Aortic Stenosis

ExitCare ImageAortic stenosis is a narrowing of the aortic valve. The aortic valve is a gatelike structure that is located between the lower left chamber of the heart (left ventricle) and the blood vessel that leads away from the heart (aorta). When the aortic valve is narrowed, it does not open all the way. This makes it hard for the heart to pump blood into the aorta and causes the heart to work harder. The extra work can weaken the heart over time and lead to heart failure.

CAUSES

Causes of aortic stenosis include:

  • Calcium deposits on the aortic valve that have made the valve stiff. This condition generally affects those over the age of 65. It is the most common cause of aortic stenosis.

  • A birth defect. 

  • Rheumatic fever. This is a problem that may occur after a strep throat infection that was not treated adequately. Rheumatic fever can cause permanent damage to heart valves.

SYMPTOMS

People with aortic stenosis usually have no symptoms until the condition becomes severe. It may take 10–20 years for mild or moderate aortic stenosis to become severe. Symptoms may include:

  • Shortness of breath, especially with physical activity.  

  • Feeling weak and tired (fatigued) or getting tired easily.

  • Chest discomfort (angina). This may occur with minimal activity if the aortic stenosis is severe. 

  • An irregular or faster-than-normal heartbeat.

  • Dizziness or fainting that happens with exertion or after taking certain heart medicines (such as nitroglycerin).

DIAGNOSIS

Aortic stenosis is usually diagnosed with a physical exam and with a type of imaging test called echocardiography. During echocardiography, sound waves are used to evaluate how blood flows through the heart. If your caregiver suspects aortic stenosis but the test does not clearly show it, a procedure called cardiac catheterization may be done to diagnose the condition. Tests may also be done to evaluate heart function. They may include:

  • Electrocardiography. During this test, the electrical impulses of the heart are recorded while you are lying down and sticky patches are placed on your chest, arms, and legs.

  • Stress tests. There is more than one type of stress test. If a stress test is needed, ask your caregiver about which type is best for you.

  • Blood tests.

TREATMENT

Treatment depends on how severe the aortic stenosis is, your symptoms, and the problems it is causing.

  • Observation. If the aortic stenosis is mild, no treatment may be needed. However, you will need to have the condition checked regularly to make sure it is not getting worse or causing serious problems.

  • Surgery. Surgery to repair or replace the aortic valve is the most common treatment for aortic stenosis. Several types of surgeries are available. The most common are open-heart surgery and transcutaneous aortic valve replacement (TAVR). TAVR does not require that the chest be opened. It is usually performed on elderly patients and those who are not able to have open-heart surgery.

  • Medicines. Medicines may be given to keep symptoms from getting worse. Medicines cannot reverse aortic stenosis.

HOME CARE INSTRUCTIONS

  • You may need to avoid certain types of physical activity. If your aortic stenosis is mild, you may need to avoid only strenuous activity. The more severe your aortic stenosis, the more activities you will need to avoid. Talk with your caregiver about the types of activity you should avoid.

  • Take all medicines as directed by your caregiver.

  • If you are a woman with aortic valve stenosis and want to get pregnant, talk to your caregiver before you become pregnant.

  • If you are a woman with aortic valve stenosis and are pregnant, keep all follow-up appointments with all recommended caregivers.

  • Keep all follow-up appointments for tests, exams, and treatments.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You develop chest pain or tightness.  

  • You develop shortness of breath or difficulty breathing.  

  • You develop lightheadedness or faint.  

  • It feels like your heartbeat is irregular or faster than normal.

  • You have a fever or persistent symptoms for more than 2–3 days.