Aortic Valve Stenosis
Aortic Stenosis
What is aortic stenosis? — Aortic stenosis is a condition in which one of the valves in the heart, called the aortic valve, doesn't open fully (figure 1). The heart valves keep blood flowing in only 1 direction. When the heart valves work normally, they open all the way to let blood flow through them.
Blood flows from a chamber of the heart called the left ventricle, through the aortic valve, into a large blood vessel called the aorta (figure 1). The aorta carries blood to the rest of the body.
In aortic stenosis, the aortic valve gets stuck and does not open fully. This makes the valve opening narrow. When this happens:
●Not as much blood can flow out of the heart to the rest of the body.
●The heart has to work much harder than usual to pump blood to the rest of the body. Over time, this can cause heart problems.
Aortic stenosis usually happens in adults. But some people are born with aortic stenosis.
What are the symptoms of aortic stenosis? — Early on, most people have no symptoms. They usually find out they have aortic stenosis after their doctor or nurse hears a heart murmur on a routine exam. A heart murmur is an extra sound in the heartbeat that doctors or nurses hear when they listen to the heart with a stethoscope.
When people do have symptoms, they can have:
●Shortness of breath
●Dizziness or fainting
●Chest pain
These symptoms usually happen with physical activity. Let your doctor know if you have any of these symptoms.
Is there a test for aortic stenosis? — Yes. To check for aortic stenosis and see how severe it is, your doctor might order an echocardiogram (or "echo"). This test uses sound waves to create a picture of your heart as it beats. It shows the size of the heart chambers, how well the heart is pumping, and how well the heart valves are working (figure 2). If you have aortic stenosis, your doctor might repeat this test over time to see if your condition changes.
To get more information about your heart, your doctor might order a test called cardiac catheterization, or "cardiac cath." For this, the doctor puts a thin tube into a blood vessel in your leg or arm. Then he or she moves the tube up to your heart. When the tube is in your heart or blood vessels, he or she will take measurements. The doctor might also put a dye that shows up on an X-ray into the tube. This can show if any of the arteries in your heart are narrowed or blocked. This part of the test is called "coronary angiography."
Your doctor might order a test called an electrocardiogram (ECG or EKG). This test measures the electrical activity in your heart (figure 3).
Some people with aortic stenosis will also have a chest X-ray. A chest X-ray can show the size and shape of your heart. It can also show changes in your lungs from aortic stenosis or other diseases.
How is aortic stenosis treated? — Treatment depends on your symptoms and how severe your aortic stenosis is. If your aortic stenosis is not severe and you have no symptoms, you will likely not need any treatment. But your doctor will follow you to see if your aortic stenosis gets worse or you start to have symptoms.
If your aortic stenosis is severe and you have symptoms, you will likely need treatment. Treatment can include:
●Surgery to replace your aortic valve – During surgery, the doctor will remove your narrowed valve and replace it with a valve that opens normally. This new valve can be made from metal or from tissue from a pig, cow, or horse. In some cases, a new valve comes from another person. Your doctor will talk with you about the benefits and downsides of each option.
●A procedure to put in a new aortic valve without surgery − The procedure is called "transcatheter aortic valve implantation" (TAVI) or "transcatheter aortic valve replacement" (TAVR). This might be an option for some people who can't have valve surgery, or who are at risk for problems if they have valve surgery.
●A procedure to open the aortic valve – For this procedure, a doctor inflates a balloon in the narrowed aortic valve to try to open it. This procedure is used in children and young adults, because it is helpful in these people. This procedure is usually not as helpful in older adults.
●Medicines – There are no medicines to treat the aortic valve stenosis itself. Your doctor might prescribe medicines to treat your symptoms. He or she will also make sure your blood pressure and cholesterol level are under control.
Can I play sports? — If your aortic stenosis is mild or you have little or no symptoms, you can probably play sports. But if your aortic stenosis or symptoms are more serious, your doctor might recommend that you limit your physical activity.
What if I want to get pregnant? — If you want to get pregnant, talk with your doctor or nurse. Depending on your aortic stenosis and symptoms, he or she might recommend treating your aortic stenosis before you get pregnant.
©2017 UpToDate, Inc.
Figure 1. When people have aortic stenosis, the aortic valve does not open fully. This prevents blood from flowing normally from the left ventricle, through the aortic valve, and to the aorta. The direction of blood flow is shown by the black arrow. The aorta is a big blood vessel that carries blood to the rest of the body.
Figure 1. When people have aortic stenosis, the aortic valve does not open fully. This prevents blood from flowing normally from the left ventricle, through the aortic valve, and to the aorta. The direction of blood flow is shown by the black arrow. The aorta is a big blood vessel that carries blood to the rest of the body.
Figure 2. This picture shows a person getting an echocardiogram (or "echo"). To do an echo, a doctor or nurse puts some gel on a person's chest. He or she presses a thick wand (called a "transducer") against the chest and moves it around. An echo uses sound waves to create images of the heart that appear on a computer screen.
Figure 2. This picture shows a person getting an echocardiogram (or "echo"). To do an echo, a doctor or nurse puts some gel on a person's chest. He or she presses a thick wand (called a "transducer") against the chest and moves it around. An echo uses sound waves to create images of the heart that appear on a computer screen.
Figure 3. This drawing shows a man having an ECG (also called an electrocardiogram or EKG). He has patches, called "electrodes," stuck onto his chest, arms, and legs. Wires run from the electrodes to the ECG machine. An ECG measures the electrical activity in the heart.