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Aortic Stenosis

Aortic stenosis is a narrowing of the aortic valve opening. It is one of the most common and serious valve disease problems. Aortic stenosis restricts the blood flow from the heart's left ventricle to the aorta. It may also affect the pressure in the heart's left atrium.

Some people have aortic stenosis because of a congenital heart defect called a bicuspid aortic valve. It usually gets worse during aging as calcium or scarring damages the valve and reduces the blood flow.

Aortic stenosis may cause muscular thickening in the left ventricle wall because the ventricle is working harder to pump blood through the narrow valve opening into the aorta. The thickened wall takes up more space. That allows less room for an adequate amount of blood flow. This can lead to heart failure.

What happens once you have aortic stenosis?

Many people with aortic stenosis don't experience symptoms until the amount of blood flow becomes greatly restricted.

Symptoms of aortic stenosis may include:

  • Chest pain.
  • Swollen ankles or feet.
  • Rapid, fluttering heartbeat.
  • Difficulty walking short distances.
  • Trouble breathing or feeling short of breath.
  • Feeling dizzy or light-headed, even fainting.
  • Difficulty sleeping or needing to sleep sitting up.
  • A decline in activity level or reduced ability to do normal activities.

Infants and children who have aortic stenosis due to a congenital defect may exhibit symptoms such as:

  • Fatigue upon exertion.
  • Failure to gain weight.
  • Poor or inadequate feeding.
  • Breathing problems.

If you notice a decline in your physical activity or feel fatigued, ask your doctor to check for reduced heart function. Appropriate treatment can help reverse or slow down the progression of aortic stenosis.

What causes aortic stenosis?

  • Calcium buildup: Aortic stenosis mainly affects older people as a result of scarring and calcium buildup in the valve cusp (flap or fold). Age-related aortic stenosis usually begins after age 60, but often doesn’t show until your 70s or 80s.

  • Congenital heart defect: The most common cause of aortic stenosis in young people is a birth defect where only two cusps grow instead of the normal three. This is the bicuspid aortic valve.

  • Defective valve: Sometimes the valve opening doesn't grow along with the heart. This makes the heart work harder to pump blood. Over the years the defective valve becomes stiff and narrow.

  • Rheumatic fever: If you had strep throat infection and it was not treated properly, you may have had rheumatic fever. That may result in scar tissue forming on the aortic valve. While rheumatic fever is rare in the United States, some older adults may have had rheumatic fever as children.

What types of tests are used to diagnosis aortic stenosis?

To diagnose aortic stenosis, your doctor may review your signs and symptoms, discuss your medical history, and conduct a physical exam. Your doctor may listen to your heart with a stethoscope to determine if you have a heart murmur.

Your doctor may order any of these tests:

  • Echocardiogram: This test uses sound waves to produce video images of the aortic valve, and the cause and severity of your condition.

  • Electrocardiogram (EKG): In this test, wires are attached to pads on your skin to measure the electrical activity of your heart. An EKG can detect if your heart chambers are enlarged, abnormal heart rhythms and heart disease.

  • Chest X-ray: A chest X-ray can help your doctor determine if your heart is enlarged, an enlarged blood vessel (aorta), or any calcium buildup on your aortic valve.

  • Stress tests: Doctors measure stress during physical activity to analyze any signs and symptoms of aortic valve disease.

  • Cardiac computerized tomography (CT) scan or MRI: These imaging tests can show aortic valve problems.

What types of treatments and procedures are used to treat aortic stenosis?

Even if there are no symptoms or mild symptoms, it is best to have regular follow-ups with your doctor.

Anyone with aortic stenosis should be checked with an echocardiogram to determine treatment options. According to American Family Physician, serial Doppler echocardiography is recommended annually for severe aortic stenosis, every one to two years for moderate disease, and every three to five years for mild disease.

Possible treatments may include:

  • Medications.
  • Valve repair.
  • Valve replacement.

Discuss the best options with your doctor to ensure you receive the most effective treatment possible.

What can I do to support my health when I have aortic stenosis?

Some possible ways to prevent aortic stenosis include:

  • Keep your weight, blood pressure, and cholesterol levels under control. High blood pressure, obesity, and high cholesterol levels are linked to coronary artery disease.
  • Prevent rheumatic fever by ensuring you see your doctor when you have a bad sore throat. Untreated strep throat can develop into rheumatic fever. Fortunately, strep throat can be easily treated with antibiotics.
  • Take care of your teeth and gums. There may be a link between infected gums (gingivitis) and infected heart tissue (endocarditis). Inflammation of heart tissue caused by infection can narrow arteries and make aortic stenosis worse.

Once you know that you have aortic stenosis, your doctor may recommend limiting strenuous activity to avoid overworking your heart.

Why choose Presbyterian for aortic stenosis treatment?

Presbyterian’s Heart and Vascular team has many different options to help you manage your heart condition. The team performs various diagnostic tests and procedures to help form an accurate diagnosis and create individualized treatment plans for your heart health needs. Depending on the type of heart condition you have and its underlying cause, the team can recommend a wide variety of treatment options; these may include lifestyle modifications, medications and procedures. Our cardiologists and cardiovascular surgeons work closely together for cases in which surgery is the best treatment option. We also offer a customized cardiac rehabilitation program at our Healthplex, where clinically appropriate, which can improve your endurance and exercise tolerance, as well as improve heart-related symptoms. Your cardiologist will work with the rehabilitation team to create a plan that will be tailored to your individual health needs.