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Aortic Stenosis

Definition

Aortic stenosis (AS) is a narrowing of the aortic valve opening. This valve controls the flow of blood from the heart to a large artery called the aorta. This artery carries blood from the heart to the rest of body.

AS makes it hard for blood to leave the heart. It can decrease the amount of blood that goes to the body and cause a backup of blood into the heart. This backup can raise pressure in the heart and lungs. AS can range from mild to severe.

Causes

The aortic valve has 3 flaps that should open and close smoothly. AS is caused by a problem with these flaps. Common reasons for the problems are:

  • A person is born with an aortic valve that has 2 parts, or cusps, not 3
  • A 2 part aortic valve narrows with wear and tear over time
  • An aortic valve has only 1 cusp or was narrow from birth
  • The valve hardens or calcium builds up over time as a person ages
  • The aortic valve is scarred due to rheumatic fever—this is rare

Risk Factors

This condition is more common in men.

Things that may raise the risk of AS include:

  • Family members with heart valve problems
  • History of rheumatic fever
  • High blood pressure
  • High cholesterol
  • Diabetes
  • Smoking

Symptoms

A person with AS does not always have symptoms. Symptoms a person may have are:

Rarely, AS can cause abnormal heart rhythms or sudden death with no symptoms before.

Diagnosis

The doctor will ask about symptoms and past health. A physical exam will be done. The doctor may be alerted to AS by the following:

  • Odd chest sounds such as a heart murmur or clicking sound
  • Noticeable chest heave or vibration when the doctor's hand is held over the heart

Images may need to be taken of the chest with:

Treatment

The goals of treatment are to reduce pressure on the heart and lungs and manage symptoms. People with mild AS may need to be checked often. They may not need treatment right away.

People with more severe AS may:

  • Be asked to avoid intense physical activity.
  • Be given medicine to decrease pressure on the heart and help prevent heart failure.
  • Have surgery to repair the valve.

Medications

Vasodilators may be given to widen blood vessels and decrease blood pressure. Statins can help lower cholesterol.

Surgery

Surgical options include:

  • Balloon valvuloplasty—A balloon device is passed through the arteries to open or enlarge the stenotic aortic valve. This may help symptoms for a short time. The valve can get blocked again.
  • Aortic valve replacement—An incision is made in the chest to put in a donor valve, tissue valve (from animal tissue), or a man made valve.
  • Transcatheter aortic valve replacement (TAVR)—A small incision is made in the leg or chest. A wire is passed through the incision to the heart. The replacement valve is sent through the wire and is placed within the original valve. This does not need as big of an incision as open surgery.
Aortic Valve Replacement—Mechanical and Bioprosthetic Valve Shown
heart valve replacement
Copyright © Nucleus Medical Media, Inc.

Lower the Risk of Problems

People with AS can take steps to try to avoid problems it can cause.

Get regular health care, including exams and tests.

Some people with AS may need antibiotics before dental or medical procedures. This could prevent heart infections. Ask the doctor if antibiotics should be taken before getting medical or dental work done.

Prevention

AS cannot be prevented.

References

  • Antibiotic prophylaxis for heart patients. Mouth Healthy—American Dental Association website. Available at: http://www.mouthhealthy.org/en/az-topics/a/premedication-or-antibiotics.
  • Aortic stenosis. EBSCO DynaMed website. Available at: http://www.dynamed.com/condition/aortic-stenosis.
  • Grimard, B.H., Safford, R.E., et al. Aortic stenosis: diagnosis and treatment. Am Fam Physician, 2016; 93 (5): 371-378.
  • Infective endocarditis. American Heart Association website. Available at: https://www.heart.org/en/health-topics/infective-endocarditis.
 
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