What is aortic valve stenosis?
Aortic valve stenosis occurs when the aortic valve narrows and doesn’t open as it should. This limits the amount of blood pumped from your heart into, and then out of, the aorta. This is the main artery of the body. The aortic valve is a key valve in the body’s blood circulation system.
Aortic valve stenosis generally produces symptoms only once it progresses. You may not have symptoms in the beginning.
You may experience symptoms of severe aortic valve stenosis once the condition has progressed to the symptomatic stage. Symptoms of severe aortic valve stenosis include:
- chest pain as the heart strains to pump enough blood through the compromised valve
- feeling tired after exertion, as when you exercise or move
- feeling short of breath, especially after exertion
- heart palpitations, or abnormal heartbeats
- a heart murmur, which is an abnormal swooshing sound produced by the heart as it beats
Infants and children may have different symptoms from adults, or they may not appear to display any symptoms at all. If they do display symptoms, these might include:
- inability to put on weight
- not eating well
- becoming easily fatigued
In severe cases, an infant may have major breathing difficulties that develop within weeks of birth. Mild cases have the potential to worsen as the child gets older.
Genetics and certain health conditions may prevent the aortic valve from completing its proper functions. The aortic valve opens and closes every time your heart beats. This continuous action occurs every second of your life.
Aortic valve stenosis may be present at birth. When it is, the flaps, or “leaflets,” of the aortic valve are irregularly formed. These leaflets make up the opening of the aortic valve. When functioning properly, they fit together tightly when closed. Children born with aortic valve stenosis usually have one of the following irregularities in their aortic valve leaflets:
- All three leaflets aren’t present.
- The leaflets don’t separate properly.
- The leaflets are too thick to completely open or close.
Rheumatic fever is one of the most common causes of heart valve problems. Rheumatic fever may affect many parts of the body, including the:
Rheumatic fever can occur in adults and children who have, or have had, strep throat. Strep throat is a contagious condition caused by Streptococcus bacteria.
Calcification of the valves
Aortic valve stenosis most often occurs in older adults. Age-related aortic valve stenosis is the most common form of the condition, according to the American Heart Association. It’s caused by calcification or scarring of the aortic valve. It usually begins sometime after the age of 60, but people may not begin to experience symptoms until age 70 or 80.
Calcium is an important mineral needed for strong bones. However, the mineral may lead to problems in your heart if it deposits in the aortic valve. Calcium deposits usually affect the leaflets of the aortic valve. They can also prevent the aortic valve from properly opening and closing. These deposits often increase in the aortic valve as we age due to scarring and calcium buildup.
Improperly functioning aortic valve leaflets may also allow blood to leak back into the left ventricle after it enters the aorta. This is called valvular insufficiency, or regurgitation.
The risk factors for aortic valve stenosis include:
Men have a higher risk of aortic valve stenosis than women. The condition occurs most often in men between the ages of 30 and 60.
Children born with either malformed valve leaflets or fewer than three leaflets will have problems with normal blood flow through the aorta.
Rheumatic fever can produce significant problems with the valve leaflets. Scar tissue from the disease can make the leaflets hard or even fused. Rheumatic fever damages:
- heart tissue
- coronary arteries
After reporting your symptoms to your doctor, you may be referred to a cardiologist. This type of doctor is a heart specialist. They’ll check your physical condition with a thorough examination. This includes listening to your heart for any abnormal sounds. You may need imaging tests to show what’s going on inside your heart.
Here are some of the imaging tests your cardiologist may order:
- MRI scan. MRIs create highly detailed images of internal body structures.
- CT scan. This test takes cross-sectional images of internal body structures.
- Chest X-ray. This type of X-ray creates images of the heart, lungs, airways, blood vessels, and bones in your spine and chest.
- Echocardiogram. This test provides video images of your heart.
- Cardiac catheterization. This test uses dye to highlight any blockages in the heart.
There are no specific medications to fix aortic valve stenosis. This is because the condition is irreversible once it occurs. Instead, your doctor can prescribe medication to treat the problems caused by the condition, or for the health issues that produced the condition in the first place. Surgery may be able to repair or replace the valve.
Although medication can’t cure aortic valve stenosis, your doctor may prescribe drugs to manage symptoms or reduce the burden on your heart. Some medications include:
- Antibiotics. Rheumatic fever requires antibiotics to keep any infection from advancing and causing heart damage.
- Blood pressure medications. Beta-blockers or calcium channel blockers can help lower your blood pressure.
- Blood thinners. Blood thinners such as Coumadin may be necessary.
- Anti-arrhythmics. Medications to manage your heart’s rhythm, called anti-arrhythmics, are sometimes prescribed.
Your doctor may recommend a procedure or surgery to repair or replace the damaged valve. A minimally invasive procedure to repair the valve is called valvuloplasty. This procedure can be performed through a soft thin tube called a catheter, which is less invasive than traditional surgery.
In this type of procedure, the surgeon inserts a long, thin catheter with a tiny balloon at the end into an artery, usually in your groin. The surgeon guides the tube into your heart and inflates the balloon. Once the valve is opened, the surgical team removes the balloon and catheter.
The procedure is minimally invasive. Recovery time is shorter than the alternative of open-heart surgery.
Your surgeon may decide that your damaged valve must be replaced. This requires open-heart surgery. Your surgeon may insert a mechanical valve or a valve from a cow or pig. Sometimes valves from human cadavers are used. Open-heart surgery requires a much longer recovery period.
Your health may improve dramatically once you receive treatment. Surgical treatments for aortic valve stenosis have high rates of success. Your outlook depends on a combination of factors:
- how long you’ve lived with the condition
- the extent of damage to your heart
- any complications that may arise from your condition
Sometimes, aortic valve stenosis isn’t a congenital defect, meaning you weren’t born with the condition. If this is the case, there are healthy lifestyle steps you can take to ease the burden on your heart:
- Eat a healthy diet low in saturated fat.
- Exercise regularly.
- Maintain a healthy weight.
- Abstain from smoking.
- Report any abnormal health issues to your doctor.
- Visit your doctor for any severe sore throat to prevent rheumatic fever.
- Practice good dental hygiene, as dental infections can travel through the bloodstream and damage the heart valves and muscles.
Be sure to discuss any related health concerns with your doctor.
Can this cause difficulty in breathing?
It helps to understand the pathophysiology of aortic valve stenosis as to how it relates to difficulty breathing. When the aortic valve narrows over time, the blood won’t circulate efficiently. When the blood being pumped from the lungs can’t circulate efficiently through the aortic valve, it will cause increased pressure in the blood vessels of the lungs due to the increased pressure in the left ventricle and left atrium of the heart. If the aortic stenosis is acquired, then as the stenosis worsens or progresses, shortness of breath or difficulty breathing could be noticeable first with exercise and then later with minimal or no activity.Debra Sullivan, PhD, MSN, CNE, COIAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.