What is Aortic Stenosis?
For you to fully understand this valve disease, you need to 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 that the blood is flowing in one direction through your heart. These valves open and close in such a way that they 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. Aorta is the biggest 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 so that it can 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 where the upper chambers are called atriums and the lower chambers are called ventricles. The name of the chambers are; 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 backward.
Aortic Stenosis, also known as AS, is a grave valve disease. Another name for Aortic Stenosis is aortic valve stenosis and it is one of the most common types of heart valve diseases. Aortic Stenosis occurs when the opening of the aortic valve becomes narrow. This leads to a reduction in the 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 is unable to get the blood that it requires 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 over time, your heart is unable to pump as much blood. This affects the rest of your body since it is unable to receive oxygen-rich blood. This can be detrimental to your heart muscle as it becomes weaker due to pumping harder. Various complications can arise as a result of Aortic Stenosis that can be dangerous. Various causes can lead to aortic valve stenosis and some risk factors can make you more prone to having Aortic Stenosis.
Symptoms and Causes of Aortic Stenosis
Aortic Stenosis doesn’t always exhibit symptoms which is what makes it a tricky disease to detect. This is generally the case when you have mild Aortic Stenosis or when you have 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 Aortic Stenosis symptoms in adults.
- You may feel tightness in your chest or increased pressure on your chest. This is accompanied by chest pain.
- You will experience breathlessness or the inability to breathe normally.
- You will notice that you are unable to be as active as you once used to be 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 heart murmur which is an abnormal heart sound.
Aortic Stenosis causes are as follows:
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. This is known as a bicuspid valve. Some babies are born with even one cusp which is known as a unicuspid valve or four cusps that are known as quadricuspid valves. Unicuspid and quadricuspid valves are rare but they do occur in some people. The resultant symptoms due to 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. But these can cause aortic valve stenosis to occur.
Another popular cause of Aortic Stenosis is rheumatic fever. Rheumatic fever is a complication that occurs due to scarlet fever or strep throat. There is a chance that rheumatic fever results in the development of scar tissue. This scar tissue forms on the aortic valve and can lead to the narrowing of the aortic valve which results 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. It is a possibility that the scar tissue may damage more than one valve in the heart. Rheumatic fever is now rare.
A leading cause of Aortic Stenosis is calcium buildup on the valve. As you age, calcium deposits can start to add up on your heart valves. This is known as aortic valve calcification. Calcium is one of the nutrients and minerals that is carried by your blood. As blood continues to flow over the aortic valve day after day and year after year, the cusps of the valve may have a buildup of calcium. People with bicuspid valves are more prone to experiencing the narrowing of the cusps which might increase their stiffness as well. This can happen at any age. It is possible that calcium buildup does not cause any problems in people too.
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 that was present at the time of your birth can cause problems after you become an adult. While only monitoring might be required in 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 of the 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 can increase the risk of Aortic Stenosis such as congenital heart disease.
- If you have chronic kidney problems, then you are highly likely to have aortic valve stenosis.
- People who have had previous heart infections have a higher chance of developing aortic valve stenosis compared to people who 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 if you had it in the past, then you may have Aortic Stenosis.
Steps to prevent Aortic Stenosis
If you have 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 follows.
- You should maintain good oral hygiene. Having 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 ensure you treat strep throat before it leads to rheumatic fever. If you are suffering from rheumatic fever, then your doctor will prescribe you some antibiotics to heal it. Once healed, the chances of having Aortic Stenosis are low.
- You should maintain a healthy weight and make changes to your lifestyle accordingly. For example, 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 focus on making 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 fiber 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 take a look at your medical history, conduct your physical exam to know about your overall health. Then s/he will listen to your heartbeat to check whether it is regular or not. 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 the proper diagnosis can be made. Some of the tests are as follows.
CT scan stands for cardiac computerized tomography scan. This is used by your doctor to see your heart in detail. A CT scan produces detailed images and this allows your doctor to take a thorough look at your heart valves too. Your doctor can use a CT scan to check how big your aorta is. If your doctor suspects you have aortic valve stenosis, then he can use this test to examine the aortic valve in more detail.
Cardiac MRI is another method that is used to create images of your heart so your doctor can take a look at them in detail. Your aorta’s size can be determined with the help of this test and your doctor can understand how severe your heart valve condition is with the help of a cardiac MRI.
Echocardiogram is a test that is used to analyze how the blood flow is taking place. It is used for checking the aortic valve and the heart chambers too. In an echocardiogram, your doctor will keep a transducer on top of your chest. Your doctor will be able to recognize if you have aortic valve disease or not through an echocardiogram. Another test that is linked to an echocardiogram is a transesophageal echocardiogram which lets your doctor take a closer look at your aortic valve.
A chest X-ray is used to see how your heart is performing. Your doctor can determine whether your heart is of normal size or whether it has become enlarged, with a chest X-ray. A chest X-ray is useful to determine the condition of your aortic valve and whether the aorta is of normal size or has become enlarged. A chest X-ray can help determine if the aortic valve has calcium buildup on it.
Cardiac catheterization is not used at the beginning. Your doctor might perform this test when your doctor is unable to diagnose your problem or when s/he is unable to 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. This enables your doctor to get a clear image of how your heart arteries are. It can tell your doctor about how well your heart is functioning and the pressure inside your heart’s chambers.
Electrocardiogram or ECG is used by your doctor to determine whether any of the chambers in your heart have enlarged abnormally or not. Through ECG, your doctor can determine whether there are any abnormal heart rhythms and this can help detect any heart disease. In an ECG, pads are placed on your skin and wires are attached to these pads. Your heart’s activity is then monitored and analyzed by your doctor.
Exercise tests are also known as stress tests. These are used by your doctor to determine whether the aortic valve condition symptoms 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 give you appropriate treatment if he finds 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 then 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 that are used for decreasing symptoms if any. Your doctor might give you tips to reduce complications too.
People with severe Aortic Stenosis need Aortic Stenosis surgery. Some people who do not show symptoms of aortic valve stenosis might need to have surgery as well. It is possible that if you are undergoing surgery for another heart condition, then your doctor might recommend you to have the 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 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 or of a pig or a 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 will be required to take blood thinners for the rest of your life.
A transcatheter aortic valve replacement (TAVR) is another surgery option that you might be a candidate for. The Aortic Stenosis TAVR is a surgical method that is 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 your leg. A balloon can be used to expand the valve else the valve can expand by itself. After the valve is replaced, the catheter is removed.
In balloon valvuloplasty, a catheter with a balloon on the tip of it 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 your arm. The catheter is then guided to your aortic valve. The balloon is then inflated by your doctor which helps the valve to open like it normally should. This enables the cusps to stretch too. Once this is done, the balloon is deflated and the catheter along with the balloon at the end of the catheter, are removed. This procedure is recommended by doctors for kids and infants although it can be useful for adults too.
Aortic root and ascending aorta surgery may be required. In this procedure, your doctor will remove the section of the aorta that has enlarged. A graft is used which is a synthetic tube. This surgery enables repair or replacement of the aortic valve. Your treatment might require that the aorta’s part that is enlarged to be replaced while the aortic valve is left in its 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 treatment option that is chosen and your health. People who don’t show any 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 elderly people are not candidates for surgery. You should discuss the prognosis with your doctor as he will be able to accurately tell you what you can expect from the treatment.
Road to Recovery and Aftercare
Your road to recovery might be tough or easy depending on the treatment that you receive after you are diagnosed with aortic valve stenosis. Other factors that determine 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 come to the follow-up appointments to see how your condition is progressing and if any changes to treatment need to be made. It is important that you follow your doctor’s instructions about how to take 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 is cut short and you might be able to get back to normal activities much faster. Right after you have your surgery, you are encouraged to take care of yourself, breathe deeply, and to start walking among other things. It will take some days or weeks for you to regain your energy 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.
Aortic Stenosis FAQs: All your concerns addressed
Q. What are the aortic valve stenosis symptoms in children?
- Children and infants can have Aortic Stenosis due to a congenital defect. There are chances that children may show symptoms such as the inability to gain any weight. You might notice they have breathing problems. They probably do not eat properly. You might notice that your child becomes tired quickly. If you notice these symptoms then you should take him to the pediatrician.
Q. What are the complications caused due to Aortic Stenosis?
- Aortic valve stenosis may cause various complications such as stroke, arrhythmias, blood clots, heart failure, heart infections, and bleeding. Untreated Aortic Stenosis may also lead to death in some cases.
Q. I take calcium tablets. Will this cause Aortic Stenosis?
- No, it won’t. People think that calcium deposits are caused due to intake of calcium but that is not true. Taking calcium tablets or having drinks that have high calcium content does not affect your risk of having aortic valve stenosis. There is no link between the two as many people tend to believe.
Q. How do I take care of my emotional health after surgery?
- Emotions usually take a backseat but that should never be the case especially after surgery. Surgery can be taxing and it can take a toll on you. Instead of letting the negative momentum take over, you need to focus on the positive. This is not impossible if you try. You should celebrate every small milestone such as being able to walk or being able to eat after surgery. You need to focus on the right frame of mind. You should give yourself time and do things that you enjoy such as reading a book from your favourite author, inviting a family member. You can ask your doctor for any recommendations.
Q. What happens when you have Aortic Stenosis (AS)?
- Aortic stenosis or Aortic valve stenosis (AS) is one of the most common valve diseases and is equally serious as well. The aortic valve opening narrows and restricts the blood flow from the left ventricle to the aorta and also affect the pressure in the left atrium.
Another cause of AS is the congenital heart defect called a Bicuspid Aortic Valve (BAV). BAV is present at birth (congenital). An abnormal aortic valve develops during the early weeks of pregnancy when the baby's heart is developing. BAV often runs in families.
Q. What is the most common cause of Aortic Stenosis?
- Accumulation of calcium deposits on the aortic valve, which increases with age, is one of the most common causes of aortic stenosis. The aortic valve stiffens and narrows over time. Coronary artery disease, such as high cholesterol, diabetes and smoking are the risk factors which aids in the active inflammatory process.
Another cause of Aortic stenosis is the congenital abnormality of the aortic valve, Bicuspid Aortic Valve (BAV). Compared to a normal aortic valve comprising three cusps, BAV with two cusps, may cause narrowing due to the structural abnormality and the increased risk of calcium build-up.
Q. Is Aortic Stenosis life-threatening?
- Aortic valve stenosis can lead to other problems with the heart.
- Heart Failure is one of the most life-threatening complications of AS.
- AS might cause Endocarditis, an infection of the heart's valves or its inner lining (endocardium).
- Mitral valve problems, which might hinder the heart to pump blood. Though very rare it happens, but Mitral valve regurgitation and Aortic stenosis together are veru critical to deal with.
Q. Can Aortic Stenosis be cured?
- To cure AS the first step would be to improvise the overall health of the heart by:
- Taking a healthier diet.
- Working on weight loss, if needed
- Limiting alcohol
- Quitting smoking
- Managing your stress
- Exercising, depending on the symptoms
Medications might help with the symptoms like heart rhythm problems, blood vessels blockage, high amount of water which is difficult for the heart to pump.
Q. Is aortic stenosis hereditary?
- The risk of aortic stenosis doubles when an immediate first-degree relative had the disease. Aortic stenosis is associated with congenital Bicuspid aortic valve and previous rheumatic heart disease. Having a bicuspid valve can run in families which makes the Aortic Stenosis hereditary.
Q. Does diet affect aortic stenosis?
- Only a diet will not cure AS but it is advisable to take care of your heart to assist the medications. Maintain a healthy weight as being overweight or obese puts a strain on your heart. Eat a variety of vegetables and fruits, fat-free or low-fat dairy products, lean proteins, and whole grains. Avoid saturated and trans fat, and excess salt and sugar. Avoid processed food as they tend to have sugar, sodium, and unhealthy fats.