Aortic stenosis (patient information)

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What is aortic stenosis?

The aorta is the main artery leaving the heart. When blood leaves the heart, it flows from the lower chamber (the left ventricle), through the aortic valve, into the aorta. In aortic stenosis, the aortic valve does not open fully. This restricts blood flow from the heart to the rest of the body.

What are the symptoms of aortic stenosis?

You may have no symptoms at all until late in the course of the disease. The diagnosis may have been made when your healthcare provider heard a heart murmur and then performed additional tests.

Symptoms in adults

Symptoms in infants and children

  • Becoming tired or fatigued with exertion more easily than others (in mild cases)
  • Serious breathing problems that develop within days or weeks of birth (in severe cases)

Children with mild or moderate aortic stenosis may get worse as the get older. They also run the risk of developing an infection of the heart valves (bacterial endocarditis).

What are the causes of aortic stenosis?

In the United States, aortic stenosis often results from calcium deposits on the aortic valve. These deposits occur naturally with age and have no relationship with the amount of calcium in the diet. Approximately 2% of all people have a bicuspid aortic valve, which increases the risk of these calcifications and makes them more likely to develop aortic stenosis. Worldwide, rheumatic heart disease is a common cause of aortic stenosis.

As the aortic valve becomes more narrow, the pressure increases inside the lower chamber of the heart (the left ventricle). This causes the left ventricle to become thicker, decreasing blood flow and can lead to chest pain. As the pressure continues to rise, blood may back up into the lungs, and you may feel short of breath. Severe forms of aortic stenosis prevent enough blood from reaching the brain and rest of the body. This can cause lightheadedness and fainting.

Who is at risk for aortic stenosis?

Aortic stenosis occurs more often in men than in women. The calcifications that cause most cases of aortic stenosis are more likely to occur in patients above the age of 50, who are overweight, who smoke, and who have diabetes, high blood pressure, and high cholesterol. These are the same risk factors for atherosclerosis of the coronary blood vessels.

People who had rheumatic fever as a child also have a somewhat higher risk of developing aortic stenosis, but rheumatic fever is very rare in the United States. Radiation therapy for treatment of cancer, such as breast cancer or lymphoma, may also increase the risk of aortic stenosis.

How does my health care provider know if I have aortic stenosis?

Heart murmur

When listening to your heart, your health care provider may hear a new heart murmur associated with aortic stenosis. This murmur is not always there in aortic stenosis. If a new murmur is heard and your health care provider is concerned about aortic stenosis or another form of heart disease, further tests may be ordered. It is important to remember that not all heart murmurs mean you have a harmful heart condition.

Blood pressure

You may have high blood pressure if you have mild aortic stenosis. In rare cases of severe aortic stenosis, your blood pressure may actually be low.

Tests your doctor might perform

How do I know if my child has aortic stenosis?

Infants and children may be:

  • Extremely tired
  • Sweaty
  • Have pale skin
  • Fast breathing.
  • They may also be smaller than other children their age.

When should I seek urgent medical care?

Call your health care provider if you or your child have symptoms of aortic stenosis. For example, call if you or your child have a sensation of feeling the heart beat (palpitations) for more than a short period of time.

Also contact your doctor if you have been diagnosed with this condition and your symptoms get worse or new symptoms develop.

Treatment options

If there are no symptoms or symptoms are mild, you may only need to be monitored by a health care provider. Patients with aortic stenosis may be told not to play competitive sports, even if they don't have symptoms. If symptoms do occur, strenuous activity must be limited.

Medication

Medications are used to treat symptoms of heart failure or abnormal heart rhythms (most commonly atrial fibrillation). These include diuretics (water pills), nitrates, and beta-blockers. High blood pressure should also be treated.

Lifestyle changes

  • Stop smoking and be treated for high cholesterol.
  • See a cardiologist every 3 to 6 months.

Surgery

Surgery to repair or replace the aortic valve is the preferred treatment for adults or children who develop symptoms. Even if symptoms are not very bad, the doctor may recommend surgery. People with no symptoms but worrisome results on diagnostic tests may also require surgery.

Some high-risk patients may be poor candidates for heart valve surgery. A less invasive procedure called balloon valvuloplasty may be done in adults or children instead. This is a procedure in which a balloon is placed into an artery in the groin, advanced to the heart, placed across the valve, and inflated. This may relieve the obstruction caused by the narrowed valve.

Treatment options for children

Children with mild aortic stenosis may be able to participate in most activities and sports. As the illness progresses, sports such as golf and baseball may be permitted, but not more physically demanding activities.

Surgery

Valvuloplasty is often the first-choice for surgery in children. Some children may require aortic valve repair or replacement. If possible, the pulmonary valve may be used to replace the aortic valve, called a Ross procedure.

Prevention of aortic stenosis

Treat strep throat promptly to prevent rheumatic fever, which can cause aortic stenosis.

Follow your health care provider's treatment recommendation for conditions that may cause valve disease. Notify you provider if there is a family history of congenital heart diseases.

What is the outlook and prognosis?

People with mild aortic stenosis may do very well using a watchful waiting approach with their health care provider. They may be treated medically for some conditions associated with aortic stenosis, such as high blood pressure, and may have a normal life expectancy.

Those with more severe symptoms, such as chest pain or signs of heart failure like shortness of breath and leg swelling, generally do poorly without surgery. However, surgery does have the potential to cure a person's aortic stenosis. The success of surgery depends on a number of factors, including patient age, overall activity level, and presence of other medical conditions. As with any operation, aortic valve surgery has some risks, most of which occur during the first 1-2 days after surgery. These include an irregular heart rhythm and blood clots in the legs. There is also a chance that the new or repaired valve may stop working which might require another surgery.

Sources

  • "MedlinePlus Medical Encyclopedia: Aortic stenosis". Retrieved 2009-07-15.

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