Aortic stenosis – What Is It?

 

By Julian Booker MD

Our body’s primary artery, the aorta, supplies blood to the entire body. The aortic valve allows blood to flow from the heart into the aorta but prevents blood from leaking back into the heart.  In aortic stenosis, sometimes called aortic valve stenosis, the aortic valve does not open normally. This forces the heart to work harder and can even result in diminished blood flow to the body.

 What causes aortic stenosis?

 Your valve is just getting old.

As we get older, calcium deposits on the aortic valve. Just like a painful knee in arthritis, the aortic valve becomes stiffened and has restricted movement. For most people, this is not a problem. Unfortunately, for others the calcification and thickening can become so severe that it results in narrowing of the aortic valve opening.  The narrowed opening behaves much like placing your thumb over the end of a water hose; the pressure builds behind the heart blockage and the velocity of the blood increases dramatically.

 You were born with an abnormal valve

The aortic valve should have three cusps. The cusps are specialized pieces of tissue that fit tightly together and is responsible for the bulk of the work that the valve performs. A few of us are born with only two cusps (bicuspid) or rarely only one cusp (unicuspid).  These congenitally abnormal valves are more prone to damage than a normal valve so much so that surgical intervention is often required decades earlier than a typical tricuspid valve.  These valves are frequently associated with aortic aneursyms that are at risk for rupture.

 Anyone with a congenitally abnormal valve should be regularly evaluated by an echocardiogram and consider being seen by a cardiologist. The bicuspid aortic valve is the commonest congenital abnormality and affects 1-2% of the population. These abnormalities also tend to run in families as 9% of persons have a family member with the condition. The American Heart Association recommends that parents, siblings and children of anyone found to have a bicuspid valve be screened by a healthcare provider familiar with bicuspid aortic valve.

 Other reasons to have aortic stenosis

Rheumatic fever is not as common as it once was in America but still has a presence.  Rheumatic fever results from prior untreated strep throat infection and can result in rheumatic heart disease. In rheumatic heart disease the cusps become fused together resulting in a narrowed opening. Rheumatic fever is more common in older adults although there have been occasional outbreaks since the 1980s. Rarely other causes like infection or a obstruction above or below the valve can also occur.

 What can I expect from aortic stenosis

 The symptoms to look for are heart failure (swelling, shortness of breath, etc), angina (chest pain) and syncope (fainting spells). Unfortunately, most medical conditions do not read the textbooks and presenting symptoms may vary. It is not uncommon for patients to present with subtle symptoms such as fatigue and exercise intolerance.

 If you have progressive symptoms in the setting of aortic stenosis it is crucial to tell your physician. Aortic stenosis does not respond well to medical therapy and surgical intervention remains the best treatment. Once symptoms arise, the average survival for severe aortic stenosis is only two to three years without surgical intervention. Time is of the essence.

 If you have severe aortic stenosis and are truly asymptomatic, watchful waiting is reasonable under most circumstance. There still may be high-risk features that encourage you and your doctor to pursue aortic valve replacement sooner than later.  Talk to your doctor. It is never too early.

Related articles

• Chest Pain – Part 2 – more chest pains (myheart.net/articles)
• Angina or some other chest pain (myheart.net/articles)
• Echocardiography – Part 1 – What is an echocardiogram (myheart.net/articles)
• Echocardiography – Part 2 – Transesophageal echo (myheart.net/articles)

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