Defining Aortic Stenosis
The main artery leaving a person's heart is the aorta. When blood leaves the heart it flows from the lower left chamber, referred to as a, 'ventricle,' through the aortic valve, and into the aorta. When a person has aortic stenosis, their aortic valve does not open fully, restricting the flow of blood. Aortic stenosis is also known as, 'left ventricular outflow obstruction,' 'rheumatic aortic stenosis,' and, 'calcium aortic stenosis.'
Causes of Aortic Stenosis
When a person's aortic valve becomes more narrow, the pressure inside their left heart ventricle increases, causing the left heart ventricle to thicken. The result is a decrease in blood flow that may lead to chest pain. Pressure can continue to increase, and blood can back up into the person's lungs, making them feel short of breath. With severe forms of aortic stenosis, enough blood is prevented from reaching the person's brain and the rest of their body that they may become light-headed and could potentially faint.
A person may experience aortic stenosis from birth, meaning that it is congenital; the condition may also be acquired later on in a person's life. Children who experience aortic stenosis might also have other forms of congenital conditions. Adults who have aortic stenosis usually acquired the condition due to rheumatic fever. Rheumatic fever is a condition that can develop after a person has experienced either scarlet fever or strep throat. Problems with the person's left ventricular valve do not develop until five-to-ten years after rheumatic fever has occurred. In America, Rheumatic fever is increasingly rare.
The presence of other factors as a cause of aortic stenosis in adults is rare. Among these factors are calcium deposits forming around the person's aortic valve, some particular forms of medication use, as well as radiation treatments administered to the person's chest. Aortic stenosis itself is not common, occurring more often in men than in women.
Symptoms of Aortic Stenosis
People who experience aortic stenosis might not present with any symptoms at all until they are late in the course of the disease. The person might receive a diagnosis once a health care provider hears a heart murmur and then performs testing to confirm a diagnosis. The symptoms of aortic stenosis can include breathlessness when the person is active. They may feel chest pains with squeezing, pressure, crushing, and tightness. The chest pain increases with exercise and eases with rest, and is present under the chest bone - although it may move to other areas of the chest. The person can experience weakness, fainting, or dizziness with activity, or palpitations of their heart.
Infants and children can experience symptoms such as fatigue, or becoming tired more easily than others. They may have serious breathing issues which develop within a matter of days or weeks after they have been born, in more severe cases. Children with either mild or moderate aortic stenosis can worsen as they grow older. Children with the condition also have the risk of developing a heart infection.
Diagnosing Aortic Stenosis
A health care provider will check for a vibration, or movement, when they place their hand over the person's heart. They will listen to the person's heart with a stethoscope, listening for a heart murmur, click, or any other form of abnormal sound. The person may have a faint pulse, or changes in the quality of the pulse in their neck, referred to as the, 'pulsus parvus et tardus. Infants and children who have aortic stenosis can become very sweaty, tired, and may present with breathing that is rapid and skin that is pale in color. Children who experience this condition may also be smaller than children of the same age. The person's blood pressure may also be questionable. There are a number of tests that can be performed in relation to aortic stenosis, to include:
MRI of the heart
Exercise stress testing
Left cardiac catheterization
Treating Aortic Stenosis
People who are not experiencing symptoms related to aortic stenosis, or are experiencing mild symptoms, might only need monitoring by their health care provider. People with the condition are usually informed that they should not participate in competitive sports, despite a lack of symptoms. Should they experience any symptoms, their activity should be limited.
There are medications available for use in treatment of the symptoms of either abnormal heart rhythms, atrial fibrillation, or heart failure. The forms of medications administered include diuretics, nitrates, and beta-blockers. Any high-blood pressure the person experiences should be treated as well. People with aortic stenosis should receive treatment for high cholesterol and quit smoking. They should also see a cardiologist every three-to-six months.
A preferred treatment for both children and adults with aortic stenosis who develop symptoms is surgical repair or replacement of the valve. Even if the symptoms the person is experiencing are not bad, a doctor might recommend surgery. Even people who are not experiencing symptoms, yet present with troubling results through diagnostic testing, might also need surgery.
There are some people with aortic stenosis who are not good candidates for surgery. There is a less-invasive procedure referred to as a, 'balloon valvuloplasty,' which can be performed on both children and adults instead. The procedure involves placement of a balloon into an artery in the person's groin, advancing it into their heart, placing it across the valve, and inflating it. The desired result is to relieve the obstruction caused by the narrowing in the person's valve.
Valvuloplasty is many times the option of first-choice for children. Some children might need either aortic valve repair or replacement. If it is possible, the child's pulmonary valve can be used to replace their aortic valve.
People who have aortic stenosis need to inform health care providers before any procedures or surgeries. Procedures including dental work, a colonoscopy, or other forms of health care procedures, can introduce bacteria into their bloodstream and potentially infect their damaged heart valve. While people with heart valve problems are not automatically administered antibiotics prior to dental or other medical procedures, they might still be recommended in some cases to decrease the risk of infection and complications.