I was told I have a murmur. Does that mean valve disease?

Not necessarily. Some murmurs are innocent — produced by normal flow, common in children, in pregnancy, in anaemia and during fever, and of no consequence. Others reflect a genuine valve problem. The two cannot be separated reliably by listening alone, which is why an echocardiogram is usually arranged. It answers the question directly and, in the majority of cases, reassuringly.

My valve disease is moderate and I feel fine. Why do I need repeat scans?

Because the heart compensates so effectively that symptoms appear late, sometimes only after the muscle has taken damage that does not fully reverse. Serial echocardiograms track severity and, more importantly, the size and function of the chambers. The purpose is to identify the point at which intervention gives the best long-term result — which is often before you feel unwell.

Mechanical or tissue valve — which is better?

Neither is better in general; they trade off differently. A mechanical valve lasts decades but requires lifelong anticoagulation with regular blood tests, and carries the bleeding risk that goes with it. A tissue valve usually does not require long-term anticoagulation but wears out over time and may need replacing, sooner in younger patients. Age, other conditions, plans for pregnancy, and how practical regular monitoring is all feed into the decision, which should be made jointly.

Also called Valvular heart disease, Leaking valve, Narrowed valve, Heart murmur

Heart valve disease

Disease of one or more of the heart's four valves, which either narrow and obstruct flow or leak and let blood travel backwards. Often silent for years, and often first noticed as a murmur.

When to seek urgent care

Fainting or near-fainting on exertion
Chest pain on exertion in someone known to have a narrowed aortic valve
Breathlessness at rest, or an inability to lie flat
Fever with night sweats and fatigue in someone with known valve disease or a prosthetic valve — this may be valve infection and needs same-day assessment
A sudden change in exercise tolerance

Call 108 for an ambulance, or go straight to the nearest emergency department. Do not wait for a reply from this website.

What it is

The heart has four valves, and each is a one-way door. They open to let blood through and close to stop it going back. Two things can go wrong: a valve can narrow, so the heart must work harder to push blood through it, or it can leak, so a proportion of each beat travels backwards and the work is wasted.

Either fault makes the heart compensate. Chambers thicken or enlarge, and for years this compensation works well enough that the person feels normal. Symptoms tend to appear late, once compensation is running out — which is why valve disease is often picked up as a murmur on examination before the patient has noticed anything.

In this region two causes dominate. Rheumatic heart disease, following streptococcal throat infection in childhood, remains an important cause in India and characteristically affects the mitral valve. Degenerative disease, in which the aortic valve calcifies and stiffens with age, is the other major group.

Timing is the central question in valve disease. Intervene too early and a patient undergoes a procedure they did not yet need; too late and the heart muscle has already sustained damage that does not fully recover. This is why people with known valve disease are followed with periodic echocardiograms even while they feel entirely well.

Fig.A valve is three leaflets that meet in the middle and fold back against the wall. Narrowing is a failure to open; leaking is a failure to close.

What people notice

Often nothing for many years
A murmur heard by a doctor during an examination for something else
Breathlessness on exertion, then at lower and lower levels of activity
Chest tightness on exertion, particularly in aortic narrowing
Light-headedness or fainting on exertion — a significant symptom in aortic stenosis
Palpitations, often from atrial fibrillation developing alongside mitral disease
Ankle swelling and fatigue
Reduced exercise tolerance that the person has quietly adapted to over years

What causes it

Rheumatic fever in childhood, following untreated streptococcal throat infection
Age-related calcification and degeneration, most commonly of the aortic valve
Congenital valve abnormality, such as a bicuspid aortic valve, which presents earlier in life
Infective endocarditis — infection of a valve
Dilation of the heart from other disease, which stretches a valve ring until it no longer closes
Previous heart attack affecting the muscles that anchor the mitral valve

How it is assessed

Examination — the character, timing and location of a murmur narrows the diagnosis considerably before any test
Echocardiography, which is the definitive test: it identifies the valve, the fault, its severity, and the effect on the chambers
ECG, for chamber enlargement and associated rhythm disturbance
Chest X-ray
Serial echocardiograms at planned intervals, since severity and the state of the heart muscle over time drive the decision to intervene
Transoesophageal echocardiography or cardiac catheterisation in selected cases before intervention

How it is treated

Surveillance with periodic echocardiography for mild and moderate disease, which is active management rather than doing nothing
Medication to control symptoms, blood pressure, fluid and rhythm — this does not correct the valve itself
Anticoagulation where atrial fibrillation or a mechanical valve requires it
Antibiotic prophylaxis and prompt treatment of throat infections in rheumatic disease
Balloon valvotomy for suitable rheumatic mitral narrowing
Surgical repair, which is preferred over replacement where the valve is repairable
Valve replacement, mechanical or tissue, with the choice depending on age, the ability to take lifelong anticoagulation, and the patient's own priorities
Transcatheter valve implantation in selected patients for whom open surgery carries high risk

Good dental hygiene matters more than patients expect in valve disease, because mouth bacteria entering the bloodstream can infect an abnormal valve.

Reducing the risk

Treat sore throats in children properly — rheumatic heart disease is a preventable consequence of untreated streptococcal infection.
Complete the full course of prophylactic penicillin if it has been prescribed after rheumatic fever.
Keep dental care up to date, and tell your dentist you have valve disease.
Do not skip surveillance echocardiograms because you feel well. Feeling well is expected at the stage where they matter most.

The things people most often ask in the consulting room.

Related conditions

Tests you may be offered

Discuss valve disease with a cardiologist

Bring your previous reports and current medicines. A consultation turns a general guide into an answer about you.

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