Valvular heart disease / Aortic stenosis

Overview – Aortic stenosis is a valvular heart disease that occurs when the heart’s aortic valve narrows.

The heart pumps blood from the left ventricle (Left lower chamber) into the aorta through the aortic valve. Aorta is the main artery that carries blood from the heart to the body. In aortic stenosis, the valve is narrowed and hence the aorta delivers less blood. The left ventricle (lower chamber) has to work harder to pump a sufficient amount of blood into the aorta and onward to the rest of the body. This can lead to the enlargement of the left ventricle and heart failure.

Aortic stenosis is the most common cause of left ventricular outflow obstruction. The causes of aortic stenosis are congenital heart defect, aortic valve calcification, rheumatic fever (a common complication of streptococcal infection).

 

Symptoms

  • Shortness of breath on exertion
  • Dizziness, fainting
  • Chest pain or tightness on exertion
  • Weight loss
  • Palpitations

 

Complications

  • Heart failure – Aortic stenosis puts a strain on the ventricular function which may lead to heart failure. The patient with heart failure presents with fatigue, shortness of breath, swollen ankles and feet.
  • Pulmonary hypertension – Pulmonary artery (arteries of the lung) pressure may be increased in aortic stenosis.
  • Arrhythmias – Conduction abnormalities are uncommon, when present, may be due to severe aortic stenosis.
  • Sudden cardiac death – Death is reduced by valve replacement, so prompt valve replacement is generally recommended for symptomatic aortic stenosis patients.
  • Infections of the heart are common particularly in those with a congenitally bicuspid aortic valve.
  • Blood clots.

 

Diagnosis

  • Echocardiography is done to confirm the diagnosis in a patient with signs and symptoms of aortic stenosis.
  • Other tests that may be done are electrocardiogram to detect the enlarged chambers of your heart, heart disease, and abnormal heart rhythms; chest x-ray to determine the enlargement of the heart; exercise or stress test to determine the severity of the condition; cardiac catheterization may be used sometimes to diagnose or determine the severity of the condition; cardiac MRI to determine the severity of aortic stenosis and evaluate the size of your aorta.

 

Lifestyle management

  • Follow a healthy diet and exercise program as recommended by your doctor. Your doctor will recommend a heart-healthy diet that includes lean proteins, fruits, vegetables, and whole grains. Your diet should be low in saturated fat, trans fat, salt. Your doctor may recommend that you limit strenuous activity to avoid overworking your heart.
  • Aortic stenosis due to rheumatic fever can be prevented by taking steps to prevent rheumatic fever from happening. Rheumatic fever is a complication of untreated strep throat. Rheumatic fever causes inflammation, especially of the heart, blood vessels, and joints. Make sure you see your doctor when you have a sore throat. Strep throat can usually be easily treated with antibiotics.
  • Manage your weight well. Blood pressure and cholesterol levels should be under control when you have aortic stenosis. Talk to your doctor about ways to keep your blood pressure, cholesterol within the limits recommended by your doctor.
  • There is a link between infected teeth, gums, and endocarditis (infection of the heart tissue). The infection of the heart tissue can aggravate aortic stenosis. Schedule regular dentist appointments and take care of your gums and teeth.
  • Manage stress well with relaxation activities, meditation, spending time with friends and family.
  • Do not smoke.
  • If you are planning a pregnancy, talk to your doctor before pregnancy about your risks.

 

Medical management

  • Aortic valve replacement is recommended to all patients especially in symptomatic patients. The damaged valve is removed and replaced by a mechanical valve or a valve made from cow, pig or human heart tissue (biological tissue valve). Aortic valve replacement not only treats the symptoms but prolongs life in people with aortic stenosis.
  • Other treatment options depend on the complications of aortic stenosis. Atrial fibrillation is treated with digoxin and beta-blockers, heart failure is treated with diuretics and/or ACE inhibitors.

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