What is aortic stenosis?
Aortic stenosis—or aortic valve stenosis—occurs when the heart's aortic valve stiffens and narrows. The aortic valve keeps blood flowing in the correct direction in the heart, from the main left chamber (ventricle) to the main heart artery (aorta).
Aortic stenosis can disrupt blood flow, particularly to the brain, and cause dizziness or chest pain. When the blood flow through the aortic valve is reduced or blocked, your heart needs to work harder to pump blood to your body. Eventually, this can weaken your heart muscle.
Treatment depends on the severity of your condition. You may need surgery to replace the valve. Left untreated, aortic valve stenosis can lead to serious heart problems.
Most common symptoms
Asymptomatic patients are usually diagnosed when a doctor hears a heart murmur during a physical exam and then refers them for an echocardiogram—an ultrasound of the heart. —Dr. Jay Patel
Often aortic stenosis is discovered by accident when doing other tests. When you do have symptoms, it’s usually because you have more advanced narrowing and stiffness of the valve.
- Chest pain
- Heart palpitations (rapid, strong or irregular heartbeats)
- Shortness of breath
- Easily tired
Causes of aortic stenosis
Some people are born with valves that are likely to get narrowed and others develop narrowing due to risk factors such as age, smoking, and scar tissue. Other conditions like high blood pressure, radiation exposure, or infections can also increase risk.
Specific causes of aortic stenosis include:
- Calcium buildup on the valve: With age, heart valves may accumulate deposits of calcium. Calcium is a mineral found in your blood. These calcium deposits aren't linked to taking calcium tablets or drinks. In some people, calcium deposits result in stiffening of the cusps of the valve. It usually doesn't cause symptoms until ages 70 or 80.
- Congenital heart defect: Some children are born with an aortic valve that has only two (bicuspid) cusps instead of three, according to the U.S. National Library of Medicine. This defect may not cause any problems until they become adults. It requires regular monitoring to watch for signs of valve problems.
- Rheumatic fever: A complication of untreated strep throat, rheumatic fever may result in scar tissue forming on the aortic valve. Scar tissue can narrow the aortic valve and lead to stenosis.
There are usually no symptoms with aortic stenosis. If you have intermittent chest pain or dizziness, visit your doctor. You may need to see a cardiologist or cardiac surgeon. If you experience sudden chest pain or dizziness, you should go to the emergency room immediately.
Can aortic stenosis be cured?
In the last 10 years, we have completely changed the course on how this disease is managed with great effectiveness. TAVR is a safe and minimally invasive way to treat what was once thought to be a surgical disease. Ask your doctor if you are a candidate for TAVR. —Dr. Patel
Your doctor will ask you a series of questions and will examine you carefully. You may undergo an EKG (electrocardiogram) to record the electrical signal from your heart, an ultrasound of the heart, and/or a stress test to evaluate your heart’s function.
Different treatments include:
Watch and wait
If your symptoms are mild or you aren't experiencing symptoms, your doctor may monitor your condition with regular follow-up appointments.
Your doctor may recommend you make healthy lifestyle changes like eating a healthy diet and getting more physical activity.
You may be prescribed medications for high blood pressure. You may also be prescribed medications to help remove excess fluid accumulation, which can occur as the valve gets tighter.
Your doctor may recommend surgery, with or without symptoms. In some cases, surgery may be minimally invasive. In other cases, an open heart surgery may be required.
Surgery options include:
- Balloon valvuloplasty: A doctor inserts a catheter with a balloon into the aortic valve and inflates a little balloon. This expands the opening of the valve. The balloon is then deflated, and the catheter and balloon are removed. This is a minimally invasive procedure.
- Transcatheter aortic valve replacement: This is a new technique that has changed the way aortic stenosis is treated today. This is a minimally invasive procedure to replace the aortic valve and help relieve symptoms.
- Surgical aortic valve replacement: In this open heart surgery procedure, the surgeon removes the damaged valve and replaces it with a mechanical valve or a valve made from cow, pig, or human heart tissue.
People who are more at risk for aortic valve stenosis include:
- Over 70 years old
- History of rheumatic fever
- Certain heart conditions present at birth (congenital heart disease) such as a bicuspid aortic valve
- History of infections (endocarditis) that can affect the heart
- Having health issues that can lead to heart problems such as diabetes, high cholesterol, and high blood pressure
- Chronic kidney disease
- History of radiation therapy to the chest
- History of smoking
You should follow up with your doctor for regular heart exams on a long-term basis.
If you had surgery, you will also see a cardiac surgeon to ensure healing is going well. You'll need to continue to take your medications as prescribed.
People with a childhood history of rheumatic fever or heart abnormalities should get evaluated even if they don’t have symptoms.
If TAVR is not an option and you will need surgical aortic valve replacement, ask your doctor which kind of valve replacement you are being considered for. There are different kinds of surgical valves. Some require being on blood thinners lifelong—it is important to know this beforehand. —Dr. Patel
There are many ways to reduce your risk of aortic stenosis:
- Eat a heart-healthy diet of fruits and vegetables, low-fat or fat-free dairy products, poultry, fish, and whole grains. Avoid saturated and trans fat, and excess salt and sugar.
- Maintain a healthy weight.
- Get regular physical activity. Aim to get about 30 minutes of physical activity every day.
- Try to relieve your stress. Activities like meditation, exercise, and time with family and friends can help you relax.
- Avoid tobacco. If you smoke, ask your doctor about resources to help you quit. Joining a support group may be helpful.
Sourav Bose is a postdoctoral research fellow at the Center for Fetal Research in the Department of Surgery at the Children’s Hospital of Philadelphia and is a general surgery resident at the Brigham and Women’s Hospital affiliated with Harvard Medical School.
His current clinical investigation is in care programs for children with congenital anomalies and he is particularly interested in understanding how organizational structure and management influence patient outcomes and access to advanced precision care. He is also actively engaged in translational work investigating the efficacy of in utero gene therapy for congenital metabolic diseases. Previously, Sourav conducted and published research on pricing of healthcare services in Guatemala and Mongolia and on pediatric trauma outcomes.
Sourav received a BSc Economics from the Wharton School and a BA Biology from the School of Arts and Sciences through the Roy & Diana Vagelos Program in Life Sciences and Management at the University of Pennsylvania. He subsequently was awarded the Thouron Fellowship to pursue an MSc Public Health at the London School of Hygiene and Tropical Medicine. His master’s thesis evaluated the organizational and human resources investments necessary to conduct global clinical trials focusing on the Crash-2 investigative group. He returned to Penn where he received his MD from the Perelman School of Medicine and his MBA in Healthcare Management from the Wharton School.