Aortic Valve Stenosis
Topic Overview What is aortic valve stenosis?Aortic valve stenosis is a narrowing of the aortic valve. The aortic valve allows blood to flow from the heart's lower left chamber (ventricle) into the aorta and to the body. Stenosis prevents the valve from opening properly, forcing the heart to work harder to pump blood through the valve. This causes pressure to build up in the left ventricle and thickens the heart muscle. Your heart can make up for aortic valve stenosis and the extra pressure for a long time. But at some point, it won't be able to keep up the extra effort of pumping blood through the narrowed valve. This can lead to
heart failure. What causes aortic valve stenosis? Problems that
can cause aortic valve stenosis include: - Calcium buildup on the aortic valve. As you
age, calcium can build up on the valve, making it hard and thick. This buildup
happens over time, so symptoms usually don't appear until after age 65.
- A heart defect you were born
with (congenital).
- Rheumatic fever
or
endocarditis. These infections can damage the valve.
What are the symptoms?Aortic valve stenosis is a
slow process. For many years, even decades, you will not feel any symptoms. But
at some point, the valve will likely become so narrow (often one-fourth of its
normal size) that you start having problems. Symptoms are often brought on
by exercise, when the heart has to work harder. As aortic valve
stenosis gets worse, you may have symptoms such as: - Chest pain or pressure (angina). You
may have a heavy, tight feeling in your chest.
- Feeling dizzy or
faint.
- Feeling tired and being
short of breath.
- A feeling that your heart is
pounding, racing, or beating unevenly (palpitations).
If you start to notice any of these symptoms, let your
doctor know right away. If you have symptoms, your doctor will likely recommend a valve replacement. By the time
you have symptoms, your condition probably is serious. If you have symptoms,
you also have a high risk of sudden death. How is aortic valve stenosis diagnosed?Most
people find out they have it when their doctor hears a heart murmur during a
regular physical exam. To be sure of the diagnosis, your doctor may want you to
have an
echocardiogram, which can show moving pictures of your
heart. You may have other tests to help your doctor judge how well your heart
is working. How is it treated?If you have mild or moderate aortic valve stenosis and you don't
have symptoms, your doctor will see you regularly to check your heart. You
probably will not have surgery until your stenosis is severe or until the benefits of surgery outweigh the risks. If you have severe stenosis, you
probably need a valve replacement. Valve replacement can be done with an open-heart surgery or a minimally invasive procedure. Some young people or pregnant women may have another procedure called balloon valvuloplasty
to enlarge the valve opening. If you have severe stenosis but don't have your valve replaced, you have a high risk of dying suddenly or developing heart failure. Replacing your valve can help you have a more normal life span and improve your quality of life. Your doctor will probably recommend some lifestyle
changes to keep your heart healthy. He or she may advise you to: - Quit smoking and stay away from secondhand
smoke.
- Follow a heart-healthy diet and limit sodium.
- Be active. Ask your doctor what level and type of exercise is safe for you. You may need to avoid intense activity.
- Stay at a healthy
weight, or lose weight if you need to.
Frequently Asked QuestionsLearning about aortic valve stenosis: | | Being diagnosed: | | Getting treatment: | | Ongoing concerns: | | Living with aortic valve stenosis: | |
CauseMost people who have
aortic valve stenosis are born with a normal, healthy
aortic valve but develop
aortic stenosis late in life. Aging and calcium buildup cause the leaflets of
the valve to thicken and harden, preventing the valve from opening properly.
Typically, stenosis develops slowly over many years. Most young people and teens who have aortic valve stenosis developed it from a congenital heart defect. The most common heart
defect that causes aortic stenosis is a
bicuspid aortic valve. Some people may develop aortic stenosis after having rheumatic fever. SymptomsYou probably won't have any symptoms if
you have mild or moderate
aortic valve stenosis, because your heart can make up
for the stenosis. You may begin to notice symptoms if the pressure buildup in
the heart becomes severe or if blood flow to the heart and the rest of the body
is reduced. You may have symptoms when you exercise or do
something strenuous, because your heart has to work
harder. Symptoms may include: - Chest pain or
pressure (angina), often described as a heavy, tight feeling in your chest. You may
also have a burning, choking, or constricting feeling that may spread to your
arms, shoulders, or neck.
- Dizziness, fainting, or loss of consciousness.
- Signs of
heart failure, such as fatigue and shortness of breath
with activity.
- Palpitations (an
uncomfortable feeling that your heart is beating rapidly or
irregularly).
What Increases Your RiskCertain medical problems or
conditions make it more likely that you will develop
aortic valve stenosis: - Calcium buildup. Aging can cause calcium buildup
around the aortic valve, which can make the normally thin and flexible valve
flaps thick and stiff. This is also called calcific aortic valve stenosis. Many of the things that increase the
risk of atherosclerosis and heart disease are the same for aortic valve
stenosis. They include smoking,
high cholesterol,
high blood pressure,
diabetes, and being male.
- Birth defect. Sometimes a person is born with a
bicuspid aortic valve that has two flaps instead of the normal three. Over time,
the valve becomes damaged and calcium builds up. As the valve narrows, less
blood can flow through it.
- Infection.Rheumatic fever
can cause scar tissue to build up at the edges of the valve. Rheumatic fever is not common now. But if you had it as a child, your risk of aortic valve stenosis may be increased.
- Artificial valve. Aortic valve disease also may
develop in an artificial aortic valve that is made from human or animal
tissue.
Other things that increase the risk for aortic valve
stenosis include: When to Call a DoctorCall your doctor immediately if you have any of the
symptoms of
aortic valve stenosis, such as: - Chest pain or pressure.
- Fainting.
- Shortness of breath.
- Palpitations (feeling like your heart is pounding or racing).
Who to seeYour
family doctor may diagnose aortic valve stenosis
during a routine checkup. Other health professionals who also may discover
aortic valve stenosis during a physical exam include: Exams and TestsPhysical examA physical exam and review of your
medical history are important first steps in diagnosing
aortic valve stenosis. If you have stenosis but no
symptoms, your doctor will likely find the condition during a routine exam or a
checkup for another health problem. A distinctive heart murmur is usually the
first clue that leads a doctor to suspect aortic valve stenosis.
During the physical exam, the doctor will: - Take your blood pressure. Low blood pressure may
mean that not enough blood is getting through the narrowed aortic valve.
- Check your pulse. A weak pulse may mean that there is
narrowing of the heart valve.
- Listen to your heart and lungs for abnormal sounds. A soft whooshing or humming sound (murmur) heard through a
stethoscope is an important finding that often points to heart valve disease.
Abnormal sounds in the lungs can mean fluid buildup in the lungs that is
caused by heart valve disease.
- Look at your legs and feet. Swelling in the legs
and feet may be a sign of
heart failure.
EchocardiogramAn echocardiogram (echo) can confirm your symptoms and tell your doctor how severe stenosis is, how well your left ventricle is working, and whether there are problems with other valves. It's also an important test to help monitor aortic valve stenosis over time. Recommended frequency for checking aortic valve stenosisfootnote 1 Severity of aortic valve stenosis | How often you should have an echocardiogram |
---|
Mild | Every 3 to 5 years | Moderate | Every 1 to 2 years | Severe | Every 6 to 12 months | Other tests for aortic valve stenosis- Stress echocardiogram. This test can
show how severe your aortic valve stenosis is.
- Electrocardiogram (EKG or ECG). This test may show abnormalities in heart rhythm or lower left heart
chamber (ventricle) thickness.
- Exercise electrocardiogram. This test may be done to see how the heart responds to exercise.
- Chest X-ray.
It may show calcium buildup in the valve, an enlarged left
ventricle, or fluid buildup if you have developed heart failure. In some cases,
the
aorta may be enlarged just beyond the aortic
valve.
- Brain natriuretic peptide (BNP) test. This test may help show how well your heart is working and if you have heart
failure.
- Cardiac catheterization.
This test may be done to check the valve or check blood pressure in the heart chambers.
Treatment OverviewTreatment for
aortic valve stenosis is replacement of the aortic valve. Valve replacement is recommended based on many things including how severe the stenosis is, whether you have symptoms, and how well your heart is pumping blood. It is typically recommended when a person has severe stenosis. If you have severe stenosis, especially with symptoms, valve replacement is
usually required. If you don't have your valve replaced after your stenosis is severe, you have a high risk of dying suddenly or developing heart failure. Valve replacement can relieve symptoms, improve your quality of life, and help you have a more normal life span. Balloon valvuloplasty is a less invasive procedure that might be done for some people, including children, teens, or young adults in their
20s. For more information, see Surgery. You may need medicine to prevent or treat a heart infection
or to help manage
heart failure, which is the most common complication of aortic valve stenosis. For more information, see Medications. End-of-life careAortic valve stenosis tends to get worse over time. So you need to decide what kind of care you want at the end of your life. It can be hard to have talks with your doctor and family about the end of your life. But making these decisions now may bring you and your family peace of mind. Your family won't have to wonder what you want. And you can spend your time focusing on your relationships.
You will need to decide if you want life-support measures if your health gets very bad. An advance directive is a legal document that tells doctors how to care for you at the end of your life. This care includes electronic devices that are used for heart failure, such as pacemakers. You also can say where you want to have care. And you can name someone who can make sure your wishes are followed.
For more information, see the topic
Care at the End of Life. Living With Aortic Valve Stenosis How you will feel
and how
aortic valve stenosis will affect your life will vary
greatly depending on whether you have symptoms and the treatment decisions you
make. Your doctor will probably suggest
lifestyle changes to help keep your heart and body healthy. Make healthy lifestyle changes- If you smoke, try to quit. Medicines and counseling can help you quit for good.
- Your doctor will also
recommend that you follow a
heart-healthy diet and
limit how much sodium you eat.
- Be active, but you might need to avoid strenuous exercise. Physical activity is good for your overall health. But the type of
exercise that is appropriate varies depending on how severe your
aortic valve stenosis is. If you have mild stenosis, you will not need to restrict your level
or type of physical exercise. But if you have severe stenosis, you should avoid strenuous activities such as
weight lifting or running. Talk with your doctor about what kinds of exercise are safe for you.
- Stay at a healthy weight. Lose weight if you need to. For help, see the topic Weight Management.
Take care of yourself- See your doctor right away if you have new symptoms or symptoms that get worse. Symptoms may include chest pain or pressure, fainting, and shortness of breath.
- See your doctor regularly, and get the tests you need to assess your heart, such as echocardiograms. For more information, see Exams and Tests.
- Manage other health problems including high blood pressure, diabetes, and high cholesterol.
- Practice good dental hygiene and have regular checkups.
Good dental health is especially important, because bacteria can spread from
infected teeth and gums to the heart valves.
- Get a flu vaccine every year. Get a pneumococcal vaccine shot. If you have had one before, ask your doctor if you need another dose.
- Talk with your doctor if you have concerns about sex and your heart. Your doctor can help you know if or when it's okay for you to have sex.
MedicationsMedicines aren't used to treat aortic valve stenosis. But you may need medicines to prevent and treat complications from the condition. Or you may need to take medicines if you have your valve replaced. If you have an artificial valve, you may need: - Blood thinners. You may take a blood thinner to prevent blood clots. Blood thinners include antiplatelet medicine, such as aspirin, or anticoagulant medicine.
- Antibiotics. If you have an artificial valve, you may need these medicines before you have certain dental or surgical procedures. The antibiotics help
prevent an infection in your heart called
endocarditis.
You may need other medicines if you develop other problems, such as arrhythmias or heart failure. For more information, see the topic
Heart Failure. Other Places To Get HelpOrganizationsAmerican Heart Association www.heart.org National Heart, Lung, and Blood Institute (U.S.) www.nhlbi.nih.gov ReferencesCitations- Nishimura RA, et al. (2014). 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, published online March 3, 2014. DOI: 10.1161/CIR.0000000000000031. Accessed May 1, 2014.
Other Works Consulted- Freeman RV, Otto CM (2011). Aortic valve disease. In V Fuster et al., eds., Hurst's The Heart, 13th ed., vol. 2, pp. 1692-1720. New York: McGraw-Hill.
- Nishimura RA, et al. (2014). 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, published online March 3, 2014. DOI: 10.1161/CIR.0000000000000031. Accessed May 1, 2014.
- Nishimura RA, et al. (2017). 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease. Circulation, published online March 15, 2017. DOI: 10.1161/CIR.0000000000000503. Accessed March 15, 2017.
- Oakley RE, et al. (2008). Choice of prosthetic heart valve in today's practice. Circulation, 117(2): 253-256.
- Whitlock RP, et al. (2012). Antithrombotic and thrombolytic therapy for valvular disease: Antithrombotic therapy and prevention of thrombosis, 9th ed.-American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2, Suppl): e576S-e600S.
CreditsByHealthwise Staff Primary Medical ReviewerRakesh K. Pai, MD, FACC - Cardiology, Electrophysiology Martin J. Gabica, MD - Family Medicine E. Gregory Thompson, MD - Internal Medicine Adam Husney, MD - Family Medicine Elizabeth T. Russo, MD - Internal Medicine Specialist Medical ReviewerMichael P. Pignone, MD, MPH, FACP - Internal Medicine Current as ofJune 1, 2017 Current as of:
June 1, 2017 Author:
Healthwise Staff Medical Review:
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology & Martin J. Gabica, MD - Family Medicine & E. Gregory Thompson, MD - Internal Medicine & Adam Husney, MD - Family Medicine & Elizabeth T. Russo, MD - Internal Medicine & Michael P. Pignone, MD, MPH, FACP - Internal Medicine Nishimura RA, et al. (2014). 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, published online March 3, 2014. DOI: 10.1161/CIR.0000000000000031. Accessed May 1, 2014. Last modified on: 8 September 2017
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