|
Getting your Trinity Audio player ready...
|
Almost one-third of U.S. adults 65 and older have this heart valve disorder that impedes blood flow from the heart
By: Allison DeMajistre
Aortic stenosis is a heart valve disorder that causes the aortic valve opening to narrow, hindering blood flow out of the heart. The condition makes the heart work much harder, causing damage over time and, if left untreated, can eventually lead to death.
According to the American Heart Association, aortic stenosis is one of the most common and severe heart valve problems. About 29 percent of people 65 years and older have it, and 2 percent to 9 percent of those over 75 have a severe case.
Although it is found most often in older people, about 1 percent to 2 percent of those younger than 65 are diagnosed with aortic stenosis as a result of childhood illnesses or congenital defects.
What Are the Symptoms of Aortic Stenosis?
In a healthy heart, blood flows freely from the left ventricle through the aortic valve to the aorta and sends oxygen-rich blood throughout the body. When the valve becomes stenotic due to calcium buildup, it doesn’t open and close properly, and blood flow is restricted, causing symptoms such as:
Chest pain
Rapid, fluttering heartbeat
Shortness of breath
Dizziness or lightheadedness
Difficulty walking short distances
Swelling in the feet or ankles
Difficulty sleeping or needing to sleep sitting up
People often dismiss these symptoms as typical signs of aging and don’t mention them during routine doctor visits. Unfortunately, waiting too long for diagnosis and treatment can cause heart damage that can’t be repaired or reversed. Severe aortic stenosis comes with a risk of sudden death, so it’s important to discuss symptoms with a primary care physician who can make a referral to a cardiologist.
What Causes Aortic Stenosis?
The aortic valve is between the left ventricle and the largest artery in the body, the aorta. After the left ventricle fills with blood, oxygen-rich blood is pumped into the aorta, which carries blood to the brain and into the rest of the body.
With aortic stenosis, the valve becomes stiff, and the left ventricle can’t pump enough blood out of the heart and into the aorta. The heart has to work harder to pump enough for the body to receive a sufficient supply of oxygen-rich blood. As the heart works harder, the muscle becomes stretched and can no longer contract properly, eventually leading to heart failure.
Certain conditions, such as scarring or structural changes, can cause the aortic valve opening to become smaller. These changes make the valve more prone to calcium buildup, which can make it stenotic.
The following are conditions that can cause aortic stenosis.
Bicuspid Aortic Valve
A bicuspid aortic valve is the most common congenital heart defect, affecting approximately 1 percent to 2 percent of the population. It is more common in males than females.
A normal aortic valve has three leaflets, but a bicuspid valve only has two. The valve may not grow with the rest of the heart, making it more difficult for blood to pump through the opening. Over time, the restriction and overwork cause the valve to narrow further and become stiff from calcium buildup.
Many people born with a bicuspid aortic valve don’t have symptoms until later in life. These people may find out after having tests for another health problem or when a doctor hears a murmur when listening to the heart and investigates further to find the source.
Rheumatic Heart Disease
Bacterial infections, such as group A streptococcal infections and scarlet or rheumatic fever, trigger an immune response that causes inflammation throughout the body, including the heart. This can result in rheumatic heart disease. The inflammation can damage heart valves, including the aortic valve, and cause the valve to become stenotic over time.
Rheumatic heart disease is uncommon in the United States and more common in developing nations, yet about 300,000 people worldwide die each year from it. Signs of heart valve damage may not appear until years after the infection is resolved, and most people begin to show symptoms as young adults.
Connective Tissue Disorders
People with autoimmune connective tissue disorders often have heart valve problems. Some of these disorders include:
Marfan’s syndrome
Systemic lupus erythematosus
Rheumatoid arthritis
Systemic sclerosis
Sjogren’s syndrome
Who Is at Risk of Aortic Stenosis?
Calcium buildup, also called atherosclerosis, on the aortic valve increases with age, so people over 65 have the highest incidence of aortic stenosis. Risk factors include:
Older age
Male sex
Congenital heart defects (bicuspid aortic valve)
Chronic kidney disease
Diabetes
High cholesterol
High blood pressure
Infections that may affect the heart, such as rheumatic fever and infective endocarditis
Radiation therapy to the chest
What Are the Stages of Aortic Stenosis?
After confirming a diagnosis of aortic stenosis, a health care provider will determine the stage of the disease and decide on the most appropriate treatment. The stage of heart valve disease depends on several aspects, including symptoms, disease severity, valve structure, and blood flow through the heart and lungs.
Heart valve disease is categorized into four primary groups:
Stage A (at risk): There are risk factors for heart valve disease present.
Stage B (progressive): The valve disease is mild to moderate, with no current symptoms.
Stage C (asymptomatic severe): The valve disease is severe, but there are no apparent symptoms.
Stage D (symptomatic severe): Heart valve disease is severe and is causing symptoms.
How Is Aortic Stenosis Diagnosed?
Several tests can confirm or rule out aortic stenosis and help determine the severity of the disease.
An echocardiogram is the gold standard for diagnosing aortic stenosis and monitoring its progression. It is an ultrasound of the heart that uses sound waves to show detailed images of the heart in motion. It shows how well the valves open and close and if there is any backflow of blood if the valves don’t close tightly. It can also help measure the severity of aortic stenosis and how weakened the heart has become.
There are two types of echocardiogram: transthoracic echocardiogram (TTE) and transesophageal echocardiogram (TEE). A TTE is noninvasive and reads images taken with an ultrasound probe on the chest. A TEE is more invasive and involves guiding a flexible tube with an ultrasound probe down the throat and into the esophagus to get a closer look at the heart. A TEE usually requires the patient to be sedated and asleep during the procedure.
Other diagnostic tests for aortic valve stenosis include:
Electrocardiogram (ECG or EKG): An electrocardiogram is a painless test that only lasts a few minutes and measures the heart’s electrical activity. It can determine how fast or slow the heart is beating, detect irregular heart rhythms, and show patterns related to heart disease or problems within the heart chambers.
Exercise or stress test: These tests involve riding a stationary bike or walking on a treadmill while monitoring the heart. Exercise and stress tests can help identify symptoms of aortic stenosis during physical activity. If a patient cannot exercise, medications that mimic the effect of exercise on the heart can be administered.
Chest X-ray: A chest X-ray can show the condition of the heart and lungs. It can show an enlarged heart, which often happens with aortic stenosis. A chest X-ray can also show calcium buildup on the aortic valve or an enlarged aorta.
Cardiac computerized tomography (CT) scan: A cardiac CT scan provides a cross-sectional view of the heart. It can accurately measure the aorta and provide a detailed view of the aortic valve.
Cardiac magnetic resonance imaging (MRI) scan: A cardiac MRI uses magnetic fields and radio waves to create detailed heart images that can show the size of the aorta and determine the severity of aortic valve stenosis.
