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.
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.
Common symptoms of aortic stenosis include: coughing at nightfainting, especially with physical activityfatigueshortness of breath that worsens at night or with exertionvisual impairments
The coronary arteries, which carry oxygen to heart muscles, may be deprived of blood. That can cause heart pains called angina. This type of pain has been described as a tightness, squeezing, or pressing sensation in the middle of the chest. The pain commonly extends into the left shoulder and down the arm.
The severity of symptoms is not always related to the severity of the disease. In fact, people sometimes die suddenly from aortic stenosis without having had symptoms.
The causes of aortic stenosis include: calcium deposits that harden, or calcify, the valvecongenital heart disease from heart defects present at birthscarring of the valve from rheumatic heart disease
In many cases, nothing can prevent aortic stenosis. Proper treatment of rheumatic fever with antibiotics can prevent damage to the aortic valve.
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 catheterizationchest X-rayechocardiogram with or without color Doppler studieselectrocardiogram (ECG)
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 bodycoronary heart diseaseenlargement of the left ventricle, which cuts down the output of the heart still morepulmonary edema, or congestion in the lungssudden death
Aortic stenosis is not contagious, and poses no risk to others.
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
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.
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 infectionsblood-thinning drugs to avoid blood clots, such as deep venous thrombosis
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.
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