infection of the valve and enlargement of the heart or aorta.
Is a heart murmur the same as valve disease?
No. Many murmurs are harmless, but a murmur can be the first sign of valve disease, so an echocardiogram is the way to find out.
How is heart valve disease diagnosed?
With an examination, ECG and an echocardiogram, sometimes with exercise testing, CT or cardiac MRI.
Can heart valve disease be cured without surgery?
Medicines cannot repair a valve, but they control symptoms and related problems. Severe disease is treated by valve repair or replacement, which can now often be done through a catheter (TAVI or transcatheter mitral repair).
Do I need surgery if I have a leaking valve?
Not always. Mild and moderate leaks are monitored. Surgery or a catheter procedure is considered when the leak is severe and causing symptoms, or is starting to affect the heart.
Can I exercise with heart valve disease?
Usually yes for mild to moderate disease. With severe disease, ask first, particularly about strenuous exercise or heavy lifting.
How often do I need an echocardiogram?
It depends on the valve and severity, from every few years for mild disease to every 6 to 12 months for severe disease. Your cardiologist will advise.
Can I have a private valve assessment?
Yes. A telephone, video or face-to-face consultation in Peterborough or Corby can assess your valve, with echocardiography and other tests arranged as needed.
Which valve is affected, and is it narrowed, leaking or both?
How severe is it, and how do you know?
Is it causing my symptoms?
How often do I need an echocardiogram?
What would make you recommend repair or replacement, and when?
If I need a procedure, would I be suitable for a catheter approach such as TAVI?
Would a tissue or a mechanical valve suit me better?
How much exercise is safe for me?
Do I need antibiotics for dental work, or special dental care?
What symptoms should make me contact you urgently?
The four heart valves
Each valve opens to let blood through and closes to stop it flowing back. Disease of the left-sided aortic and mitral valves is the most common and has the greatest effect on the heart.
A valve can narrow or leak
A valve can fail by not opening fully (stenosis), by not closing tightly (regurgitation), or both.
From murmur to treatment
Most people with valve disease are monitored. Repair or replacement is considered when the valve is severe, is causing symptoms or is affecting the heart.
If you have a heart murmur, breathlessness, reduced stamina or a known valve problem, you may benefit from a telephone consultation or video consultation to discuss your symptoms in detail, or a face-to-face consultation in Peterborough or Corby for a more comprehensive assessment. Severe breathlessness needs a 999 call.
Investigations such as echocardiography, ECG reporting and stress echo may be recommended.
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Medically reviewed by Dr Salam Salloum, Consultant Cardiologist. Last updated: . This page is for general information and does not replace personal medical advice.