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FREQUENTLY ASKED QUESTONS
Frequently Asked Questions
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Presented in part with the support of Novartis Pharmaceuticals and Boston Scientific / Guidant
Aortic Stenosis
1. What is the aortic valve?2. What is aortic stenosis?
3. What causes aortic stenosis?
4. How is aortic valve disase diagnosed?
5. What are the symptoms of aortic stenosis?
6. How is aortic stenosis treated?
What is the aortic valve?
The aortic valve is located between the main pumping chamber of the heart, the left ventricle, and the aorta, the blood vessel that carries blood full of oxygen to the rest of the body. The aortic valve normally has three thin leaflets that open widely as the left ventricle pumps the blood out of the heart. When the left ventricle has finished ejecting the blood, the backflow of blood against the valve leaflets closes the aortic valve preventing blood from leaking back into the left ventricle.What is aortic stenosis?
Aortic stenosis refers to a narrowing of the aortic valve opening. This is often due to an age related thickening and calcification of the valve leaflets. There are alse inflammatory conditions involving the aortic valve that lead to thickening of the leaflets and fusion along the margins of the valve cusps. Rheumatic heart disease may cause these changes. Some aortic valves are imperfectly formed at birth having two rather than the usual three leaflets. These two leaflet or bicuspid valves tend to wear out sooner than normal by becoming thickened, fused and non-pliable.The end result of aortic stenosis is a progressive narrowing of the valve to the point where blood flow across the valve becomes limited. This is manifest by a decline in the ability to exert, increased shortness of breath, heart failure, chest pain and fainting episodes. Once the aortic valve becomes narrowed to the point where symptoms are present, there is a significant increase in the chances of dying suddenly.
What causes aortic stenosis?
Aortic stenosis is caused by many disorders. One cause is rheumatic fever. Other causes include calcification of the valve and congenital abnormalities (problems present at birth). There may be a history of other valve diseases, coronary artery disease, or heart murmur.Aortic stenosis occurs in approximately 5 out of 10,000 people. It is more common among men. Symptoms often do not appear until middle age or older.
How is aortic valve disase diagnosed?
Both narrowed and leaking aortic valves cause the blood flow across the valve to become turbulent. This turbulence creates a sound that can be heard with a stethoscope. This is called a heart murmur. The diagnosis of aortic valvular disease starts with a physical examination in which a heart murmur is heard. Heart murmurs due to the aortic valve have a characteristic sound and location.An echocardiogram, an ultrasound examination of the heart, is a useful way to look at the aortic valve to see if there is significant disease present. The appearance of the leaflets can provide important information as to thickening, mobility and whether there are two or three leaflets. The amount of leakage and narrowing can be determined by Doppler ultrasound. The effect of the aortic valve disease on the heart function can also be assessed.
If the echocardiogram suggests that the aortic valve is significantly diseased to warrent surgical replacement, a cardiac catheterization is performed. This is a hospital test that involves measuring pressures in various heart chambers using small tubes or catheters inserted into an artery and a vein in the groin and directed into the heart. Motion picture x-ray are also obtained to assess the heart function and the appearance of the valve and the aorta. X-ray pictures are usually obtained of the coronary arteries at the same time. If there is co-existing coronary artery disease, this is usually bypassed at the time of the aortic valve surgery.
How is aortic stenosis diagnosed?
Examination shows vibration or movement felt by holding the hand over the heart. There is almost always a heart murmur, click, or other abnormal sounds when examining the chest with a stethoscope. There may be faint pulses or changes in the quality of the pulse in the neck (the change in pulse is known as pulsus tardus). Blood pressure may be low.
Certain diagnostic imaging tests can reveal aortic stenosis. They include:
• a left coronary angiography
• an echocardiogram
• a Doppler ultrasonography
• a chest X-ray
An ECG may show left-ventricle enlargement or arrhythmias (unusual pattern of heart beats) such as ventricular tachycardia or sinus bradycardia.
This disease may also alter the results of the following:
• a chest MRI
• an aortic angiography
What are the symptoms of aortic stenosis?
Aortic stenosis might show no symptoms until late in the disease process.Symptoms can include:
• fainting or weakness with activity
• breathlessness with activity
• sensation of feeling the heart beat (palpitations)
• chest pain, angina-type
• cough
How is aortic stenosis treated?
Mild to moderate aortic valvular disease requires no specific treatment. Your physician will want to see you periodically to be certain the disease is not progressing. Your physician will also obtain periodic echocardiograms to follow the status of your aortic valve.Because diseased heart valve are more susceptible to infection when bacteria are present in the blood stream, antibiotics should be given before any procedures that are likely to cause bacteria in your blood stream. This would include dental work (including dental cleaning), genitourinary procedures, colonoscopy, sigmoidoscopy and the like. If you have aortic valvular disease, please ask your doctor about antibiotic prophylaxis (antibiotic drugs given in advance to help make sure that you don't get an infection during a procedure).
Medications may include diuretics, digoxin, and other medications to control heart failure. Symptomatic people may be advised to avoid strenuous physical activity. People with symptoms of aortic stenosis (difficulty breathing, chest pain, syncope) should have a physical exam every 6 to 12 months, and an ECG performed every 1 to 3 years.
Surgery involves replacement of the aortic valve. There are a variety of heart valves available. There are man made mechanical valves that have great durability but which require life long blood thinners (coumadin) to prevent clots from forming. There are valves constructed from animal tissue. These include pig aortic valves and valves made from pericardium. Aortic valves from human cadavers may also be used. In general the tissue valves require only short term blood thinners but they have a limited life of around ten years. If aortic valve replacement is recommended, your cardiac surgeon and cardiologist will discuss the various options with you.
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4725 N. Federal Hwy, Suite #401
The Jim Moran Heart and Vascular Center
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