Aortic stenosis (patient information)

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What is aortic stenosis?

The aorta is the main artery leaving the heart. When blood leaves the heart, it flows from the lower chamber (the left ventricle), through the aortic valve, into the aorta. In aortic stenosis, the aortic valve does not open fully. This restricts blood flow.

How do I know if I have aortic stenosis and what are the symptoms of aortic stenosis?

You may have no symptoms at all until late in the course of the disease. The diagnosis may have been made when your healthcare provider heard a heart murmur and then performed additional tests.

Symptoms in adults

• Breathlessness with activity
• Chest pain, angina-type
  • Crushing, squeezing, pressure, tightness
  • Pain increases with exercise, relieved with rest
  • Under the chest bone, may move to other areas
• Fainting, weakness, or dizziness with activity
• Sensation of feeling the heart beat (palpitations)

Symptoms in infants and children

• Becoming tired or fatigued with exertion more easily than others (in mild cases)
• Serious breathing problems that develop within days or weeks of birth (in severe cases)

Children with mild or moderate aortic stenosis may get worse as the get older. They also run the risk of developing a heart infection (bacterial endocarditis).

What are the causes of aortic stenosis

As the aortic valve becomes more narrow, the pressure increases inside the left heart ventricle. This causes the left heart ventricle to become thicker, which decreases blood flow and can lead to chest pain. As the pressure continues to rise, blood may back up into the lungs, and you may feel short of breath. Severe forms of aortic stenosis prevent enough blood from reaching the brain and rest of the body. This can cause lightheadedness and fainting.

Who is at risk for aortic stenosis?

Aortic stenosis is not common. It occurs more often in men than in women. In adults, aortic stenosis occurs most commonly in those who've had rheumatic fever, a condition that may develop after strep throat or scarlet fever. Valve problems do not develop for 5 - 10 years after rheumatic fever occurs. Rheumatic fever is increasingly rare in the United States. If you have calcium deposits forming around the aortic valve, or have had radiation treatment to the chest, or are on certain medications you may also be at a slight risk for aortic stenosis.

How to know you have aortic stenosis?

How your heart sounds

Your health care provider will be able to feel a vibration or movement when placing a hand over your heart. A heart murmur, click, or other abnormal sound is almost always heard through a stethoscope. There may be a faint pulse or changes in the quality of the pulse in the neck (this is called pulsus parvus et tardus).

Blood pressure

Blood pressure may be low.

Tests your Doctor might perform

• Chest x-ray
• Doppler echocardiography
• ECG
• Exercise stress testing
• Left cardiac catheterization
• MRI of the heart
• Transesophageal echocardiogram (TEE)

How to know if your child has aortic stenosis?

Infants and children may be:

• Extremely tired
• Sweaty
• Have pale skin
• Fast breathing.
• They may also be smaller than other children their age.

When to seek urgent medical care

Call your health care provider if you or your child have symptoms of aortic stenosis. For example, call if you or your child have a sensation of feeling the heart beat (palpitations) for more than a short period of time.

Also contact your doctor if you have been diagnosed with this condition and your symptoms get worse or new ones develop.

Treatment options

If there are no symptoms or symptoms are mild, you may only need to be monitored by a health care provider. Patients with aortic stenosis are usually told not to play competitive sports, even if they don't have symptoms. If symptoms do occur, strenuous activity must be limited.

Medication

Medications are used to treat symptoms of heart failure or abnormal heart rhythms (most commonly atrial fibrillation). These include diuretics (water pills), nitrates, and beta-blockers. High blood pressure should also be treated.

Lifestyle Changes

• Stop smoking and be treated for high cholesterol.
• See a cardiologist every 3 to 6 months.

Surgery

Surgery to repair or replace the valve is the preferred treatment for adults or children who develop symptoms. Even if symptoms are not very bad, the doctor may recommend surgery. People with no symptoms but worrisome results on diagnostic tests may also require surgery.

Some high-risk patients may be poor candidates for heart valve surgery. A less invasive procedure called balloon valvuloplasty may be done in adults or children instead. This is a procedure in which a balloon is placed into an artery in the groin, advanced to the heart, placed across the valve, and inflated. This may relieve the obstruction caused by the narrowed valve.

Treatment Options for Children

Children with mild aortic stenosis may be able to participate in most activities and sports. As the illness progresses, sports such as golf and baseball may be permitted, but not more physically demanding activities.

Surgery

Valvuloplasty is often the first-choice for surgery in children. Some children may require aortic valve repair or replacement. If possible, the pulmonary valve may be used to replace the aortic valve.

Where to find medical care for aortic stenosis

Directions to Hospitals Treating aortic stenosis

Prevention of aortic stenosis

Treat strep infections promptly to prevent rheumatic fever, which can cause aortic stenosis. This condition itself often cannot be prevented, but some of the complications can be.

Follow you health care provider's treatment recommendation for conditions that may cause valve disease. Notify you provider if there is a family history of congenital heart diseases.

What to expect (Outlook/Prognosis)

Without surgery, a person with aortic stenosis who has angina or signs of heart failure may do poorly.

Aortic stenosis can be cured with surgery. After surgery there is a risk for irregular heart rhythms, which can cause sudden death, and blood clots, which can cause a stroke. There is also a risk that the new valve will stop working and need to be replaced.

Sources

MedlinePlus Medical Encyclopedia - Aortic Stenosis Template:WH Template:WS