About aortic valve stenosis
What is aortic valve stenosis?
Aortic stenosis is abnormal narrowing of the aortic valve. A number of conditions cause disease resulting in narrowing of the aortic valve. When the degree of narrowing becomes significant enough to impede the flow of blood from the left ventricle to the arteries, heart problems develop. The basic mechanism is as follows:
- The heart is a muscular pump with four chambers and four heart valves.
- The upper chambers, the right atrium and left atrium (atria -- plural for atrium), are thin walled filling chambers.
- Blood flows from the right and left atria across the tricuspid and mitral valves into the lower chambers (right and left ventricles).
- The right and left ventricles have thick muscular walls for pumping blood across the pulmonic and aortic valves into the circulation.
- Heart valves are thin leaflets of tissue which open and close at the proper time during each heart beat cycle.
- The main function of these heart valves is to prevent blood from flowing backwards.
- Blood circulates through the arteries to provide oxygen and other nutrients to the body, and then returns with carbon dioxide waste through the veins to the right atrium; when the ventricles relax, blood from the right atrium passes through the tricuspid valve into the right ventricle.
- When the ventricles contract, blood from the right ventricle is pumped through the pulmonic valve into the lungs to reload on oxygen and remove carbon dioxide.
- The oxygenated blood then returns to the left atrium and passes through the mitral valve into the left ventricle.
- Blood is pumped by the left ventricle across the aortic valve into the aorta and the arteries of the body.
The flow of blood to the arteries of the body is impaired when aortic stenosis exists. Ultimately, this can lead to heart failure. Aortic stenosis occurs three times more commonly in men than women.
What are the symptoms for aortic valve stenosis?
Aortic valve stenosis ranges from mild to severe. Aortic valve stenosis signs and symptoms generally develop when narrowing of the valve is severe. Some people with aortic valve stenosis may not experience symptoms for many years. Signs and symptoms of aortic valve stenosis may include:
- Abnormal heart sound (heart murmur) heard through a stethoscope
- Chest pain (angina) or tightness with activity
- Feeling faint or dizzy or fainting with activity
- Shortness of breath, especially when you have been active
- Fatigue, especially during times of increased activity
- Heart palpitations — sensations of a rapid, fluttering heartbeat
- Not eating enough (mainly in children with aortic valve stenosis)
- Not gaining enough weight (mainly in children with aortic valve stenosis)
The heart-weakening effects of aortic valve stenosis may lead to heart failure. Heart failure signs and symptoms include fatigue, shortness of breath, and swollen ankles and feet.
When to see a doctor
If you have a heart murmur, your doctor may recommend that you visit a cardiologist. If you develop any symptoms that may suggest aortic valve stenosis, see your doctor.
What are the causes for aortic valve stenosis?
Your heart has four valves that keep blood flowing in the correct direction. These valves include the mitral valve, tricuspid valve, pulmonary valve and aortic valve. Each valve has flaps (cusps or leaflets) that open and close once during each heartbeat. Sometimes, the valves don't open or close properly, disrupting the blood flow through your heart and potentially impairing the ability to pump blood to your body.
In aortic valve stenosis, the aortic valve between the lower left heart chamber (left ventricle) and the main artery that delivers blood from the heart to the body (aorta) is narrowed (stenosis).
When the aortic valve is narrowed, the left ventricle has to work harder to pump a sufficient amount of blood into the aorta and onward to the rest of your body. This can cause the left ventricle to thicken and enlarge. Eventually the extra work of the heart can weaken the left ventricle and your heart overall, and it can ultimately lead to heart failure and other problems.
Aortic valve stenosis can occur due to many causes, including:
Congenital heart defect. The aortic valve consists of three tightly fitting, triangular-shaped flaps of tissue called cusps. Some children are born with an aortic valve that has only two (bicuspid) cusps instead of three. People may also be born with one (unicuspid) or four (quadricuspid) cusps, but these are rare.
This defect may not cause any problems until adulthood, at which time the valve may begin to narrow or leak and may need to be repaired or replaced.
Having a congenitally abnormal aortic valve requires regular evaluation by a doctor to watch for signs of valve problems. In most cases, doctors don't know why a heart valve fails to develop properly, so it isn't something you could have prevented.
Calcium buildup on the valve. With age, heart valves may accumulate deposits of calcium (aortic valve calcification). Calcium is a mineral found in your blood. As blood repeatedly flows over the aortic valve, deposits of calcium can build up on the valve's cusps. These calcium deposits aren't linked to taking calcium tablets or drinking calcium-fortified drinks.
These deposits may never cause any problems. However, in some people — particularly those with a congenitally abnormal aortic valve, such as a bicuspid aortic valve — calcium deposits result in stiffening of the cusps of the valve. This stiffening narrows the aortic valve and can occur at a younger age.
However, aortic valve stenosis that is related to increasing age and the buildup of calcium deposits on the aortic valve is most common in older people. It usually doesn't cause symptoms until ages 70 or 80.
Rheumatic fever. A complication of strep throat infection, rheumatic fever may result in scar tissue forming on the aortic valve. Scar tissue alone can narrow the aortic valve and lead to aortic valve stenosis. Scar tissue can also create a rough surface on which calcium deposits can collect, contributing to aortic valve stenosis later in life.
Rheumatic fever may damage more than one heart valve, and in more than one way. A damaged heart valve may not open fully or close fully — or both. While rheumatic fever is rare in the United States, some older adults had rheumatic fever as children.
What are the treatments for aortic valve stenosis?
Treatment for aortic valve stenosis depends on your signs and symptoms and the severity of the condition.
If you have mild symptoms or none at all, you may only need to have your condition monitored with regular doctor's appointments. Your doctor may recommend healthy lifestyle changes and medications to treat symptoms or reduce the risk of complications.
Surgery or Other procedures
You may eventually need surgery to repair or replace the diseased aortic valve, even if you don't have symptoms. Aortic valve surgery may be done at the same time as other heart surgery.
Surgery to repair or replace an aortic valve is usually done through a cut (incision) in the chest. Less invasive approaches may be available. Ask your doctor if you're a candidate for these procedures. Aortic valve surgery may be done at the same time as other heart surgery.
Surgery options for aortic valve stenosis include:
- Aortic valve repair. To repair an aortic valve, surgeons separate valve flaps (cusps) that have fused. However, surgeons rarely repair an aortic valve to treat aortic valve stenosis. Generally aortic valve stenosis requires aortic valve replacement.
Balloon valvuloplasty. This procedure can treat aortic valve stenosis in infants and children. However, the valve tends to narrow again in adults who've had the procedure, so it's usually only done in adults who are too ill for surgery or who are waiting for a valve replacement, as they typically need additional procedures to treat the narrowed valve over time.
In this procedure, a doctor inserts a long, thin tube (catheter) with a balloon on the tip into an artery in your arm or groin and guides it to the aortic valve. Once in place, the balloon is inflated, which widens the valve opening. The balloon is then deflated, and the catheter and balloon are removed.
Aortic valve replacement. Aortic valve replacement is often needed to treat aortic valve stenosis. In aortic valve replacement, your surgeon removes the damaged valve and replaces it with a mechanical valve or a valve made from cow, pig or human heart tissue (biological tissue valve).
Biological tissue valves break down over time and may eventually need to be replaced. People with mechanical valves will need to take blood-thinning medications for life to prevent blood clots. Your doctor will discuss with you the benefits and risks of each type of valve.
Transcatheter aortic valve replacement (TAVR). This less invasive procedure may be an option for people who are considered to be at intermediate or high risk of complications from surgical aortic valve replacement.
In TAVR, doctors insert a catheter in your leg or chest and guide it to your heart. A replacement valve is then inserted through the catheter and guided to your heart. A balloon may expand the valve, or some valves can self-expand. When the valve is implanted, doctors remove the catheter from your blood vessel. Doctors may also perform a catheter procedure to insert a replacement valve into a biological tissue valve that is no longer working properly.
What are the risk factors for aortic valve stenosis?
Risk factors of aortic valve stenosis include:
- Older age
- Certain heart conditions present at birth (congenital heart disease) such as a bicuspid aortic valve
- History of infections that can affect the heart
- Having cardiovascular risk factors, such as diabetes, high cholesterol and high blood pressure
- Chronic kidney disease
- History of radiation therapy to the chest
Is there a cure/medications for aortic valve stenosis?
The aortic valve can be narrowed as a side effect of various conditions. It gives rise to numerous heart problems when the degree of narrowing turns severe enough to harm the flow of blood from the left ventricle to the arteries. Neglected, it can cause heart failure. Aortic valve stenosis is three times more common in men than women.
Cure/medications for Aortic Valve Stenosis
The only cure for Aortic Valve Stenosis is to replace the diseased valve. This is achieved through open-heart surgery, during which the patient is attached to a heart-lung machine to support the heart process while the organ has temporarily stopped functioning.
1. Beta-Adrenergic Receptor Blockers
This is limited to those patients who are not active candidates for surgery with angina as a predominant symptom.
2. Cardiac glycoside
For patients with evident pulmonary congestion and not active candidates for surgery. Cardiac glycosides slow down AV nodal conduction by increasing vagal tone.
3. Loop diuretics
For patients with uncontrolled heart failure.
4. Angiotensin-converting enzyme inhibitor
They lessen angiotensin-II levels, thus reducing aldosterone secretion.
5. Opioid analgesics
Help the patient in managing anxiety, distress, and dyspnea. It binds opioid receptors on neurons distributed across the nervous and immune systems.
An irregular heart sound (heart murmur) heard through a stethoscope,Chest pain (angina) or tightness with activity,Feeling faint or dizzy or fainting with activity,Shortness of breath, especially with activity,Fatigue, especially during times of increased activity
Valvular heart disease
ACE inhibitors,Beta-blockers, which slow your heart rate,Diuretics (“water pills”), which lessen the amount of fluid in your body and ease stress on your heart