Aortic stenosis is a heart condition that is characterized by a narrowing of the aortic valve due to a build-up of plaque or calcium. It can affect people at any time, but it tends to occur most often in older adults over the age of 60.
Most people who develop aortic stenosis are male and have a history of coronary artery disease. A person with aortic stenosis will usually not experience symptoms until their condition becomes severe, which makes early detection key for this type of heart disease.
Symptoms of Aortic Stenosis
There are a number of symptoms a person may experience if they have aortic stenosis. However, a person will usually only present with a few of these symptoms at a time:
- Shortness of breath
- Chest pain
- Heart murmur
- Palpitation or abnormal heart rhythms
- Low-grade fever
- Loss of appetite
It can be very difficult to diagnose aortic stenosis based on the symptoms alone since many other medical conditions can cause similar symptoms. For instance, a viral infection, such as pneumonia, could produce similar shortness of breath in someone who has aortic stenosis.
Causes and Risk Factors for Aortic Stenosis
The four valves in your heart, namely mitral valve, tricuspid valve, pulmonary valve and aortic valve, ensure that blood flows in the right direction. In every heartbeat, each valve's leaflet (or cusps) open and close once. In some cases, the valves fail to open and close. When this happens, blood flow is blocked. Aortic valve stenosis is an aortic valve disease as it occurs when the aortic valve does not open completely, which narrows the area through which blood leaves the heart and reaches the aorta.
Because of the small opening of the aortic valve, the heart must exert more effort to pump blood into the aorta and other parts of the body. Overexertion of the heart muscle causes the left ventricle to become thicker and enlarged, leading to ventricular dysfunction. The most common causes of this condition include:
- Congenital heart defects as a result of having bicuspid valves or two cusps in the aortic valve instead of three
- Calcium deposits resulting from calcium buildup in the aortic valves
- Rheumatic heart disease is a heart valve disease caused by rheumatic fever, which is a type of inflammatory disease that affects several connective tissues in the body
Diagnosis of Aortic Stenosis
In order to find an effective treatment for aortic stenosis, the condition has to be properly diagnosed. A person who exhibits the classic symptoms of aortic stenosis will have to undergo a number of tests performed. First, the doctor will check the patient's pulse and listen to their heart for any irregularities. This may involve the use of a stethoscope or a sonogram machine called an echocardiograph. They also also order blood tests to measure the closing and opening times of the heart valves and spot the possible presence of aortic regurgitation, which occurs when the aortic valves don't close tightly, causing the blood pumped out from the left ventricle to flow backward.
A doctor will often use an echocardiogram to diagnose aortic stenosis. This is a very quick, painless test done right in a doctor's office. During this test a small probe or transducer is placed on a patient's chest and a picture of the heart can be seen on a screen. A doctor will look for a decreased opening between the aorta and left ventricle. They may also look for a narrowing of the aortic valve, which would indicate that a person has severe aortic stenosis.
As part of the diagnostic procedure, the doctor will also ask a patient about their medical history and perform a physical examination, which may include the following:
- Checking of blood pressure
- Taking weight measurements
- Listening to the lungs with a stethoscope
- Measuring how fast the heart is beating
- Looking for signs of infection
- Feeling for swollen lymph nodes in the neck and feeling abdominal areas where fluid may be present
A chest X-ray may also reveal evidence of calcified deposits on the heart valves or a narrowed aorta. Another test that can be performed is a computed tomography (CT) scan or a cardiac catheterization, which is most often the only way to properly diagnose aortic stenosis.
Treatment for Aortic Stenosis
Treatment options vary depending on how severe a person's case is, but a doctor will usually start with medications to ease mild symptoms. If the patient doesn't respond well to medications, the doctor may suggest another medical treatment, specifically a balloon valvuloplasty, which involves using a balloon-tipped catheter to stretch open the narrowed valve or replace it altogether with an artificial valve.
Some people with aortic stenosis may also need a heart catheterization where a doctor will insert a thin tube into their artery and advance it to the aortic valve to check for narrowing and possibly widen the aortic opening.
For high-risk patients, especially those with an enlarged aorta, surgery is usually necessary to replace the aortic valve with either a tissue or mechanical valve. Currently there is no cure for aortic stenosis but treatment options can delay further damage to the heart and prevent complications.
The Pros and Cons of Cardiac Surgery
Once a person has been diagnosed with aortic stenosis, the doctor will most likely refer them to a cardiologist who specializes in heart surgery. The symptoms a patient is experiencing and how severe their symptoms are will help a cardiologist determine whether or not a surgical treatment is necessary. Most patients choose this option without hesitation due to the symptoms they experience every day.
There are two main surgeries for a person who has aortic stenosis; they are aortic valve surgery, which aims for an aortic valve replacement in patients, and aortic valve repair that sews the existing tissue onto the new valves in order to make them functional again. The latter surgical treatment can extend a patient's life expectancy by several years compared to those patients who only receive the standard aortic valve replacement.
The surgical intervention can be done either through a median sternotomy or a less invasive, thoracoscopic procedure.
During recovery time after surgery, patients are encouraged to walk around as much as possible because it speeds up the healing process. They should avoid any strenuous physical activity that may harm their aorta such as contact sports and heavy lifting. Patients must follow a doctor's orders to a tee and have a cardiologist monitor them closely due to the amount of medication a patient needs during this time. Following a doctor's instructions after a surgery is crucial as a rupture or tear in the aorta can lead to heart failure or sudden death if not treated right away.
There are a number of complications that a person with aortic stenosis may experience after a cardiac surgery, such as:
- Blood clots in the legs or lung embolism
- Kidney failure due to prolonged taking of certain medications
- Bleeding from where surgical instruments were inserted
- Breathing difficulty caused by a complication called atelectasis which is when a section of the lungs collapses and can be brought on by not moving often enough after surgery
- Stroke from areas affected with paralysis
- Loss of memory due to lack of oxygen to the brain
- Excessive bleeding due to a medication used during surgery called a heparin that prevents blood from clotting
After a person has gone through a cardiac procedure, they may be given a device called a pacemaker. This small box implanted under a patient's skin can essentially regulate their heart rate so it doesn't become too slow or too fast, causing an irregular heartbeat. A pacemaker also helps strengthen a patient's heartbeat so they are able to participate in normal activities without any major downside effects.
Complications of Aortic Stenosis
Medical management of patients afflicted with aortic stenosis is crucial as their condition can lead to cardiac death. A person who has aortic stenosis is at risk of developing serious complications if their condition goes untreated, including:
- Thrombus or blood clots
- Myocardial infarction or heart attack
- Swelling in the blood vessel, which may lead to an aneurysm in the aorta
- Tear in the aorta called a rupture
Aortic stenosis can be managed with the help of a heart specialist. In order to counteract the adverse effects of conventional medicines, they can consult a natural health practitioner who specialises in heart-healthy nutrition and exercise.