Aortic Stenosis

Aortic stenosis — or aortic valve stenosis — happens when the heart's aortic valve narrows. The aortic valve is located on the left side of the heart and controls blood flow out of the left ventricle, the heart chamber responsible for pumping blood into the large artery that shares this supply with the rest of the body — the aorta. Because the aortic valve doesn't open fully with aortic stenosis, blood flow is reduced or blocked from your heart into the main artery to your body (aorta) and to the rest of your body.

Various conditions can cause disease resulting in the narrowing of the aortic valve. When the degree of narrowing becomes significant enough to hamper blood flow from the left ventricle to the arteries, heart problems develop.

Causes

The most common cause of aortic stenosis is a build-up of calcium (a mineral which the blood naturally contains) forming on the valve. Over time, a build-up of calcium can develop in the aortic valve, causing the valve to narrow and making the tissue less flexible. The narrowing and stiffening of the valve eventually interrupts proper functioning, affecting blood flow from the left ventricle, the main pumping chamber of the heart, to the aorta and the amount of pressure in the heart.

Aortic stenosis can also stem from a congenital heart defect called a bicuspid aortic valve. In addition, a history of rheumatic fever can also lead to the condition. Other risk factors can include:

Older age (people over the age of 60 are most at risk)
Having cardiovascular risk factors, such as diabetes, high cholesterol and high blood pressure
Chronic kidney disease
History of radiation therapy to the chest

Symptoms

Aortic stenosis ranges from mild to severe. Signs and symptoms generally occur when the narrowing of the valve is severe. In fact, some people with aortic stenosis may not have symptoms for many years.

Signs and symptoms of aortic valve stenosis may include:

Chest pain (angina) or tightness with activity
Abnormal heart sound (heart murmur) heard through a stethoscope
Shortness of breath, especially when you have been active
Feeling faint or dizzy or fainting with activity
Fatigue, especially during times of increased activity
Palpitations (rapid, fluttering heartbeat)
Not eating enough (mainly in children)
Not gaining enough weight (mainly in children)
Aortic valve stenosis may lead to heart failure. Heart failure signs and symptoms include: fatigue, shortness of breath, and swollen ankles and feet.

Treatment

Treatment depends on the severity of your condition. Often, people with aortic stenosis do not require any immediate treatment. Instead, your healthcare provider will continue to monitor your condition with regular checkups. Before the physician makes this decision, they will administer an echocardiogram, a test that allows them to see the exact state of the patient's heart valve — even symptom-free people may have more severe aortic stenosis than symptoms suggest.

Your doctor may recommend healthy lifestyle changes and medications to treat symptoms or reduce the risk of complications. In certain cases, you may need surgery to repair or replace the valve. One of the more recent advances in medicine can allow your doctor to replace your valve with another using a catheter inserted from your groin rather than full on surgery. This approach also allows us to treat many of the patients with previously replaced valves that run into problems years after their first surgery. Without treatment, severe aortic stenosis can lead to death.

Complications

Aortic valve stenosis can cause complications, including:

Stroke
Heart failure
Heart rhythm problems (arrhythmias)
Blood clots
Bleeding
Infections that affect the heart, such as endocarditis
Death

Prevention

Possible ways to prevent aortic valve stenosis include:

Taking steps to prevent rheumatic fever. You can do this by making sure you visit your doctor when you have a sore throat. Untreated strep throat can develop into rheumatic fever.
Addressing risk factors for coronary artery disease, including: high blood pressure, obesity and high cholesterol levels. These factors may be linked to aortic stenosis, so it's recommended to keep your weight, blood pressure and cholesterol levels under control if you have aortic stenosis.
Taking 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 trigger aortic stenosis.
If you do have aortic stenosis, your doctor may recommend limiting strenuous activity to avoid overworking your heart.