What is aortic stenosis?What is the aortic valve?
The aortic valve is the valve between the left ventricle of the heart and the aorta, which is the largest artery in the body and carries the entire output of blood. The aortic valve normally consists of three leaflets. When the left ventricle, the main pumping chamber of the heart, contracts, it forces blood through the valve to the aorta and then to the rest of the body. When the LV expands again, the aortic valve prevents the blood from returning to the ventricle.
What are the causes of aortic stenosis?
Aortic stenosis is most commonly caused by age-related progressive calcification of the normal tricuspid aortic valve (>50% of cases). Other causes include calcification of a congenital bicuspid aortic valve (30-40% of cases) and acute rheumatic fever (less than 10% of cases). Normal valves have three leafs (tricuspid), but some valves have two leafs (bicuspid). Typically, aortic stenosis due to calcification of a bicuspid valve appears earlier, in the 40s and 50s, and due to calcification of a normal valve appears later, in the 70s and 80s. Hypertension, diabetes mellitus, hyperlipoproteinemia and uremia may speed up the process. Approximately 2% of people over the age of 65, 3% of people over age 75, and 4% percent of people over age 85 have aortic valve stenosis. The prevalence is increasing with the aging population in North America and Europe. |
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What are the symptoms of aortic stenosis?
The initial presenting symptoms include progressive shortness of breath with activity, which may be so subtle that the patient is unaware of them, and may cut down on exertion without being aware of his/her reduced capacity.
More advanced symptoms include
- syncope (loss of consciousness)
- chest pain, and
- heart failure
What is the natural history of aortic stenosis
If untreated, the interval from onset to death varies by symptoms
- 2 years for CHF,
- 3 years for syncope, and
- 5 years for angina.
How is aortic stenosis diagnosed?
Persons with AS often have no symptoms and detection of a murmur may be discovered during a routine examination.
AS may be detected by listening with a stethoscope revealing a a murmur.
In addition to a complete medical history and physical examination, diagnostic procedures for AS may include any, or a combination, of the following:
In some situations where symptoms are more severe, additional diagnostic procedures may be performed. Additional procedures may include:
AS may be detected by listening with a stethoscope revealing a a murmur.
In addition to a complete medical history and physical examination, diagnostic procedures for AS may include any, or a combination, of the following:
- electrocardiogram (ECG or EKG) - a test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle damage.
- echocardiogram (Also called echo.) - a noninvasive test that uses sound waves to produce a study of the motion of the heart's chambers and valves. The echo sound waves create an image on the monitor as an ultrasound transducer is passed over the heart. Echocardiography is the most useful diagnostic test for AS.
In some situations where symptoms are more severe, additional diagnostic procedures may be performed. Additional procedures may include:
- stress test (Also called treadmill or exercise ECG.) - a test that is performed while a patient walks on a treadmill to monitor the heart during exercise. Breathing and blood pressure rates are also monitored.
- cardiac catheterization - with this procedure, x-rays are taken after a contrast agent is injected into an artery to locate the narrowing, occlusions, and other abnormalities of specific arteries. In addition, the function of the heart and the valves may be assessed.
- cardiac MRI - this is a noninvasive test that produces comprehensive images of the heart. It may be used as a complement to echo for a more precise look at the heart valves and heart muscle, or in preparation for heart valve surgery.
How severe is my aortic stenosis?
Severity of aortic stenosis is defined by symptoms and echocardiography.
What is the treatment for aortic stenosis?
Specific treatment for aortic stenosis will be determined by your physician based on:
- your overall health and medical history
- extent of the disease
- your signs and symptoms
- your tolerance for specific medications, procedures, or therapies
- expectations for the course of the disease
- your opinion or preference
There is no medical treatment to reverse aortic stenosis. In advanced stages, surgery is required to correct this problem. When heart valves are severely malformed or destroyed, they may need to be replaced with a new mechanism. Replacement valve mechanisms fall into two categories: tissue (biologic) valves, which include animal valves and donated human aortic valves, and mechanical valves, which can be metal, plastic, or another artificial material.
Surgical treatment is indicated in
- Patient with severe AS and symptoms or those undergoing other cardiac surgery
- Patients with severe AS with heart dysfunction, defined by an ejection fraction < 50%
- Patients with severe or moderate AS undergoing cardiac surgery for coronary or other valvular heart disease.
Percutaneous and catheter based procedures are available for patients who are not candidates for surgical replacement.
For patients with less advanced disease, follow-up echocardiography is recommended as follows, for patients with:
- severe AS - yearly
- moderate AS - every 3 years
- mild AS - every 5 years
