What Is Aortic Stenosis?

To fully understand this valve disease, you must understand how the heart valves function under normal conditions. Your heart has four valves which are responsible for blood circulation. Each valve's job is to ensure the blood flows in one direction through your heart. These valves open and close to facilitate blood flow to the rest of your body. One of these valves is the aortic valve. The blood flows through the aortic valve before it leaves your heart to be pumped to the rest of your body. The aortic valve carries oxygen-rich blood to the aorta. The aorta is the most significant blood vessel found in your body.

The blood always flows in the same way. It comes from your body and then passes through the heart's right side. It then goes out towards the lungs to get oxygen-rich blood. Then, the blood passes back from the left side of your heart. It then travels to the rest of your body. There are four chambers in your heart: the upper chambers, which are called atriums, and the lower chambers, which are called ventricles. The names of the chambers are the right atrium, left atrium, right ventricle, and left ventricle. The valves need to open properly so that blood flows out of the chamber, and the valves need to close properly so that blood flow doesn't happen backwards.

Aortic Stenosis, also known as AS, is a grave valve disease. Another name for Aortic Stenosis is aortic valve stenosis, one of the most common types of heart valve disease. Aortic Stenosis occurs when the opening of the aortic valve narrows. It leads to reduced blood flow since the normal amount of blood cannot flow anymore due to the narrow valve. When this occurs, the blood flow is restricted from the left ventricle to the aorta. This narrow valve can affect the pressure inside the left atrium. When this happens, the rest of your body cannot get the required blood because the aorta doesn't receive it.

Once the heart is aware of this problem, the heart works harder so that your body can receive the blood and function properly. As this continues, your heart cannot pump as much blood. It affects the rest of your body since it cannot receive oxygen-rich blood. It can harm your heart muscle as it weakens due to pumping harder. Various complications can arise due to Aortic Stenosis, which can be dangerous. Different causes can lead to aortic valve stenosis; some risk factors can make you more prone to aortic Stenosis.

Symptoms And Causes Of Aortic Stenosis

Aortic Stenosis doesn't always exhibit symptoms, making it a tricky disease to detect. This is generally the case when you have mild or moderate Aortic Stenosis. Usually, you will only experience symptoms after the blood flow has been restricted for a long time. It can take some people a few years to show symptoms, and this can be when you have severe Aortic Stenosis. The following are the symptoms of aortic Stenosis in adults.

You may feel tightness or increased pressure on your chest. It is accompanied by chest pain.
You will experience breathlessness or the inability to breathe normally.
You will notice that you cannot be as active as you once were, and even normal activities might start to seem like a lot of work.
You may feel dizzy.
You might experience irregular heartbeats or palpitations. You can feel as if your heartbeats are intense and heavy.
You can experience a heart murmur, which is an abnormal heart sound.

Aortic Stenosis causes are as follows:

1. Congenital Heart Disease- Heart defect from birth or congenital heart disease is one of the causes. A normal aortic valve has three cusps, which are triangular tissue flaps. Some babies are born with only two cusps instead of the usual three. It is known as a bicuspid valve. Some babies are born with even one cusp, known as a unicuspid valve, or four cusps, which are known as quadricuspid valves. Unicuspid and quadricuspid valves are rare but occur in some people. The symptoms of abnormal cusp numbers may not be noticeable until adulthood. The reason why people have one, two or four valves at the time of birth is unclear. However, these can cause aortic valve stenosis to occur.

2. Rheumatic Fever- Another popular cause of Aortic Stenosis is rheumatic fever. Rheumatic fever is a complication due to scarlet fever or strep throat. Rheumatic fever may result in the development of scar tissue. This scar tissue forms on the aortic valve and can lead to aortic valve narrowing, resulting in Aortic Stenosis. The scar tissue may lead to the development of a rough surface on the aortic valve, which can lead to Aortic Stenosis when you age. The scar tissue may damage more than one valve in the heart. Rheumatic fever is now rare.

3. Calcium Buildup- A leading cause of Aortic Stenosis is calcium buildup on the valve. Calcium deposits can start adding up on your heart valves as you age. It is known as aortic valve calcification. Calcium is one of the nutrients and minerals carried by your blood. As blood continues to flow over the aortic valve day after day and year after year, the valve's cusps may have a calcium buildup. People with bicuspid valves are more prone to experiencing the narrowing of the cusps, which might also increase their stiffness. It can happen at any age. Calcium buildup does not cause any problems for people, either.

Types Of Aortic Stenosis

There are two types of Aortic Stenosis - Acquired and Congenital.

Acquired Aortic Stenosis is when Aortic Stenosis develops after birth due to causes such as rheumatic fever or degeneration.

Congenital Aortic Stenosis is something that is caused due to a problem that you are born with. For example, a malformed valve present at the time of your birth can cause problems after you become an adult. While monitoring might be required only at the beginning, when you are young, you might need to look for other treatment options after you become an adult.

Are You At Risk?

The following are some factors that increase your risk of aortic valve stenosis.

People who are 60 years or above are most likely to have aortic valve stenosis.
Certain conditions, such as congenital heart disease, can increase the risk of Aortic Stenosis.
If you have chronic kidney problems, then you are highly likely to have aortic valve stenosis.
People with previous heart infections have a higher chance of developing aortic valve stenosis than those who have never had any heart infections.
If you have had radiation therapy on your chest, then your chances of Aortic Stenosis increase.
Risk factors that are associated with cardiovascular disease increase the chance of having aortic valve stenosis.
If you have rheumatic fever or had it in the past, you may have Aortic Stenosis.

Steps To Prevent Aortic Stenosis

If you have had a heart defect since you were born, then you cannot do anything about it to prevent Aortic Stenosis. However, some factors can be controlled, such as the following:

You should maintain good oral hygiene. Any type of gum disease can lead to heart inflammation. For instance, research has found that gingivitis and Endocarditis are linked. This is because gingivitis can cause the heart tissue to inflame, leading to Aortic Stenosis.
You should follow measures to treat strep throat before it leads to rheumatic fever. If you suffer from rheumatic fever, your doctor will prescribe some antibiotics to heal it. Once healed, the chances of having Aortic Stenosis are low.
You should maintain a healthy weight and change your lifestyle accordingly. Eating healthy home-cooked foods, adding fruits and vegetables, and exercising sufficiently ensure good heart health.
You should quit smoking and drinking alcohol if possible. Smoking is highly injurious, and limiting your alcohol intake will be good for your health. You should make healthy decisions daily to ensure your heart health remains good.
You should ensure you manage your cholesterol levels. This can be done by eating soluble fibre and avoiding trans fat. You can consume foods that have unsaturated fats as these help improve good HDL

Diagnosis And Treatment Of Aortic Stenosis

Your doctor will ask you about the symptoms that you have experienced. S/he will look at your medical history and conduct your physical exam to know about your overall health. Then, s/he will listen to your heartbeat to check whether it is regular. If you have irregular heartbeats, then it will indicate that there is a chance you might have aortic valve stenosis. There are several tests that your doctor will perform so that s/he understands the cause of your problem and can make the proper diagnosis. Some of the tests are as follows.

CT Scan- CT scan stands for cardiac computerized tomography scan. Your doctor uses this to see your heart in detail. A CT scan produces detailed images, allowing your doctor to take a thorough look at your heart valves. Your doctor can also use a CT scan to check your aorta's size. If your doctor suspects you have aortic valve stenosis, he can use this test to examine the aortic valve in more detail.
Cardiac MRI- Cardiac MRI is another method for creating images of your heart so your doctor can examine them in detail. This test can determine your aorta's size and help your doctor understand how severe your heart valve condition is.
Echocardiogram- An echocardiogram is a test that is used to analyze how the blood flow is taking place. It is used to check the aortic valve and the heart chambers. In an echocardiogram, your doctor will keep a transducer on your chest. Your doctor can recognize whether you have aortic valve disease through an echocardiogram. Another test linked to an echocardiogram is a transesophageal echocardiogram, which lets your doctor look closer at your aortic valve.
Chest X-Ray- A chest X-ray is used to see how your heart is performing. Your doctor can determine whether your heart is normal or enlarged with a chest X-ray. A chest X-ray is also useful to determine the condition of your aortic valve and whether the aorta is of normal size or has become enlarged. It can help determine if the aortic valve has calcium buildup.
Cardiac Catherisation- Cardiac catheterisation is not used at the beginning. Your doctor might perform this test when your doctor cannot diagnose your problem or when s/he cannot evaluate the severity of your condition. A catheter is used, and it is inserted in your blood vessel, after which it is guided to one of your heart's arteries. Your doctor can perform a coronary angiogram. It enables your doctor to get a clear image of your heart arteries. It can tell your doctor how well your heart functions and the pressure inside your heart's chambers.
ECG- Your doctor uses an electrocardiogram or ECG to determine whether any of the chambers in your heart have enlarged abnormally. Through ECG, your doctor can decide if there are any abnormal heart rhythms, which can help detect any heart disease. In an ECG, pads are placed on your skin, and wires are attached. Your heart's activity is then monitored and analyzed by your doctor.
Stress Tests- Exercise tests are also known as stress tests. Your doctor uses these to determine whether the symptoms of the aortic valve condition are present when you perform physical activity. Exercise tests can help determine if you have severe Aortic Stenosis symptoms and what can be done to reduce and manage the symptoms. Some people have difficulty when they exercise. An exercise test can help your doctor treat you appropriately if you have aortic valve stenosis.

Aortic Stenosis treatment

The treatment depends on the severity of Aortic Stenosis and if there are noticeable symptoms of Aortic Stenosis. Your doctor will determine whether your condition is stable or whether it is becoming worse by the day. If the symptoms are nothing to worry about and there are no symptoms, your doctor will probably monitor you. For this, you will be required to come for tests. Sometimes, doctors give you recommendations such as lifestyle changes that you can make to become healthier. These recommendations can include treatments for decreasing symptoms, if any. Your doctor might give you tips to reduce complications, too.

People with severe Aortic Stenosis need surgery. Some people who do not show symptoms of aortic valve stenosis might also need surgery. If you are undergoing surgery for another heart condition, your doctor might recommend that you have surgery for aortic valve stenosis done at the same time, too. There are three severe Aortic Stenosis treatment surgery options: aortic valve repair, balloon valvuloplasty, and aortic valve replacement.

Aortic Valve Repair- Aortic valve repair is when aortic valve stenosis is treated by separating cusps of your valve that may have fit snugly together. Aortic valve repair is rarely done. Aortic valve replacement is a procedure that requires the damaged valve to be removed and replaced by a biological tissue valve. A biological tissue valve can be made of human heart tissue, pig, or cow tissue. Instead of a biological tissue, a mechanical valve may be used. The problem with a biological tissue valve is that it needs to be replaced after a certain time due to degeneration. The problem with the mechanical tissue valve is that you must take blood thinners for the rest of your life.
TAVR- A transcatheter aortic valve replacement (TAVR) is another surgery option for which you might be a candidate. The Aortic Stenosis TAVR is a surgical method used to replace an aortic valve that has become narrow. This surgical method is usually recommended for those people who have a higher risk of complications if they have undergone aortic valve replacement surgery. In TAVR, a catheter is guided to your heart by inserting it into your chest or leg. A balloon can expand the valve, or it can expand by itself. After the valve is replaced, the catheter is removed.
Balloon Valvuloplasty- In balloon valvuloplasty, a catheter with a balloon on the tip is used to perform valve repair. This surgical method involves using a catheter with the balloon and then inserting it into an artery in your groin or arm. The catheter is then guided to your aortic valve. Your doctor then inflates the balloon, which helps the valve open normally. This enables the cusps to stretch, too. Once this is done, the balloon is deflated, and the catheter, and the balloon at the end of the catheter, is removed. Doctors recommend this procedure for kids and infants, although it can be helpful for adults, too.
Aortic Root Surgery- Aortic root and ascending aorta surgery may be required. In this procedure, your doctor will remove the enlarged aorta section. A synthetic tube graft is used. This surgery enables repair or replacement of the aortic valve. Your treatment might require replacing the aorta's enlarged part while the aortic valve is in place. The treatment option that is best for you can only be determined after you have discussed it with your doctor. You should weigh the pros, cons, the requirements, and the cost of the treatment before you choose what is best for you.

Outlook And Prognosis

The Aortic Stenosis prognosis and outlook depend on the chosen treatment option and your health. People with no symptoms of Aortic Stenosis have an excellent prognosis. This is true for people who have moderate or mild Aortic Stenosis. Elderly people who have critical Aortic Stenosis do not have a favourable outlook because various complications can arise. Moreover, some older adults are not candidates for surgery. You should discuss the prognosis with your doctor as he can tell you accurately what you can expect from the treatment.

Road To Recovery And Aftercare

Your road to recovery might be challenging or accessible, depending on the treatment you receive after being diagnosed with aortic valve stenosis. Other factors determining your recovery are the severity of your problem and how well your body can adjust to the treatment. Your doctor will probably recommend that you attend follow-up appointments to see how your condition is progressing and if any changes to treatment need to be made. You must follow your doctor's instructions about taking care after treatment to ensure you can live a fulfilling life.

It might take you two months or more to recover fully after surgery. However, if you had minimally invasive surgeries, the recovery time would be cut short, and you can return to normal activities much faster. Right after you have your surgery, you are encouraged to take care of yourself, breathe deeply, and start walking, among other things. Regaining your energy will take some days or weeks, as it is a gradual process. Proper diet and appropriate exercise after surgery can help you get back to being healthy. It is recommended that you discuss this with your doctor first.