Aortic Stenosis

What is aortic stenosis?

When aortic valve stenosis occurs, the aortic valve, located between the aorta and left ventricle of the heart, is narrower than normal size. When the degree of narrowing becomes significant enough to impede the flow of blood from the left ventricle to the arteries, heart problems develop. Aortic stenosis is caused by many disorders. One cause is rheumatic fever, which may occur with strep throat and scarlet fever. Other causes include calcification of the valve and congenital abnormalities. There may be a history of other valve diseases, coronary artery disease, or heart murmur.

Aortic stenosis is three times more common among men than women. Symptoms usually do not appear until middle age or older.

Prevention:

Aortic stenosis cannot be prevented, but some of the complications can be.

Notify your health care provider about any history of heart valve disease before treatment for any condition. Also, any dental work, including cleaning, and any invasive procedure, can introduce bacteria into the bloodstream, which can infect a weakened valve.

Follow your provider's treatment recommended for conditions that may cause valve disease. Treat strep infections promptly to prevent rheumatic fever. Notify the provider if there is a family history of congenital heart diseases.

Symptoms (some may not show until late in the course of the disease):

• Breathlessness, fainting or weakness with activity
• sensation of feeling the heart beat
• cough
• chest pain, angina-type
  • under the sternum, may radiate
  • crushing, squeezing, pressure, tightness
  • increased with exercise, relieved with rest
• decreased urine output
• dizziness

Signs and Tests:

Examination shows a palpable chest thrill or heave (vibration or movement felt by holding the hand over the heart). There is almost always a heart murmur, click, or other abnormal sounds on auscultation (examination of the chest with a stethoscope). There may be faint pulses or changes in the quality of the pulse in the neck and blood pressure may be low.

Aortic stenosis and/or enlargement of the left ventricle may be revealed on:

• a left coronary angiography
• an echocardiogram
• a Doppler ultrasonography
• a chest X-ray

An ECG may show left-ventricle enlargement or arrhythmias (unusual pattern of heart beats) such as ventricular tachycardia or sinus bradycardia.

This disease may also alter the results of the following:

• a chest MRI
• an aortic angiography

Treatment:

If there are no symptoms or symptoms are mild, only observation may be required. If symptoms are mild to severe, hospitalization may be required. Medications may include diuretics, digoxin, and other medications to control heart failure. Symptomatic people may be advised to avoid strenuous physical activity. People with symptoms of aortic difficulty breathing, chest pain, and syncope should have a physical exam every 6 to 12 months, and an ECG performed every 1 to 3 years.

Surgical repair or replacement of the valve is the preferred treatment for symptomatic aortic stenosis.

Expectations:

Aortic stenosis is curable with surgical repair, although there may be a continued risk for arrhythmias. The person may be symptom-free until complications develop. Without surgery, probable outcome is poor if there are signs of angina or heart failure.

Complications:

• left ventricular hypertrophy (enlargement) caused by the extra work of pushing blood through the narrowed valve
• angina
• left-sided heart failure
• sudden death from arrhythmias
• endocarditis

Call Your Healthcare Provider:

Call for an appointment with your health care provider if symptoms indicate aortic stenosis may be present or if aortic stenosis has been diagnosed and symptoms worsen or new symptoms develop.