Valve disease often develops slowly. Understanding the warning signs can make the difference between a repair and a replacement.
The heart has four valves — mitral, aortic, tricuspid, and pulmonary — whose job is to ensure blood flows in one direction only through the heart's chambers. When a valve leaks (regurgitation) or fails to open fully (stenosis), the heart must work harder to compensate, often for years before symptoms appear.
The Danger of Slow Progression
This gradual adaptation is both a feature and a hazard. Patients often feel well even as significant valve dysfunction develops. By the time breathlessness, fatigue, or ankle swelling become obvious, the heart may have already sustained irreversible changes. This is why regular echocardiographic surveillance of known valve disease is essential.
Warning Signs
Seek assessment promptly if you experience:
- ›Progressive shortness of breath on exertion (doing less than you used to for the same symptoms)
- ›Waking at night breathless (orthopnoea or paroxysmal nocturnal dyspnoea)
- ›Ankle or leg swelling
- ›Palpitations or an irregular heartbeat (atrial fibrillation is commonly triggered by mitral valve disease)
- ›Dizzy spells or fainting, especially with exertion (a serious warning sign in aortic stenosis)
- ›A new heart murmur detected by your doctor
Repair vs Replacement
When surgery is indicated, the aim is always to repair rather than replace a valve. A repaired native valve — particularly the mitral — lasts a lifetime without requiring blood thinning medication (anticoagulation). Replacement with a biological prosthesis avoids anticoagulation but may need revision after 10–15 years; a mechanical valve is more durable but requires lifelong anticoagulation.
The timing of surgery, and the choice of valve strategy, must be individualised. An early referral to a cardiothoracic surgeon — ideally while the valve is still repairable and before heart function has declined — gives the best long-term outcome.