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What is Aortic Stenosis?





*Otto CM. Timing of aortic valve surgery. Heart. 2000;84:211-18.



Aortic Stenosis

Human heart valves are remarkable structures.  These tissue-paper thin membranes attached to the heart wall constantly open and close to regulate blood flow (causing the sound of a heartbeat). When there is a narrowing of your heart's aortic valve opening, this is known as aortic stenosis. This narrowing does not allow normal blood flow.  It is most often caused by age-related calcification, but can be caused by a birth defect, rheumatic fever, or radiation therapy.

There are four valves that control the flow of blood through your heart.  One of which is called the aortic valve.

Heart Valve Diagram

With aortic stenosis, your heart needs to work harder and may not pump enough oxygen-rich blood to your body.

Age and aortic stenosis

Calcification is the process that refers to the build-up of calcium on the heart's valves.  In elderly patients, aortic stenosis is sometimes caused by the build-up of calcium (mineral deposits) on the aortic valve’s leaflets.  Over time the leaflets become stiff, reducing their ability to fully open and close.  When the leaflets don’t fully open, your heart must work harder to push blood through the aortic valve to your body.  Eventually, your heart gets weaker - increasing the risk of heart failure (your heart cannot supply enough blood to your body).

Severe, symptomatic aortic stenosis (symptomatic means when you are showing symptoms) is a life threatening condition that progresses rapidly.1 People who have developed symptoms from severe aortic stenosis have about a 50% chance of living 2 years, without aortic valve replacement.2 

This information is not a substitute for talking with your doctor.

 

TAVR Diagram

Treatment for severe aortic stenosis 
Today, there are multiple treatment options for aortic valve stenosis. For people who have been diagnosed with severe aortic stenosis and who are high-risk or too sick for open heart surgery, treatment is now available. Transcatheter aortic valve replacement (TAVR) is a less invasive procedure that does not require open heart surgery.

Aortic Stenosis Symptoms

Aortic stenosis is the narrowing of the aortic valve, which limits the aortic valve leaflet's ability to fully open and close.  Valve leaflets are flaps of tissue that open and close to regulate the one-way flow of blood through the aortic valve.  As a result, less oxygen-rich blood flows from the lungs to the brain and rest of the body, which may cause symptoms like severe shortness of breath and extreme fatigue.  It's important to know that heart valve disease may occur with no outward symptoms.

The symptoms of aortic disease are commonly misunderstood by patients as ‘normal’ signs of aging.  Many patients initially appear asymptomatic, but on closer examination up to 37% exhibit symptoms.

Click here to use the Symptom Checklist. You can print a copy to bring with you to your next doctor appointment.

Symptom Checklist

What are the signs of aortic stenosis?
You may notice symptoms like:

  • Chest pain
  • Fatigue
  • Shortness of breath
  • Lightheadedness, feeling dizzy, and/or fainting
  • Difficulty when exercising

Major risk factors
Factors associated with aortic valve disease include the following:3  

  • Increasing age
  • High blood pressure
  • High cholesterol
  • Smoking

If you are experiencing symptoms, consult a cardiologist right away.


Once a person is diagnosed with severe aortic stenosis and begins feeling symptoms, treatment is necessary per guidelines provided by the American College of Cardiology and the American Heart Association.

Treatment Options

Aortic Stenosis Disease Progression

Aortic stenosis is life threatening and progresses rapidly1  
Over time the leaflets (flaps of tissue that open and close to regulate the one-way flow of blood through the aortic valve) become stiff due to calcium (mineral) deposits, reducing your leaflets' ability to fully open and close.  When your leaflets don’t fully open, your heart must work harder to push blood through the aortic valve to your body.

Eventually, your heart muscle gets weaker - increasing the risk of heart failure (your heart cannot supply enough blood to your body). If you have severe aortic valve stenosis, you'll most likely need surgery to replace the aortic valve.

Healthy Aortic Valve

Diseased Aortic Valve

Comparison of Healthy and Diseased Aortic Valves

Aortic Stenosis: If Untreated

Some patients with aortic stenosis may not show any symptoms. However, once you begin experiencing symptoms, prompt treatment becomes necessary. Severe aortic stenosis is a very serious problem. People who have developed symptoms from severe aortic stenosis have about a 50% chance of living 2 years, without aortic valve replacement. 2  

Untreated Severe Aortic Stenosis Mortality Rate

Click here to use the Symptom Checklist. You can print a copy to bring with you to your next doctor appointment.

Symptom Checklist

Treatment for severe aortic stenosis
Today, there are multiple treatment options for aortic valve stenosis.  For people who have been diagnosed with severe aortic stenosis and who are high-risk or too sick for open heart surgery, another option is available. Transcatheter aortic valve replacement (TAVR) is a less invasive procedure that does not require open heart surgery.

If you have been diagnosed with severe aortic stenosis and are experiencing any symptoms, consult a cardiologist right away.

People who need treatment
If you are showing symptoms, treatment is crucial. The only effective treatment for severe aortic stenosis is to replace your aortic valve. Unfortunately, studies show that at least 40% (and perhaps up to 60%) of patients with severe aortic stenosis do not receive aortic valve replacement.4-10  

Aortic Stenosis: Getting Diagnosed

In addition to a physical exam, your cardiologist may use some of the tests below to diagnose heart valve disease:

Diagnostic Procedures for Aortic Stenosis

Auscultation - Your cardiologist will use a stethoscope to listen to the sounds of your heart.

Echocardiography - This test uses ultrasound waves to obtain images of the heart chambers and valves.

Cardiac catheterization (angiography) - Under X-ray guidance, small hollow tubes (catheters) are advanced to the aortic valve and into the left ventricle.  The rate of blood flow across the aortic valve and pressures can be measured.

Chest X-ray - A chest X-ray displays images of the organs and structures inside your chest, such as your heart, lungs, and blood vessels. A chest X-ray can reveal signs of aortic stenosis, and other causes of symptoms not related to coronary heart disease.

Electrocardiography (also EKG) - An EKG is a recording of the heart's electrical activity using electrodes attached to your skin.  An EKG can show the heart’s rhythm, the heart’s rate, and the strength and timing of the electrical currents.

Call or see your doctor whenever you have questions or concerns about your health, especially if you experience any symptoms or unusual changes in your overall health.

References:

  1. Lester SJ, Heilbron B, Dodek A, Gin K, Jue J. The Natural History And Rate Of Progression Of Aortic Stenosis. CHEST. 1998;113(4):1109-1114.
  2. Otto CM. Timing of aortic valve surgery. Heart. 2000;84:211-18.
  3. Stewart BF, Siscovick D, Lind BK, et al. Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study. J Am Coll Cardiol. 1997;29:630-634.
  4. Bouma BJ, Van Den Brink RB, Van Der Meulen JH, et al. To operate or not on elderly patients with aortic stenosis: the decision and its consequences. Heart. 1999;82:143-148.
  5. Pellikka PA, Sarano ME, Nishimura RA, et al. Outcome of 622 adults with asymptomatic, hemodynamically significant aortic stenosis during prolonged follow-up. Circulation. 2005;111:3290-3295.
  6. Charlson E, Legedza AT, Hamel MB. Decision-making and outcomes in severe symptomatic aortic stenosis. J Heart Valve Dis. 2006;15:312-321
  7. Varadarajan P, Kapoor N, Banscal RC, Pai RG. Clinical profile and natural history of 453 nonsurgically managed patients with severe aortic stenosis. Ann Thorac Surg. 2006;82:2111-2115.
  8. Jan F, Andreev M, Mori N, Janosik B, Sagar K. Unoperated patients with severe symptomatic aortic stenosis. Circulation. 2009;120;S753.
  9. Bach DS, Siao D, Girard SE, et al. Evaluation of patients with severe symptomatic aortic stenosis who do not undergo aortic valve replacement: the potential role of subjectively overestimated operative risk. Circ Cardiovasc Qual Outcomes. 2009;2:533-539.
  10. Freed BH, Sugeng L, Furlong K, et al. Reasons for nonadherence to guidelines for aortic valve replacement in patients with severe aortic stenosis and potential solutions. Am J Cardiol. 2010;105:1339-1342.