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Aortic Stenosis

  • Aortic stenosis (narrowing) of the aortic valve

Definition

Aortic stenosis is a narrowing of the opening of the aortic valve. The aortic valve is a flap-like opening located between the left side of the heart and the aorta. The aorta is the main artery carrying blood from the heart.

What is going on in the body?

The heart is divided into two halves, right and left. Each side has a pumping chamber, called a ventricle. The left ventricle receives blood from the lungs. During a heartbeat, the left heart chamber squeezes, generating enough pressure to open the aortic valve. Blood from the left side is then pumped into the aorta and out into the body. When aortic stenosis has occurred, the opening of the valve is narrower than normal. This reduces the amount of blood flow to the body.

Risks

What are the causes and risks of the condition?

The causes of aortic stenosis include:
  • calcium deposits that harden, or calcify, the valve
  • congenital heart disease from heart defects present at birth
  • scarring of the valve from rheumatic heart disease

Prevention

What can be done to prevent the condition?

In many cases, nothing can prevent aortic stenosis. Proper treatment of rheumatic fever with antibiotics can prevent damage to the aortic valve.

Diagnosed

How is the condition diagnosed?

Diagnosis of aortic stenosis begins with a history and physical exam. Aortic stenosis causes a heart murmur which is characteristic and can be heard with a stethoscope.
The healthcare provider also may do one or more of these tests:
  • cardiac catheterization
  • chest X-ray
  • echocardiogram with or without color Doppler studies
  • electrocardiogram (ECG)

Long Term Effects

What are the long-term effects of the condition?

As the aortic valve slowly narrows, it deprives body organs of blood. Serious long-term effects may include:
  • congestive heart failure, a condition in which the weakened heart is unable to pump enough blood throughout the body
  • coronary heart disease
  • enlargement of the left ventricle, which cuts down the output of the heart still more
  • pulmonary edema, or congestion in the lungs
  • sudden death

Other Risks

What are the risks to others?

Aortic stenosis is not contagious, and poses no risk to others.

Treatments

What are the treatments for the condition?

The goal of treatment is to allow the heart to get more blood into general circulation. Various medicines can help improve overall blood supply to the body and the heart. They can also help reduce the person's symptoms.
In some cases, it is possible to widen the aortic valve opening using a small balloon inserted through an artery. This is usually done when someone is not stable enough for corrective surgery. In most cases, the valve is opened or replaced directly with open heart surgery

Side Effects

What are the side effects of the treatments?

Medicines used to treat aortic stenosis can cause a variety of side effects. Surgery can be complicated by bleeding, infection, or allergic reaction to anesthesia.

After Treatment

What happens after treatment for the condition?

Successful replacement of the valve restores normal blood flow. The long-term outcome is usually very good. Artificial valves wear out over a period of years. Their function is monitored, and the valves are replaced as necessary. Some artificial valves require that the person take:
  • antibiotics before and after surgeries or dental work to avoid serious heart infections
  • blood-thinning drugs to avoid blood clots, such as deep venous thrombosis

Monitor

How is the condition monitored?

An individual with aortic stenosis needs to make regular visits to the healthcare provider. The provider may order electrocardiograms and echocardiograms periodically to detect any signs of deterioration. Any new or worsening symptoms should be reported to the provider.

Sources

Merck Manual 1999

Current Medical Diagnosis and Treatment 1996

Harrison's Principles of Internal Medicine 1991

Heart Disease: A Textbook of Cardiovascular Medicine, Braunwald, E., 1980

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