Aortic Valve Stenosis

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Aortic Valve Stenosis

Topic Overview

Picture of the heart

What is aortic valve stenosis?

Aortic valve stenosis is a narrowing of the aortic valve. The aortic valve allows blood to flow from the heart's lower left chamber (ventricle) into the aorta and to the body. Stenosis prevents the valve from opening properly, forcing the heart to work harder to pump blood through the valve. This causes pressure to build up in the left ventricle and thickens the heart muscle.

Your heart can make up for aortic valve stenosis and the extra pressure for a long time. But at some point, it won't be able to keep up the extra effort of pumping blood through the narrowed valve. This can lead to heart failure.

What causes aortic valve stenosis?

Problems that can cause aortic valve stenosis include:

  • Calcium buildup on the aortic valve. As you age, calcium can build up on the valve, making it hard and thick. This buildup happens over time, so symptoms usually don't appear until after age 65.
  • A heart defect you were born with (congenital).
  • Rheumatic fever or endocarditis. These infections can damage the valve.

What are the symptoms?

Aortic valve stenosis is a slow process. For many years, even decades, you will not feel any symptoms. But at some point, the valve will likely become so narrow (often one-fourth of its normal size) that you start having problems. Symptoms are often brought on by exercise, when the heart has to work harder.

As aortic valve stenosis gets worse, you may have symptoms such as:

  • Chest pain or pressure (angina). You may have a heavy, tight feeling in your chest.
  • Feeling dizzy or faint.
  • Feeling tired and being short of breath.
  • A feeling that your heart is pounding, racing, or beating unevenly (palpitations).

If you start to notice any of these symptoms, let your doctor know right away. If you have symptoms, you need treatment. By the time you have symptoms, your condition probably is serious. If you have symptoms, you also have a high risk of sudden death.

How is aortic valve stenosis diagnosed?

Most people find out they have it when their doctor hears a heart murmur during a regular physical exam. To be sure of the diagnosis, your doctor may want you to have an echocardiogram, which can show moving pictures of your heart. You may have other tests to help your doctor judge how well your heart is working.

How is it treated?

If you don't have symptoms, your doctor will see you regularly to check your heart. You probably will not have surgery. Unless you have symptoms, or tests show that the heart's pumping action is getting weak, surgery is likely to be more risky than the disease.

If you have symptoms, you probably need surgery right away. Surgery to replace the aortic valve is the best treatment for most people. View a slideshow on aortic valve replacement surgery. Some young people or people who cannot have open-heart surgery may have another procedure called balloon valvuloplasty to enlarge the valve opening.

If you don't have surgery after you start having symptoms, you may die suddenly or develop heart failure. Surgery can help you have a more normal life span.

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Decision Points focus on key medical care decisions that are important to many health problems. Decision Points focus on key medical care decisions that are important to many health problems.
  Aortic Valve Stenosis: Should I Have Surgery?
  Heart Valve Problems: Should I Choose a Mechanical Valve or Tissue Valve to Replace My Heart Valve?

Cause

Most people who have aortic valve stenosis are born with a normal, healthy aortic valve but develop aortic stenosis late in life. Aging and calcium buildup cause the leaflets of the valve to thicken and harden, preventing the valve from opening properly. Typically, stenosis develops slowly over many years.

Most young people and teens who have aortic valve stenosis developed it from a congenital heart defect. The most common heart defect that causes aortic stenosis is a bicuspid aortic valve.

Some people may develop aortic stenosis after having rheumatic fever as a child. It usually takes 30 to 40 years after a case of rheumatic fever for aortic stenosis to develop. Rheumatic fever has been rare in the United States since the 1970s.

Symptoms

You probably won't have any symptoms if you have mild or moderate aortic valve stenosis, because your heart can make up for the stenosis. You may begin to notice symptoms if the pressure buildup in the heart becomes severe or if blood flow to the heart and the rest of the body is reduced. You may have symptoms when you exercise or do something strenuous, because your heart has to work harder.

Symptoms may include:

  • Chest pain or pressure (angina), often described as a heavy, tight feeling in your chest. You may also have a burning, choking, or constricting feeling that may spread to your arms, shoulders, or neck.
  • Dizziness, fainting, or loss of consciousness.
  • Signs of heart failure, such as fatigue and shortness of breath with activity.
  • Palpitations (an uncomfortable feeling that your heart is beating rapidly or irregularly).

What Increases Your Risk

Certain medical problems or conditions make it more likely that you will develop aortic valve stenosis:

  • Calcium buildup. Aging can cause calcium buildup around the aortic valve, which can make the normally thin and flexible valve flaps thick and stiff. This is also called calcific aortic valve stenosis. Many of the things that increase the risk of atherosclerosis and heart disease are the same for aortic valve stenosis. They include smoking, high cholesterol, high blood pressure, diabetes, and being male.
  • Birth defect. Sometimes a person is born with a bicuspid aortic valve that has two flaps instead of the normal three. Over time, the valve becomes damaged and calcium builds up. As the valve narrows, less blood can flow through it.
  • Infection. Rheumatic fever can cause scar tissue to build up at the edges of the valve. Rheumatic fever is not common now. But if you had it as a child, your risk of aortic valve stenosis may be increased.
  • Artificial valve. Aortic valve disease also may develop in an artificial aortic valve that is made from human or animal tissue.

Other things that increase the risk for aortic valve stenosis include:

  • Kidney failure.
  • Smoking.

When to Call a Doctor

Call your doctor immediately if you have any of the symptoms of aortic valve stenosis, such as:

  • Chest pain or pressure.
  • Fainting.
  • Shortness of breath.
  • Palpitations (feeling like your heart is pounding or racing).

Who to see

Your family doctor may diagnose aortic valve stenosis during a routine checkup. Other health professionals who also may discover aortic valve stenosis during a physical exam include:

Exams and Tests

Physical exam

A physical exam and review of your medical history are important first steps in diagnosing aortic valve stenosis. If you have stenosis but no symptoms, your doctor will likely find the condition during a routine exam or a checkup for another health problem. A distinctive heart murmur is usually the first clue that leads a doctor to suspect aortic valve stenosis.

During the physical exam, the doctor will:

  • Take your blood pressure. Low blood pressure may mean that not enough blood is getting through the narrowed aortic valve.
  • Check your pulse. A weak pulse may mean that there is narrowing of the heart valve.
  • Listen to your heart and lungs for abnormal sounds. A soft whooshing or humming sound (murmur) heard through a stethoscope is an important finding that often points to heart valve disease. Abnormal sounds in the lungs can mean fluid buildup in the lungs that is caused by heart valve disease.
  • Look at your legs and feet. Swelling in the legs and feet may be a sign of heart failure.

Echocardiogram

An echocardiogram (echo) can confirm your symptoms and tell your doctor how severe stenosis is, how well your left ventricle is working, and whether there are problems with other valves.

It's also an important test to help monitor aortic valve stenosis over time.

Recommended frequency for checking aortic valve stenosis 1
Severity of aortic valve stenosis How often you should have an echocardiogram

Mild

Every 3 to 5 years

Moderate

Every 1 to 2 years

Severe

Every 6 to 12 months

Other tests for aortic valve stenosis

  • Stress echocardiogram. This test can show how severe your aortic valve stenosis is and how it affects how much you can exercise.
  • Electrocardiogram (EKG or ECG). This test may show abnormalities in heart rhythm or lower left heart chamber (ventricle) thickness.
  • Chest X-ray. It may show calcium buildup in the valve, an enlarged left ventricle, or fluid buildup if you have developed heart failure. In some cases, the aorta may be enlarged just beyond the aortic valve.
  • Brain natriuretic peptide (BNP) test. This test may help show how well your heart is working and if you have heart failure.
  • Cardiac catheterization. This test may be done to confirm the results of other tests.

Treatment Overview

Treatment for aortic valve stenosis usually depends on whether you have symptoms.

If you have symptoms, surgery to replace the aortic valve is usually required. If you don't have surgery after you start having symptoms, you may die suddenly or develop heart failure. Surgery can help you have a more normal life span.

View a slideshow on aortic valve replacement surgery. For more information, see Surgery.

Click here to view a Decision Point. Aortic Valve Stenosis: Should I Have Surgery?

A less invasive procedure called balloon valvuloplasty might be done for some children, teens, or young adults in their 20s, or for people for whom valve surgery is too great a risk. For more information, see Surgery.

You may need medicine to prevent or treat a heart infection or to help manage heart failure, which is the most common complication of aortic valve stenosis. For more information, see Medications.

End-of-life care

People who have symptoms of aortic valve stenosis have a high risk of sudden death. On average, people may die within 2 to 3 years if they don't have valve replacement surgery.1 So it is important to consider end-of-life issues.

If you choose not to have surgery, your doctor will prescribe medicines to make you comfortable. As you get sicker, you may be unable to make decisions about your medical care. You may want to consider the type of care you wish to receive in case you are unable to make your wishes known. For more information, see the topic Care at the End of Life.

Living With Aortic Valve Stenosis

How you will feel and how aortic valve stenosis will affect your life will vary greatly depending on whether you have symptoms and the treatment decisions you make.

If you have no symptoms

  • Watch for changes in your health. See your doctor right away if you have any signs of chest pain, lightheadedness, fainting, shortness of breath, palpitations, or other symptoms that worry you.
  • Keep your heart healthy. Make healthy lifestyle changes such as eating a heart-healthy diet, staying at a healthy weight, and managing other health problems such as high blood pressure, diabetes, and high cholesterol.
  • Get the tests you need to monitor your health. You will need to have an echocardiogram every 6 months to 1 year for severe stenosis and every 1 to 5 years for mild to moderate stenosis.1
  • Be active, but you might need to avoid strenuous exercise. Physical activity is good for your overall health. But the type of exercise that is appropriate varies depending on how severe your aortic valve stenosis is. If you have mild stenosis, you will not need to restrict your level or type of physical exercise. But if you have severe stenosis, you should avoid strenuous activities such as weight lifting or running. Talk with your doctor about what kinds of exercise are safe for you.

If you have symptoms

  • Decide on treatment. After symptoms of stenosis appear, you'll need to decide whether to have valve replacement surgery. For more information, see Surgery.
  • Manage heart failure. If you don't have surgery, you will likely develop severe heart failure. But you can make lifestyle changes to manage heart failure, such as:
    • Eating a low-sodium, heart-healthy diet.
    • Being active with walking or other mild exercise. Avoid strenuous exercise, including weight lifting. Talk with your doctor about what kinds of activities are safe for you.
    • Quitting smoking.
    • Taking medicines for heart failure.

For more help, see the topic Heart Failure.

Medications

Medicines aren't used to treat aortic valve stenosis. But you may need medicines to prevent and treat complications from the condition. Or you may need to take medicines if you have valve replacement surgery.

If you have valve replacement surgery, you may need:

  • Anticoagulant medicine, (such as warfarin). Depending on the type of valve you receive, you may need to take this medicine for a few months or for the rest of your life.
  • Antibiotics. If you have an artificial valve, you may need these medicines before you have certain dental or surgical procedures. The antibiotics help prevent an infection in your heart called endocarditis.

You may need other medicines if you develop other problems, such as arrhythmias or heart failure. For more information, see the topic Heart Failure.

Surgery

Your doctor will likely recommend valve replacement surgery if you have symptoms of aortic valve stenosis, unless you have other health problems that make surgery too risky. Most of the time, valve replacement surgery has a high rate of success and a low risk of causing other problems.

Balloon valvuloplasty is a less invasive procedure than surgery. It may be an option for some younger people who have aortic valve stenosis. This procedure might be done in older adults who cannot have valve replacement surgery. Although the heart valve is not replaced, the narrowed opening is made larger.

Aortic valve replacement

Aortic valve replacement surgery is either an open-heart surgery or a minimally invasive surgery. In an aortic valve replacement surgery, the damaged valve is removed and replaced with an artificial valve (mechanical or tissue).

View a slideshow on aortic valve replacement surgery. To learn more about this decision, see:

Click here to view a Decision Point. Aortic Valve Stenosis: Should I Have Surgery?

If you decide to have surgery, you and your doctor will decide which type of valve is right for you. For help with this decision, see:

Click here to view a Decision Point. Heart Valve Problems: Should I Choose a Mechanical Valve or Tissue Valve to Replace My Heart Valve?

Bypass surgery with valve replacement surgery

If you are going to have valve replacement surgery, your doctor may suggest that you have a coronary angiogram/catheterization test. This test can show if you have blockages in your coronary arteries (as part of coronary artery disease). If you have serious blockages, your doctor may want to do a coronary artery bypass surgery at the same time as the valve replacement surgery. For more information, see Aortic Valve Stenosis: Treatment with Other Heart Diseases.

Transcatheter aortic valve implantation

A transcatheter aortic valve implant procedure is currently being studied in the United States. This procedure is not available yet except as part of clinical trials. But it has been used in other countries. The results and the research are promising as an option for people who cannot have valve replacement surgery.2

This procedure is a minimally invasive way to insert a new aortic valve in the diseased valve. It uses a specially designed valve that can be moved into the heart using catheters in blood vessels. This procedure might be an option for people who cannot have surgery to replace their valves because a surgery would be too dangerous for them. But this procedure also includes risks of serious complications including stroke, kidney problems, and death.

Other Places To Get Help

Organizations

Society of Thoracic Surgeons
 
633 North Saint Claire Street
Suite 2320
Chicago, IL 60611
Phone: (312) 202-5800
Fax: (312) 202-5801
Email: sts@sts.org
Web Address: www.sts.org
 

The Society of Thoracic Surgeons provides patient information on surgeries of the chest and throat that are done by cardiothoracic surgeons. These surgeries include heart, lung, and throat surgery. The patient information section of the Web site describes diseases, surgeries, patient options, and what to expect after surgery. And using the Web site, you can search for surgeons in your area.


American Heart Association (AHA)
7272 Greenville Avenue
Dallas, TX  75231
Phone: 1-800-AHA-USA1 (1-800-242-8721)
Web Address: www.heart.org
 

Visit the American Heart Association (AHA) website for information on physical activity, diet, and various heart-related conditions. You can search for information on heart disease and stroke, share information with friends and family, and use tools to help you make heart-healthy goals and plans. Contact the AHA to find your nearest local or state AHA group. The AHA provides brochures and information about support groups and community programs, including Mended Hearts, a nationwide organization whose members visit people with heart problems and provide information and support.


National Heart, Lung, and Blood Institute (NHLBI)
P.O. Box 30105
Bethesda, MD  20824-0105
Phone: (301) 592-8573
Fax: (240) 629-3246
TDD: (240) 629-3255
Email: nhlbiinfo@nhlbi.nih.gov
Web Address: www.nhlbi.nih.gov
 

The U.S. National Heart, Lung, and Blood Institute (NHLBI) information center offers information and publications about preventing and treating:

  • Diseases affecting the heart and circulation, such as heart attacks, high cholesterol, high blood pressure, peripheral artery disease, and heart problems present at birth (congenital heart diseases).
  • Diseases that affect the lungs, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema, sleep apnea, and pneumonia.
  • Diseases that affect the blood, such as anemia, hemochromatosis, hemophilia, thalassemia, and von Willebrand disease.

References

Citations

  1. Bonow RO, et al. (2008). 2008 Focused update incorporated into the ACC/AHA 2006 Guidelines for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing committee to revise the 1998 Guidelines for the management of patients with valvular heart disease). Circulation, 118(15): e523–e661.
  2. Leon MB, et al. (2010). Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. New England Journal of Medicine, 363(17): 1597–1607.

Other Works Consulted

  • Bates ER (2011). Treatment options in severe aortic stenosis. Circulation, 124(3): 355–359.
  • Bonow RO, et al. (2008). 2008 Focused update incorporated into the ACC/AHA 2006 Guidelines for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing committee to revise the 1998 Guidelines for the management of patients with valvular heart disease). Circulation, 118(15): e523–e661.
  • Freeman RV, Otto CM (2011). Aortic valve disease. In V Fuster et al., eds., Hurst’s The Heart, 13th ed., vol. 2, pp. 1692–1720. New York: McGraw-Hill.
  • Oakley RE, et al. (2008). Choice of prosthetic heart valve in today's practice. Circulation, 117(2): 253–256.
  • Rosengart TK, et al. (2008). Percutaneous and minimally invasive valve procedures. A scientific statement from the American Heart Association Council on Cardiovascular Surgery and Anesthesia, Council on Clinical Cardiology, Functional Genomics and Translational Biology Interdisciplinary Working Group, and Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation, 117(13): 1750–1767.

Credits

By Healthwise Staff
Primary Medical Reviewer Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
Specialist Medical Reviewer John A. McPherson, MD, FACC, FSCAI - Cardiology
Last Revised November 2, 2011

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