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Aortic Stenosis—Adult by Michelle Badash, MS

Definition

The aortic valve is located between the left ventricle of the heart and the aorta (the largest artery in the body) that supplies blood throughout the body. Aortic stenosis (AS) is a narrowing of the aortic valve that could block blood flow from the heart and cause a back-up of flow (and pressure) in the heart and to the lungs. Aortic stenosis disease can range from mild to severe.

Causes

The main causes of aortic stenosis include:

A birth defect of the aortic valve, which normally has three cusps:
- An aortic valve that has only one cusp or is otherwise stenotic from birth
- A bicuspid (two-part) aortic valve with progressive wear and tear
Progressive calcification of the aortic valve with age (most common in elderly)
Rarely, scarring of the aortic valve caused by rheumatic fever

Risk Factors

A risk factor is something that increases your chances of getting a disease or condition.

Sex: male
Family members with valvular heart disease
History of rheumatic fever

Symptoms

Aortic stenosis does not always produce symptoms. However, if symptoms do occur, they may include the following:

Extreme fatigue after exercise or exertion
Fainting with exercise or exertion
Pain, squeezing, pressure, or tightness of the chest usually occurring with exertion
Sensation of rapid or irregular heartbeat (palpitations)
Shortness of breath
Dizziness with exertion
Neurological symptoms of a stroke or mini-stroke

In rare cases, aortic stenosis can cause abnormal heart rhythms ( arrhythmia ) or sudden death with no previous symptoms.

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. The doctor may be alerted to aortic stenosis by the following:

Abnormal chest sounds, such as a heart murmur or click
Noticeable chest heave or vibration when the doctor's hand is held over your heart

To confirm the diagnosis, tests may include:

Chest x-ray —a test that uses radiation to take pictures of structures inside the chest
Electrocardiogram (ECG, EKG)—a test that records the heart's activity by measuring electrical currents through the heart muscle; it may show signs of heart strain or enlargement.
Echocardiogram —a test that uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of the heart
Cardiac catheterization —an x-ray of the heart's circulation that is done after injection of a contrast dye

Treatment

If you have mild AS, your condition will be monitored, but may not need immediate treatment. If you have more severe AS, your doctor may advise you to avoid strenuous physical activity. If necessary, you may be given medications to help prevent heart failure.

Severe AS may require surgery. Options include:

Balloon Valvuloplasty

A balloon device is passed through the arteries to open or enlarge the stenotic aortic valve. This may provide temporary relief of symptoms. However, since the valve can become blocked again, this treatment is not a permanent solution.

Aortic Valve Replacement

This is the surgical replacement of a defective heart valve. Currently, there are two types of replacement valves used:

Bioprostheses—These valves are made from animals such as cows or pigs, and may last about 10-15 years. Blood-thinning medication is usually not needed with this type of valve.
Mechanical prostheses—These synthetic valves are more durable, and may last for 20–40 years. However, you will be required to take blood-thinning medication for the rest of your life to prevent blood clots.

Aortic Valve Replacement—Mechanical (St. Jude) and Bioprostheses (Porcine) Valve Shown

Prevention

Aortic stenosis cannot be prevented. However, if you have AS, there are several things you can do to try to avoid some of the complications:

Get regular medical care, including checkups and periodic electrocardiograms.
Only certain people with aortic stenosis need antibiotics before dental or medical procedures. Ask your doctor if you need antibiotics to prevent infection of the heart valve.

RESOURCES:

American Heart Association http://www.americanheart.org
National Heart, Lung, and Blood Institute (NHLBI) http://www.nhlbi.nih.gov

CANADIAN RESOURCES:

Canadian Cardiovascular Society http://www.ccs.ca/home/index_e.aspx
Canadian Society for Vascular Surgery http://csvs.vascularweb.org/

References:

American Dental Association. Antibiotic prophylaxis. American Dental Association website. Available at: http://www.ada.org/2157.aspx . Accessed August 30, 2010.
American Heart Association. New guidelines regarding antibiotics to prevent infective endocarditis. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=3047051 . Accessed August 30, 2010.
Aortic stenosis. DynaMed website. Available at: http://www.dynamicmedical.com/dynamed.nsf . Accessed October 13, 2005.
Fauci AS, Braunwald E, Isselbacher KJ, et al. Harrison's Principles of Internal Medicine . 14th ed. New York, NY: The McGraw-Hill Companies; 2000.
Valve replacement in patients with aortic stenosis. Am Fam Physician . 2002;65:2342.

Last reviewed July 2010 by Michael J. Fucci, DO

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