The aortic valve is located between the left ventricle of the heart and the aorta (the largest artery in the body) that supplies blood throughout the body. Aortic stenosis (AS) is a narrowing of the aortic valve that could block blood flow from the heart and cause a back-up of flow (and pressure) in the heart and to the lungs. Aortic stenosis disease can range from mild to severe.
The main causes of aortic stenosis include:
-
A birth defect of the aortic valve, which normally has three cusps:
- An aortic valve that has only one cusp or is otherwise stenotic from birth
- A bicuspid (two-part) aortic valve with progressive wear and tear
- Progressive calcification of the aortic valve with age (most common in elderly)
-
Rarely, scarring of the aortic valve caused by
rheumatic fever
Risk Factors
A risk factor is something that increases your chances of getting a disease or condition.
- Sex: male
- Family members with valvular heart disease
- History of rheumatic fever
Symptoms
Aortic stenosis does not always produce symptoms. However, if symptoms do occur, they may include the following:
- Extreme fatigue after exercise or exertion
- Fainting with exercise or exertion
- Pain, squeezing, pressure, or tightness of the chest usually occurring with exertion
- Sensation of rapid or irregular heartbeat (palpitations)
- Shortness of breath
- Dizziness with exertion
-
Neurological symptoms of a stroke or
mini-stroke
In rare cases, aortic stenosis can cause abnormal heart rhythms (
arrhythmia) or sudden death with no previous symptoms.
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. The doctor may be alerted to aortic stenosis by the following:
-
Abnormal chest sounds, such as a
heart murmur
or click
- Noticeable chest heave or vibration when the doctor's hand is held over your heart
To confirm the diagnosis, tests may include:
- Chest x-ray
—a test that uses radiation to take pictures of structures inside the chest
- Electrocardiogram
(ECG, EKG)—a test that records the heart's activity by measuring electrical currents through the heart muscle; it may show signs of heart strain or enlargement.
- Echocardiogram
—a test that uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of the heart
- Cardiac catheterization
—an x-ray of the heart's circulation that is done after injection of a contrast dye
Treatment
If you have mild AS, your condition will be monitored, but may not need immediate treatment. If you have more severe AS, your doctor may advise you to avoid strenuous physical activity. If necessary, you may be given medications to help prevent heart failure.
Severe AS may require surgery. Options include:
A balloon device is passed through the arteries to open or enlarge the stenotic aortic valve. This may provide temporary relief of symptoms. However, since the valve can become blocked again, this treatment is not a permanent solution.
This is the surgical replacement of a defective heart valve. Currently, there are two types of replacement valves used:
- Bioprostheses—These valves are made from animals such as cows or pigs, and may last about 10-15 years. Blood-thinning medication is usually not needed with this type of valve.
- Mechanical prostheses—These synthetic valves are more durable, and may last for 20–40 years. However, you will be required to take blood-thinning medication for the rest of your life to prevent blood clots.
Prevention
Aortic stenosis cannot be prevented. However, if you have AS, there are several things you can do to try to avoid some of the complications:
- Get regular medical care, including checkups and periodic electrocardiograms.
- Only certain people with aortic stenosis need antibiotics before dental or medical procedures. Ask your doctor if you need antibiotics to prevent infection of the heart valve.
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