Aortic Stenosis - Dr Nima Rudd Cardiologist
Aortic stenosis occurs when the heart’s aortic valve narrows. This narrowing prevents the valve from opening fully, which reduces blood flow from your heart into the main artery to your body (aorta) and onward to the rest of your body so your heart needs to work harder to pump blood to your body. Eventually, this can cause symptoms as well as possibly weaken your heart muscle.
If you have severe aortic stenosis, you may need surgery to repair or replace the valve. Left untreated, aortic valve stenosis can lead to serious heart problems.
Symptoms
Aortic valve stenosis ranges from mild to severe. Aortic valve stenosis signs and symptoms generally develop when narrowing of the valve is severe. Some people with aortic valve stenosis may not experience symptoms for many years. Signs and symptoms of aortic valve stenosis may include:
- Abnormal heart sound (heart murmur) heard through a stethoscope
- Chest pain (angina) or tightness with activity
- Feeling faint or dizzy or fainting with activity
- Shortness of breath, especially when you have been active
- Fatigue, especially during times of increased activity
- Heart palpitations — sensations of a rapid, fluttering heartbeat
- Not eating enough (mainly in children with aortic valve stenosis)
- Not gaining enough weight (mainly in children with aortic valve stenosis)
The heart-weakening effects of aortic valve stenosis may lead to heart failure. Heart failure signs and symptoms include fatigue, shortness of breath, and swollen ankles and feet.
Causes
Aortic valve stenosis can occur due to many causes, including:
Calcium buildup on the valve. With age, heart valves may accumulate deposits of calcium (aortic valve calcification). Calcium is a mineral found in your blood. As blood repeatedly flows over the aortic valve, deposits of calcium can build up on the valve’s cusps. These calcium deposits aren’t linked to taking calcium tablets or drinking calcium-fortified drinks.
These deposits may never cause any problems. However, in some people — particularly those with a congenitally abnormal aortic valve, such as a bicuspid aortic valve — calcium deposits result in stiffening of the cusps of the valve. This stiffening narrows the aortic valve and can occur at a younger age.
However, aortic valve stenosis that is related to increasing age and the buildup of calcium deposits on the aortic valve is most common in older people. It usually doesn’t cause symptoms until ages 70 or 80.
Congenital heart defect. The aortic valve consists of three tightly fitting, triangular-shaped flaps of tissue called cusps. Some children are born with an aortic valve that has only two (bicuspid) cusps instead of three. People may also be born with one (unicuspid) or four (quadricuspid) cusps, but these are rare.
This defect may not cause any problems until adulthood, at which time the valve may begin to narrow or leak and may need to be repaired or replaced.
Having a congenitally abnormal aortic valve requires regular evaluation by a doctor to watch for signs of valve problems. In most cases, doctors don’t know why a heart valve fails to develop properly, so it isn’t something you could have prevented.
Rheumatic fever. A complication of strep throat infection, rheumatic fever may result in scar tissue forming on the aortic valve. Scar tissue alone can narrow the aortic valve and lead to aortic valve stenosis. Scar tissue can also create a rough surface on which calcium deposits can collect, contributing to aortic valve stenosis later in life.
Rheumatic fever may damage more than one heart valve, and in more than one way. A damaged heart valve may not open fully or close fully — or both. While rheumatic fever is rare in the United States, some older adults had rheumatic fever as children.
Risk factors
Risk factors of aortic valve stenosis include:
- Older age
- Congenital heart disease such as a bicuspid aortic valve
- History of infections that can affect the heart
- Having cardiovascular risk factors, such as diabetes, high cholesterol and high blood pressure
- Chronic kidney disease
- History of radiation therapy to the chest
Complications
Aortic valve stenosis can cause complications, including:
- Heart failure
- Stroke
- Blood clots
- Bleeding ( in your gut )
- Heart rhythm abnormalities (arrhythmias)
- Infections that affect the heart, such as endocarditis
- Death