Aortic valve disease is a condition that occurs when your aorta (the main artery of your body) and left ventricle (the lower left chamber of your heart) malfunction. The aortic valve determines how blood flows from your left ventricle to your aorta.
There are two different types of aortic valve disease: aortic stenosis and aortic regurgitation. In the case of aortic stenosis, the opening of your aortic valve is narrower than it should be resulting in restricted blood flow to the aorta. In aortic regurgitation, some of the blood leaks back into your left ventricle because your aortic valve doesn’t close tightly enough.
While both forms of aortic valve disease share similar symptoms, such as chest pain during exercise that eases when you’re at rest, they do have a few different symptoms. Aortic stenosis may cause:
- swollen ankles
- shortness of breath
- rapid or fluttering pulse
Aortic regurgitation can cause:
- fainting, usually during physical activity
- heart palpitations
Both types of aortic valve disease may take a number of years to appear. As a result, you should tell your doctor if you experience these symptoms and have — or have had — any of the conditions that would put you at risk of it (such as rheumatic fever or scarlet fever).
Causes and Risks
A buildup of calcium on your aortic valve’s leaflets can also cause aortic stenosis. As blood flows through your heart, calcium gradually builds up on the leaflets. The calcium deposit can cause the leaflets to stiffen and narrow your aortic valve. This form of aortic valve disease usually only appears in older adults.
Rheumatic fever and scarlet fever can also cause aortic stenosis. Rheumatic fever and scarlet fever can begin as strep throat and then leave scars on your aortic valve. The scars can cause your aortic valve to narrow. This scar tissue may also give calcium a surface where it can collect.
Aortic regurgitation shares some of the same causes as aortic stenosis, but it is sometimes caused by simple wear and tear. Your aortic valve opens and closes thousands of times per day. As time goes on, normal wear may cause the valve to malfunction. The worn valve may allow blood to flow back into your left ventricle.
Endocarditis is an infection of the valves of your heart that can also cause aortic regurgitation. Although rare, syphilis, a sexually transmitted disease, can also damage your heart valves. Even more rare, heart valve damage is also a side effect of a disorder of the spine called ankylosing spondylitis. Both types of damage can also cause aortic regurgitation.
One cause of aortic regurgitation is a congenital heart defect present at birth. The valve of the aorta is typically made up of three triangular flaps called leaflets. When working properly, the leaflets fit tightly together, allowing blood to flow in only one direction. If you have a congenital defect, your aortic valve may only have one (unicuspid) or two (bicuspid) leaflets instead of the usual three. This type of aortic regurgitation may not show any symptoms until adulthood, when the valve finally begins to show signs of leaking.
Both types of aortic valve disease are diagnosed in similar ways. Your doctor will likely ask you questions about your health history, as well as the health history of your family. You doctor may order an electrocardiogram, a test done usually in the office that measures electrical impulses from your heart to provide information on heart rhythm, exercise tests to measure how your heart responds to exertion, an echocardiogram, a test that uses sound waves to create an image of your heart and aortic valve. A chest X-ray is also commonly used to diagnose aortic valve disease.
Your doctor may suggest a cardiac catheterization if these tests don’t provide a definitive diagnosis. This procedure uses a dye to highlight any leaks in your heart valves. The dye is injected through a vein in your groin or arm and then tracked on a monitor as it moves through your heart. The doctor may also order a cardiac magnetic resonance imaging test that uses magnetic field and radio waves to provide detailed pictures of your heart and aortic root.
There are currently no medications available to treat the valve problems of aortic stenosis or aortic regurgitation, but your doctor can prescribe medications that can help reduce the effects of the disease.
In the case of aortic regurgitation, medication can lower your blood pressure and prevent the buildup of fluid. If you have aortic stenosis, your doctor may recommend the use of drugs to control disturbances in your heart’s rhythm. Beta and calcium blockers can help with angina (chest pain). Your doctor may also prescribe statin drugs to lower your blood cholesterol levels.
While there are several surgical methods of treatment for aortic valve disease, the most common and most effective is aortic valve replacement. In this procedure, a surgeon will remove your damaged aortic valve and replace it with a new one from a human donor or a large animal, such as a cow or pig.
Your surgeon may opt for a mechanical valve. These are made of metal and are sturdy, but they increase your risk for blood clots in the heart. If you have a mechanical valve, you may need an anticoagulant drug such as warfarin (Coumadin) for permanent management of your condition.
Rather than replace the valve, your surgeon may choose to repair it with a procedure called a valvuloplasty. Unlike valve replacement, this method does not require long-term use of medication after your operation.
Among infants and children, a balloon valvuloplasty may be performed. During this procedure, a surgeon inserts a thin tube with a balloon at the tip into the child’s body. The surgeon guides the balloon to the aortic valve and inflates it. As it inflates, the balloon stretches the opening of the valve and improves blood flow. This type of valvuloplasty is usually not performed on adults, due to the likelihood that the valve would narrow again later on.
You can take steps to lower your chances of developing aortic valve disease. To lower your risk of aortic valve disease, you should try the following:
Preventing rheumatic and scarlet fever
If you have a sore throat, you may want to have it checked by your doctor to make sure that it’s not strep throat. Strep throat could progress into something that could damage your heart.
Practicing good dental hygiene
Make sure that your teeth and gums are well cared for. This reduces the chance of bloodstream infections that cause endocarditis.
Keeping your heart healthy
If you have high blood pressure or high cholesterol, talk to your doctor about steps you can take to lower them. Both of these conditions have close links to aortic valve disease.