Brinda Kumar, a 58-year-old homemaker in Bengaluru was confused when her general physician asked her about the history of heart diseases in her family after an annual health check-up three months ago. She thought that it was just a routine question. But she soon realised that the doctor was asking these questions because of a minor problem noticed in the echocardiography (an ultrasound that checks the heart’s structure and function). “The doctor mentioned that I have a leaky heart valve but there’s nothing to worry about now. She asked me to consult a cardiologist later; I’m extremely careful with my health now,” she says.
What is a leaky heart valve?
The heart, which receives and supplies blood to the body, has four valves – mitral, aortic, pulmonary and tricuspid.
Dr Ritwick Raj Bhuyan, director of cardiothoracic and vascular surgery at Fortis Escorts Heart Institute, New Delhi, explains, “The four valves pass blood from one chamber to the other. There are two valves on the left side and two on the right. All these valves are quite sophisticated.” He also adds that ideally, these valves open and close in a synchronised manner to ensure the unidirectional flow of blood. However, when there is any disruption in this pattern, blood will start flowing backwards, which is called a leaky heart valve.
Dr Pravin Kahale, a cardiology consultant at Kokilaben Dhirubhai Ambani Hospital, Mumbai, adds that the valves in the heart are like the ones found in pipes and tubes. “They allow blood to go in one direction and not let it flow back. If a valve is defective, it leads to a backflow of blood, which is called a leaky valve.”
What causes a leaky valve?
A leaky heart valve occurs in all age groups – infants to older adults. But experts say that one of the most common causes of a leaky heart valve is rheumatic heart disease. Dr Bhuyan says, “Rheumatic heart disease happens because of a particular infection in the throat. In childhood, recurrent throat infections occur; this infection goes into the heart valve and damages it. Once the valve is affected, it gets enlarged due to inflammation and starts leaking. The valve, which is supposed to close when the heart beats, does not close and blood from the other chamber gets in.”
Among the elderly, it is commonly caused by degenerative heart disease due to age. A leaky heart valve may also be present in a newborn due to heredity, where the valve is not formed properly. But such cases are rare.
The leaks in the valves on the left side (mitral valve and aortic valve) of the heart, especially the mitral valve, are usually due to rheumatic heart disease. These leaks can make the heart swell and affect the valves on the right side. Dr Bhuyan says, “Right-side valves do not have leaks until, say, a person is a drug user. If they take intravenous drugs for a long time, it can directly damage and cause leakage in the right valves.”
How is a leaky heart valve diagnosed?
The condition can remain asymptomatic if it is mild. It is diagnosed only when a doctor uses a stethoscope to check the heartbeat or through echocardiography.
Signs and symptoms
Experts say that initially, a leaky valve does not show any symptoms; symptoms may not show for two to three years. But when the disease advances, a heart attack may occur. Here are some symptoms of a severe leaky heart valve:
- Shortness of breath
- Swelling in legs
- Irregular heart rhythm
Is a leaky heart valve life-threatening?
In most cases, the condition is not very dangerous. It remains benign and shows symptoms later in life. It can be managed with medication for a couple of years, say experts. However, if left untreated, a leaky heart valve can cause heart failure, which requires surgery for valve replacement.
Dr Bhuyan says the condition can also develop suddenly after a heart attack. “It can affect a valve, leading to leaks. Those cases are very severe and can show symptoms like severe breathlessness. The person can collapse and go into a condition where they may require ventilation support and heart surgery,” he says. Dr Kahale adds that the lifespan of a person is then affected by the strength of the heart muscle and not the leaky heart valve, but the valve condition adds to the risk.
Dr Kahale adds that people with a leaky heart valve whose hearts have a good pumping capacity can live better and longer compared to those with a proper valve function but with a heart pumping capacity as low as 30 per cent. He says, “Leaky heart valves are classified as mild, moderate and severe. But before it starts putting stress on the heart, we need to replace this valve that can help people live longer, for over a decade. It takes 10 to 15 years to become severe. But if their heart muscles are weak, then their health can deteriorate further and their life span may reduce.”
Pregnant women with leaky heart valves should be careful. A 2021 study published in the American Journal of Cardiology found that pregnant women with leaky heart valves are up to 100 times more likely to face complications such as heart failure at the time of delivery compared to women without heart valve disease. Dr Kahale says that women with leaky heart valves, especially severe ones, are at an increased risk of heart failure and arrhythmia during pregnancy. “A mild to moderate leak can be well-tolerated. Patients with severe leaky hearts should reconsider pregnancy in consultation with a cardiologist and a gynecologist.”
Living with a leaky valve
Experts suggest the following measures for those diagnosed with mild leaky heart valves:
- Follow up with the cardiologist regularly, preferably every year or every six months
- Restrict fluid intake in the case of a mitral valve leak, as instructed by the doctor
- Avoid stress
- Be cautious with taking medicines for fever and other health conditions
- Exercise and maintain good health
- Prevent hypertension, diabetes and obesity as they further complicate the heart condition
- Inform the doctor while undergoing minor procedures like tooth extraction so that an antibiotic can be prescribed to prevent infections