Aortic valve stenosis

Alternative names
Aortic stenosis

Definition

The aorta is the large artery that originates in the left ventricle (lower chamber) of the heart. Aortic stenosis is the narrowing or obstruction of the heart’s aortic valve, which prevents it from opening properly and blocks the flow of blood from the left ventricle to the aorta.

Causes, incidence, and risk factors

Aortic stenosis is caused by many disorders. One common cause is rheumatic fever, a complication of untreated strep throat. Other causes include calcification of the valve and congenital abnormalities (disorders present at birth). There may be a history of other valve diseases, coronary artery disease, or heart murmur.

Aortic stenosis occurs in approximately 5 out of every 10,000 people. It is more common among men. Symptoms often do not appear until middle age or older.

Symptoms

     
  • fainting or weakness with activity  
  • breathlessness with activity  
  • sensation of feeling the heart beat (palpitations)  
  • chest pain, angina-type       o under the sternum, may radiate       o crushing, squeezing, pressure, tightness       o increased with exercise, relieved with rest

Note: Aortic stenosis may show no symptoms until late in the course of the disease.

Additional symptoms that may be associated with this disease:

     
  • dizziness

Signs and tests

Examination shows a palpable chest thrill or heave (vibration or movement felt by holding the hand over the heart). There is almost always a heart murmur, click, or other abnormal sound on auscultation (examination of the chest with a stethoscope). There may be a faint pulse or changes in the quality of the pulse in the neck (the change in pulse is known as pulsus parvus et tardus). Blood pressure may be low.

Aortic stenosis and/or enlargement of the left ventricle may be revealed on:

     
  • left Cardiac catheterization  
  • echocardiogram (sonogram test of the heart)  
  • Doppler ultrasonography  
  • transesophageal echocardiogram (TEE)  
  • Chest x-ray may show dilation of the aorta.

An ECG may show left-ventriclar enlargement or arrhythmias (unusual pattern of heart beats) such as ventricular tachycardia or sinus bradycardia.

This disease may also alter the results of the following:

Treatment

If there are no symptoms or symptoms are mild, only observation may be required. If symptoms are moderate to severe, hospitalization may be necessary.

Medications can include diuretics, digoxin, and other medications to control heart failure. Symptomatic people may be advised to avoid strenuous physical activity. People with symptoms of aortic stenosis (difficulty breathing, chest pain, fainting episodes) should have a physical exam every 6 to 12 months and an ECG performed every 1 to 3 years.

Surgical repair or replacement of the valve is the preferred treatment for symptomatic aortic stenosis. Patients with advanced heart failure may benefit from a less invasive procedure called balloon valvuloplasty. 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.

Expectations (prognosis)
Aortic stenosis is curable with surgical repair, although there may be a continued risk for arrhythmias, which can sometimes cause Sudden death. The person may be symptom-free until complications develop. Without surgery, probable outcome is poor if there are signs of angina or heart failure.

Complications

     
  • left ventricular hypertrophy (enlargement) caused by the extra work of pushing blood through the narrowed valve  
  • left-sided heart failure  
  • arrhythmias  
  • endocarditis- valve infection

Calling your health care provider

Call your health care provider if symptoms indicate the possibility of aortic stenosis.

Call your health care provider if aortic stenosis has been diagnosed and symptoms worsen or new symptoms develop.

Prevention

Treat strep infections promptly to prevent rheumatic fever, which can cause aortic stenosis. This condition itself often cannot be prevented, but some of the complications can be.

Notify the health care provider or dentist about any history of heart valve disease before treatment for any condition. Any dental work, including cleaning, and any invasive procedure can introduce bacteria into the bloodstream. This bacteria can infect a weakened valve causing endocarditis.

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

Johns Hopkins patient information

Last revised: December 8, 2012
by Armen E. Martirosyan, M.D.

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