What causes heart valve disease (valvular heart disease)?

Niberto L. Moreno, MD
Thoracic Surgery (Cardiothoracic Vascular)
Some people have congenital heart valve disease, which means they are born with valves that didn't properly develop. Others may develop the disease later in life. Some causes of acquired heart valve disease include rheumatic fever, damage from an infection or a heart attack and degeneration over time. Advanced high blood pressure and heart failure can enlarge and distort the heart or the main arteries, too.
Ramon Quesada, MD
Cardiology (Cardiovascular Disease)
Some people are born with valves that didn’t properly develop. This is called congenital heart valve disease. Others may develop the disease later in life. This is referred to as acquired heart valve disease. Causes of the acquired type include damage from an infection or a heart attack, rheumatic fever and the wearing away, or degeneration, of the valves over time. Also, advanced high blood pressure and heart failure can cause the heart or main arteries to swell, stretching and distorting the heart valves.
Chiwon Hahn, MD
Thoracic Surgery (Cardiothoracic Vascular)
Several factors, both genetic and environmental, can contribute to heart valve disease (valvular heart disease). Congenital heart valve defects are those that occur before birth, and are detected later in life. Environmental factors that increase risk include a history of rheumatic fever, infective endocarditis, heart attack, arrhythmia or cardiomyopathy. Calcification of the arteries (arteriosclerosis) is also a risk factor, as plaque buildup narrows the arterial tubes delivering blood to the heart. Not only can this affect valve health, but it can also increase a person’s risk for heart attack and stroke.

This content originally appeared on the HCA Virginia Physicians blog.
David H. Adams, MD
Thoracic Surgery (Cardiothoracic Vascular)

Valvular heart disease is actually one of the most common heart problems. Causes include the following: Degenerative valve diseases (age-related), infections (i.e. endocarditis, an infection of the heart valves due to microbial invasion), birth defects, an association with other disorders such as rheumatoid arthritis and systemic lupus, or rheumatic fever (which results from untreated strep throat, uncommon in North America).

Other contributing factors are coronary artery disease (heart attacks can eventually damage the heart muscle and the mitral valve), disorders of the aorta such as dilatation or aneurism (can affect the aortic valve), pulmonary hypertension, or elevated pressure in the arteries supplying the lungs (can affect the tricuspid valve), cardiac muscle diseases (cardiomyopathy), hypertension and atherosclerosis.

Other rare causes include: tumors of the heart, rare gut tumors (carcinoid tumor), trauma and radiation.

A number of conditions can lead to heart valvular disease. Congenital defects and infections, such as rheumatic fever, are among the most common. Rheumatic heart disease, although greatly diminished since the advent of antibiotics to treat streptococcal infections, still affects more than 1 million Americans and causes about 6,000 deaths per year.
Physicians currently do not know what causes congenital heart valve problems (those that are present at birth). However, acquired heart valve disease may be caused by a number of factors. Some of these factors are a natural outcome of aging, have hereditary elements, or can be managed with prevention. In all cases, regular check-ups with your physician can help you maintain your heart valve health.

Risk factors for acquired heart valve problems include the following:

Rheumatic fever. Rheumatic fever, which can result if strep throat is not treated, can damage the heart's valves, causing them to thicken. This can restrict the valves’ ability to open or to close properly, or both.

Endocarditis. This infection of the lining (endocardium) of the heart is typically caused when bacteria from another part of your body, such as your mouth, travels to your heart. Endocarditis is both a cause and a symptom of heart valve damage. That is, patients who already have heart valve damage are more likely to acquire endocarditis, and endocarditis itself can damage heart valves.

Wear and tear with age. With age, valve leaflets, which open to allow blood to flow through the valve and close to prohibit blood flow, can become hardened and thick and lose their mobility, detracting from their ability to work as they should. Over time, the cords of tissue that hold valve flaps to the heart can become stretched or torn, interfering with the valve's proper function.

Heart attack. A heart attack, which occurs when a blockage in an artery to the heart muscle starves the heart of oxygen and nutrients and causes damage, can affect valve function.

High blood pressure. Persistent high blood pressure can cause your heart to work harder, causing the heart's pumping chamber (the left ventricle) to enlarge. As it enlarges, tissues around the heart valves can become stretched, preventing the valve from closing properly.

Valvular heart disease has several causes. Coronary artery disease and heart attacks are conditions that can lead to heart valve problems; you can also be born with heart valve irregularities (aortic or mitral valves). The aortic and mitral valves can also develop problems if too much calcium makes them thick; the mitral valve can be damaged as people get older. Some medications, such as Fen-Phen and Redux, and treatments for cancer, such as radiation, may lead to valvular problems. Lastly, infections such as infective endocarditis and rheumatic fever, a kind of bacterial infection, can cause valvular heart disease.

Heart valve disease can have many causes including wear and tear, infection, radiation effects from cancer treatment, high blood pressure, cardiomypathies and problems that individuals were born with in terms of not enough cusps. The list is very long and the above list is only partial.

Basically heart valves open and close to allow blood to flow from one heart chamber to the next, but their role is not just a gate. They also have a special role in how the heart functions because of the parachute like chords that are attached to the valves. 

Valve dysfunction can be related to valve leaking, narrowing, or a combination of both. 

The cause of the valve dysfunction is the most important part of diagnosis and  treatment.  

Talk to a cardiologist (heart specialist) if you have been diagnosed with heart valve disease. 
James L. Januzzi, MD
Cardiology (Cardiovascular Disease)

Heart valve disease may occur due to numerous causes. These include:

  1. Inherited reasons, such as bicuspid aortic valve, a congenital valve problem that can either cause leaking or narrowing of the valve.
  2. Degenerative reasons, such as mitral valve prolapse (a floppy valve, leading to leak) or age-related aortic valve narrowing which may follow from calcification. Other causes include radiation exposure and chronic kidney disease.
  3. Inflammatory reasons, such as rheumatic fever.
  4. Infectious causes such as endocarditis, a direct infection of the valve.

Frequently we can't find a reason, but in most cases, the treatment is the same, with medications first and surgery reserved for severe cases.

Nassir A. Azimi, MD
Interventional Cardiology

Stress, stretch, calcium deposition and degeneration all are factors that lead to disease in heart valves. Recurrent inflammation, rheumatic heart disease, infection on the valves themselves is other reasons.

William D. Knopf, MD
Cardiology (Cardiovascular Disease)
Heart conditions and other disorders, age-related changes, rheumatic fever, and infections can cause acquired heart valve disease. These factors change the shape or flexibility of once-normal valves and/or its support structure.
The cause of congenital heart valve defects isn't known. These defects occur before birth as the heart is forming. Congenital heart valve defects can occur alone or with other types of congenital heart defects.
Heart Conditions and Other Disorders
Heart valves and their support structure can be stretched and distorted by:
  • Damage and scar tissue due to a heart attack or injury to the heart.
  • Advanced high blood pressure and heart failure. These conditions can enlarge the heart or the main arteries.
Age-Related Changes
Men older than 65 and women older than 75 are prone to developing calcium and other deposits on their heart valves. These deposits stiffen and thicken the valve flaps and limit blood flow (stenosis).
Rheumatic Fever
Some people have heart valve disease due to untreated strep throat or other infections with strep bacteria, which progress to rheumatic fever.
When the body tries to fight the strep infection, one or more heart valves may be damaged or scarred in the process. The aortic and mitral valves are most often affected. Symptoms due to heart valve damage often don't appear until many years after recovery from rheumatic fever.
Common germs that enter through the bloodstream and get carried to the heart can sometimes infect the inner surface of the heart, including the heart valves. This rare, but sometimes life-threatening infection is called endocarditis.
The germs can enter the bloodstream through needles, syringes, or other medical devices and through breaks in the skin or gums. Usually the body's defenses fight off the germs and no infection occurs. Sometimes these defenses fail, which leads to endocarditis.limit blood flow.
Endocarditis usually develop in people who already have abnormal blood flow through a heart valve. The abnormal blood flow causes turbulence which allows for blood clots to form on the surface of the valve. The blood clots make it easier for germs to attach to and infect the valve.
Endocarditis can worsen existing heart valve disease.
This answer from the National Heart, Lung and Blood Institute has been reviewed and/or edited by Dr. William D.

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