Aortic Valve Stenosis

Aortic valve stenosis

Aortic valve stenosis (aortic stenosis) is a valvular heart disease in which the valve between the lower left heart chamber and the aorta is narrowed and cannot fully open or close, leading to the blockage or reduction of blood flow from the heart to the rest of the body.

Regular health checkups and lifestyle changes may be sufficient for mild aortic stenosis. However, in severe cases, aortic valve replacement or repair is necessary. If left untreated, it can lead to death.

Symptoms

Patients with aortic stenosis may not develop any symptoms for years because the symptoms usually show when the condition is severe.

Symptoms of aortic valve stenosis may include:

• Palpitations
• Angina or chest tightness with physical activity
• Dizziness, fainting with physical activity
• Shortness of breath with physical activity
• Fatigue when doing more demanding physical activities

When to see a doctor

If you have the symptoms above, consult with your doctor.  

Causes

Our heart has 4 valves, including

• Aortic valve between the left ventricle and the aorta
• Mitral valve between the left atrium and the left ventricle
• Tricuspid valve between the right atrium and the right ventricle
• Pulmonary valve between the right ventricle and the pulmonary artery

Each valve has leaflets that open and close during a heartbeat. Blood flow will decrease if a valve cannot be fully opened or closed. 

For people with aortic valve stenosis, the valve does not fully open or close, causing the narrowing of the cross-sectional valve area between the heart and the aorta. The heart has to pump more forcefully to maintain sufficient blood flow to the rest of the body. The strain on the heart muscle can lead to a thickened or enlarged left ventricle, weakened heart muscle, and heart failure.

The common causes of aortic valve stenosis are:

• Congenital heart defect.
  Usually, people are born with an aortic valve having three cusps (tricuspid aortic valve). But some may have a bicuspid aortic valve (or, rarely, unicuspid or quadricuspid aortic valve). Regular health checkups are necessary for people with a congenital heart defect, such as a bicuspid aortic valve. If narrowing or leakage sets in, aortic valve replacement is in order. 

• Aortic valve calcification.
  The blood contains calcium which can deposit on the heart valves. Aortic valve stenosis due to old age or calcium buildup usually does not display any symptoms until the age of 70-80 years old. But in people with a congenital heart defect, the calcium buildup can stiffen the valve cusps and cause symptoms at a younger age. 
• Rheumatic fever.
  Strep throat or scarlet fever can lead to rheumatic fever if not treated in time. Rheumatic fever can scar tissue on the aortic valve, creating a rough surface for calcium buildup and narrowing the aortic valve. Valve damage can involve more than one valve in more than one way. 

Risk factors

• Older age
• Congenital heart defects such as a bicuspid aortic valve
• Chronic kidney disease
• Diabetes
• Hyperlipidemia
• Hypertension
• History of heart infections such as endocarditis or rheumatic fever
• History of chest radiation therapy

Complications

• Heart failure
• Stroke
• Heart arrhythmias
• Heart infections such as endocarditis

Diagnosis

• Medical history and physical exam: Your doctor will ask about your symptoms and medical history. The doctor uses a stethoscope to listen if there are heart murmurs. 
• Chest X-ray. It is to check if there is aortic valve calcification, dilatation of the aorta, or an enlarged heart from aortic valve stenosis.
• Electrocardiogram (ECG or EKG) Electrodes placed on your chest, arms, or legs to check the heart rhythm and identify if there are abnormal signals due to heart disease. 
• EchocardiogramUses sound waves to generate images of the heart, display the blood flows through the heart, check the heart muscles, and assess the severity of aortic valve stenosis. A transesophageal echocardiogram (TEE) can give a more detailed examination and better heart structure imaging by deploying a flexible ultrasound probe in the esophagus.
• Cardiac computerized tomography (Cardiac CT) . This method can visualize the heart structure and measure the aorta’s size. 
• Cardiac magnetic resonance imaging (Cardiac MRI). Create images of the heart to determine the severity of aortic valve stenosis and the size of the aorta.

Treatment

The treatment modality depends on the severity of the condition and its symptoms. Those with mild symptoms may merely need regular checkups, lifestyle changes, medications, and regular echocardiography every 6-12 months.

Lifestyle modification and home remedies

Always keep your doctor’s appointment for a regular health checkup which is necessary for patients with aortic valve stenosis. To maintain a healthy heart and prevent heart disease, you can do the following:

• Eat more heart-healthy foods. Make fruits, vegetables, and whole grains parts of your daily diet. Consume low-fat or fat-free dairy products and avoid food high in salt, sugar, saturated, and trans fat. Eat fish and poultry instead of red meat.
• Keep a healthy weight. If you are overweight, losing a few kilograms or pounds can lower the risk of developing heart disease. Talk to your doctor about proper BMI and weight targets.
• Exercise regularly. Exercise for 30 minutes every day. Try to be physically active.
• Cope with stress. Exercise, meditation, and spending time with loved ones can help calm emotional stress.
• Quit smoking.