Affecting the aortic valve, one of the heart’s four valves, aortic stenosis is a condition which causes a narrowing of the aortic valve opening, blocking left ventricle blood flow to the aorta.
The heart valve leaflets, which open and close with each heart beat to ensure blood flows in the right direction through the hearts’ four chambers and on to the rest of the body, fail to function properly in the aortic valve. In aortic stenosis patients, these leaflets cannot open or close completely. This restricts blood flow through the valve and may also allow blood to leak into the heart causing it to enlarge.
This condition forces the heart to work harder, resulting in a thickened left ventricle. The thickened heart muscle, then requires an increasing supply of blood from the coronary arteries. In some instances of physical exertion this need is not met and can cause tightening of the chest (angina), a feeling of faintness and, occasionally, sudden death.
This ongoing insufficiency of blood supply to the heart muscle may also begin to weaken the heart and lead to heart failure.
Aortic stenosis can affect patients of all ages. In those diagnosed under the age of 70, it is most commonly the result of a birth defect or rheumatic fever in childhood. In those diagnosed over the age of 70, it is usually the result of a thickening of the valve cusps, also known as aortic sclerosis.
Age-related aortic sclerosis affects approximately one in four over the age of 65 and may cause mild symptoms, including a soft heart murmur, chest tightness, fatigue and shortness of breath during exertion.
More severe cases of aortic stenosis can include fainting or feeling of lightheadedness and shortness of breath following a period of exercise or physical exertion. This is the result of a rapid fall in blood pressure.
Other Common Causes:
- Calcium build-up
- Radiation therapy
- Infection of the heart
- Failing aortic surgical valve
Diagnosis and Treatment of Aortic Stenosis
Aortic stenosis can be diagnosed upon a physical examination, understanding of patient history and echocardiogram.
Treatment is individualized to each patient based on severity of the condition and symptoms. Other considerations include the shape and size of the patient’s heart, the structure of the artery system, and whether any other medical problems exist.
Other tests used to assess the best treatment for aortic stenosis includes:
- Cardiac Catheterization
- CT scan
- Carotid ultrasound
- Blood tests
- Frailty testing
Mild asymptomatic cases may simply require periodic monitoring of heart and valve function.
For more severe symptomatic aortic stenosis and in cases where the left ventricle begins to fail, aortic valve replacement may be indicated. This is an open heart surgical procedure which replaces the damaged valve with an artificial one, restoring normal blood flow, preserving heart muscle function and prolonging life.
Many patients now qualify for a less invasive catheter based procedure known as a transcatheter aortic valve replacement (TAVR). TAVR is an alternative to surgical repair and replacement in the high-risk population.
Together patients will carefully discuss with their physician options for the best possible outcome.