You can have a problem valve for decades yet have no symptoms. If you do have symptoms, they may come on so slowly that you barely notice them. In other cases, though, symptoms appear suddenly. You might have one or more of these symptoms:

• Problems breathing when you lie down, exert yourself, or get stressed emotionally

• Pain, pressure, tightness, or numbness in your chest, neck, back, or arms (angina)

• Feeling dizzy, faint, or lightheaded

• Tiredness, especially with activity or as the day goes on

• Waking up at night coughing or short of breath

• A fast, pounding, or irregular heartbeat

• A fluttering feeling in your chest

• Swollen ankles or feet

• Fainting, especially upon standing up or with exertion

People of any age can have heart valve trouble. You may have been born with a problem valve. Or a valve may have worn out as you’ve aged. It may not be possible to pinpoint what caused your valve problem. But common causes include:

• Buildup of calcium or scar tissue on a valve

• Rheumatic fever and certain other infections and diseases

• High blood pressure

• Other heart problems, such as coronary artery disease

• Congenital defects of the heart valves

When a valve doesn’t open all the way, the problem is called stenosis. The leaflets may be stuck together or too stiff to open fully. When the valve doesn’t open fully, blood has to flow through a smaller opening. So the heart muscle has to work harder to push the blood through the valve.

When a valve doesn’t close tightly enough and blood leaks backward through the valve, the problem is called regurgitation or insufficiency. The valve itself may be described as leaky. Leaflets may fit together poorly. Or the structures that support them may be torn. Some blood leaks through the valve back into the chamber it just left. So the heart has to move that blood twice. This can result in heart muscle damage.