What is Aortic Stenosis?
Aortic stenosis is a heart condition that affects the aortic valve, one of the four valves in your heart. Aortic stenosis occurs when the aortic valve narrows, reducing blood flow from the heart into the aorta, the main blood vessel that carries oxygenated blood to the rest of the body.
Symptoms Of Aortic Stenosis
Symptoms of aortic valve stenosis range from mild to severe. Most people with aortic valve stenosis would not experience any major symptoms for many years. Symptoms generally occur when the narrowing of the valve is severe:
This is often felt during physical activity or when the heart has to work harder. This pain is often termed as angina.
You can have shortness of breath, especially during exercise or when lying flat.
You might feel lightheaded or dizzy due to reduced blood flow to the brain through the narrowed lumen of the valve. You might even have a syncope if it is too narrow.
As the condition progresses, you can tire easily, usually much faster. You might not be able to conduct the regular activities you used to do.
Children with congenital aortic stenosis can have poor growth. They can be low in weight and height about their age.
When the disease progresses to very advanced stages, patients can present with heart failure and have worsening symptoms.
Risk Factors of Aortic Stenosis
Several factors can increase the risk of developing aortic stenosis, which often develops gradually over time. Some of them are discussed below:
As we age, the risk of aortic stenosis increases. The valve may naturally thicken and become less flexible over time.
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Congenital heart conditions
Some people are born with abnormal aortic valves that may eventually lead to stenosis. The bicuspid aortic valve is the most common congenital heart defect affecting 1% of the general population and is one of the leading causes of stenosis in the young population.
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Aortic valve calcification
Calcium is a mineral present in the blood. As blood flows through the valves, calcium can deposit on the heart valves, and the process gets hastened if the valve is highly pressured, like the aortic, and has microtrauma.
High cholesterol levels can lead to the buildup of fatty deposits on the aortic valve, narrowing it.
Uncontrolled hypertension can strain the aortic valve and contribute to its deterioration.
Rheumatic fever is one of the most common conditions seen among children. A previous bout of rheumatic fever can damage the aortic valve, increasing the risk of stenosis.
Treatment Of Aortic Stenosis
Treatment options for aortic stenosis depend on the symptoms and the severity of the condition. While you might need a regular follow-up with your doctor if there is mild aortic valve disease or no symptoms, you may need surgery to repair or replace the valve for severe disease. There are less invasive options available, too, but that depends on your overall health and your choice.
The treatment options for aortic valve stenosis are:
This minimally invasive procedure is used in infants and children. The procedure is limited in adults, as the valve gets narrower afterward. So, it is usually only done if you are young or waiting for a valve replacement. In this procedure, a tube with a balloon tip is inserted into an artery through the arm or the groin. It is then taken to the aortic valve. Once it reaches the valve, the balloon is inflated, which widens the valve opening. The balloon is then deflated, and the catheter is withdrawn.
It is the ultimate treatment for aortic stenosis. The damaged valve is replaced with a mechanical valve made from cows, pigs, or human tissue. While biological valves break down over time and need to be replaced again, mechanical valves remain longer than the biological valve, but the patient will have to take a blood thinning agent.
The valve can be replaced by either of the following two procedures:
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Surgical aortic valve replacement (SAVR):
Aortic valve replacement is done via an open-heart surgical procedure. During an SAVR, you would be put under general anesthesia and placed on a ventilator while on a heart-lung bypass machine. A surgeon would then cut open your breastbone to get to the heart. In some patients, less invasive approaches can be used. The aortic stenosis valve is cut out and replaced by the new valve. Recovery in the hospital usually takes about five days. This procedure can use both bioprosthetic as well as mechanical valves.
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Transcatheter aortic valve replacement (TAVR):
TAVR is an alternative to SAVR and is done for those not candidates for open-heart surgery due to other comorbid conditions. This minimally invasive procedure requires no sternotomy or a heart-lung bypass machine. The replacement valve is usually inserted using a catheter into an artery in the leg, then threaded through arteries to the heart. Once within the diseased aortic valve, the folded TAVR valve is opened with a balloon and placed in the right place. Some valves can, however, self-expand and do not need re-positioning. The surgeon then removes the catheter once the new valve is securely placed. It is to be noted that this procedure uses only bioprosthetic valves only.
Diagnostic Evaluation Of Aortic Stenosis
Several diagnostic tests are performed to confirm and determine the cause and its severity. Tests for aortic valve stenosis may include:
It is one of the routine tests performed that measures the electrical activity of the heart. It can show how fast or slow your heart is beating. Your doctor will look for the strain pattern in the EKG if you have aortic stenosis.
In simple terms, it is an ultrasound of your heart, and it creates images of the heart. It is a fast and painless investigation that helps to evaluate the structure and function of the heart. It can recognize a weakened heart muscle, changes in the valves of the heart, and look at how the blood flows through the valves. With an ECHO, your doctor can determine the severity of aortic valve stenosis.
Chest X-ray gives you a view of the heart and lungs together. It helps to determine if there is an enlarged heart, a common finding of aortic stenosis. It can also show an enlarged aorta and calcium build-up.
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Cardiac computed tomography(CT)
This test utilizes multiple X-rays to obtain detailed heart pictures. It is also utilized to evaluate the size of the aorta and calcium deposits on the aortic valves and to guide surgical management of the condition.
This is a test where a catheter is guided from a vessel in the wrist or groin leading to the heart, and a contrast dye is injected through it. The dye goes to the arteries of the heart and helps to assess their patency. The test is not used to diagnose aortic valve disease but can be used if other tests are not able to diagnose the condition. A coronary angiogram can be used to identify patients who also might benefit from surgery on the blood vessels around the heart along with an aortic valve replacement procedure. Therefore, every patient with aortic stenosis should undergo a coronary angiogram to detect and treat any coexisting coronary vessel disease.
Complications Of Aortic Stenosis
While aortic stenosis can initially be asymptomatic, it can lead to several complications as the condition progresses. Watch out for these complications:
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Reduced exercise tolerance
As the condition progresses, reduced blood flow can lead to decreased exercise tolerance, fatigue, and a decline in overall physical capacity.
As the aortic valve narrows further, the heart must work harder to pump blood through the narrowed valve. Over time, this extra strain on the heart can lead to left ventricular hypertrophy and, eventually, heart failure.
Aortic stenosis can increase the risk of abnormal heart rhythms or arrhythmias. The irregular heartbeats can further compromise the heart’s ability to pump blood effectively.
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Infection (Infective Endocarditis)
Aortic stenosis may make the heart valve more susceptible to infection. Bacterial or microbial infections of the heart valve can lead to a condition called infective endocarditis, which is a serious and potentially life-threatening complication.
Prevention of Aortic Stenosis
You can take steps to strengthen your heart and guard against developing aortic stenosis. These include:
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Make heart-healthy choicesÂ
Healthy choices such as daily physical exercise and quitting smoking can prevent calcium buildup in arteries and aortic valve. If you have high blood pressure, high cholesterol, diabetes, or kidney problems, you should consult your doctor regarding adequate management of these chronic health conditions.
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Keep up with dental checkups
Gum infections can lead to infection and development of aortic valve stenosis. A regular dental checkup can avoid aortic valve disease secondary to gum infections.
The bacteria that cause strep throat can sometimes cause rheumatic fever if left untreated. Rheumatic fever often happens in children and young adults. This is a condition that can be easily treated with antibiotics. So, getting treated for strep throat is important to prevent valvular heart disease.
Question For Your Doctor
- What symptoms of Aortic Stenosis should prompt me to seek immediate medical attention?
- Should I limit my physical activity because of Aortic Stenosis?
- How often should I have my heart checked yearly?
- What are the treatment options?
- Are there any medications that I can take for this condition?
- How do I know if surgical or Transcatheter Aortic Valve Replacement is a better treatment option for me?
- What changes happen to the heart after having aortic stenosis over time?
References
Age: Heart block is more common in older adults (>65 years).