Aortic stenosis is a condition in which the opening of the aortic valve narrows, restricting blood flow from the heart to the rest of the body. The American Heart Association estimates that over 20% of older Americans have aortic stenosis, referring to it as a condition “common in people over age 65.”¹

Despite its prevalence, many patients may not be aware of aortic stenosis and the associated risks it presents. Left untreated, a severe case can cause chest pain, difficulty breathing, and potential heart failure. Therefore, educating at-risk patients about detection and symptoms is critical. 

What are the basics of aortic stenosis your patients should know?


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Aortic Stenosis Causes

In patients with aortic stenosis, the left ventricle in the heart must work harder to pump blood out through the valve. Aortic stenosis often occurs later in life, though it is possible for it to be present from birth.² It is generally agreed that there are 3 primary causes of aortic stenosis:

  • Calcium buildup: Over time, calcium deposits from the blood can build up in the aortic valve. Aortic stenosis resulting from age-related calcium buildup most often occurs in patients aged 70 to 80.³
  • Congenital heart defect: Aortic stenosis can occur in the young if they are born with an aortic valve containing only two cusps instead of three.³ While this requires consistent checkups and monitoring, it is possible that the heart defect may not cause severe symptoms until after childhood.
  • Rheumatic fever. Rheumatic fever and strep throat can cause scar tissue to develop in the aortic valve, making it easier for calcium deposits to collect inside.

Aortic Stenosis Risk Factors and Symptoms

Patients of an advanced age, patients with a history of infections, and patients who have received radiation therapy to the chest are all considered at risk for aortic stenosis.³ These risk factors are important for patients to know, as symptoms often don’t appear until the condition has become advanced. Common symptoms include:

  • Chest pain
  • Fatigue
  • Shortness of breath
  • Heart palpitations
  • Heart murmur

Children with aortic stenosis may also experience difficulty eating and gaining weight.

Aortic Stenosis Testing and Diagnosis

The common signal to physicians that a patient may have aortic stenosis is hearing a heart murmur when listening to the patient’s heart with a stethoscope.⁴ At that point, the clinician will likely order tests to either confirm or rule out stenosis. 

Options for aortic stenosis testing include an echocardiogram, an EKG, chest x-rays, a CT scan, and an exercise test. An exercise test can not only determine if a patient has symptoms of aortic stenosis, but also how severe the case may be. Depending on symptoms, certain tests like chest x-rays are often used to determine how the stenosis has affected the heart.

Aortic Stenosis Treatment

Treatment will depend on the severity of the patient’s condition. Lifestyle changes are often recommended, including quitting smoking, reducing cholesterol, and limiting strenuous activity.² These measures can reduce the risk of developing complications.

As the condition progresses, however, surgery is often necessary. Surgery may involve removing an aortic valve and replacing it with either a mechanical or biological tissue replacement.⁴ If a patient is high risk for surgical complications, physicians may recommend a transcatheter aortic valve replacement (TAVR). This is a less invasive procedure in which the replacement valve is guided to the heart with the use of a catheter.

In the event of pediatric aortic stenosis, a clinician may decide to do a balloon valvuloplasty. Similar to TAVR, a catheter is used, but it instead guides a balloon to the heart. The balloon is inflated to help open the valve before being deflated and removed.

References

1. Aortic stenosis overview. American Heart Association. https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-problems-and-causes/problem-aortic-valve-stenosis. Reviewed October 26, 2020. Accessed June 14, 2021.

2. Aortic stenosis. MedlinePlus Medical Encyclopedia. https://medlineplus.gov/ency/article/000178.htm. Reviewed January 27, 2020. Accessed June 15, 2021.

3. Aortic valve stenosis – symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/aortic-stenosis/symptoms-causes/syc-20353139. Updated February 26, 2021. Accessed June 15, 2021.

4. Aortic valve stenosis – diagnosis and treatment. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/aortic-stenosis/diagnosis-treatment/drc-20353145. Updated February 26, 2021. Accessed June 15, 2021.

This article originally appeared on The Cardiology Advisor