One of the most common and most serious valve problems is called aortic valve stenosis.
Stenosis can mean that the leaflets or cusps of your valve have thickened or scarred and don’t open as well as they should. So with each beat, less blood leaves the heart to go out and nourish your body.
Over time, the heart has to work harder to pump enough blood out to all your
How the Heart Works
Your heart has four valves that open and close in a steady rhythm to circulate blood through your body when they are working right.
The aortic valve is the last of the four valves that blood passes through before leaving the heart. By the time blood has reached there, it’s already been through the lungs and picked up another round of oxygen for your body.
The job of the aortic valve is to pump that oxygen-rich blood into the aorta, the largest blood vessel in your body.
Causes of Aortic Valve Stenosis
Several conditions can cause your aortic valve to thicken. Among them are:
Calcium buildup: Your blood carries calcium, among other minerals and nutrients. As blood passes through the aortic valve year after year, calcium deposits can form on the valve. This can make it stiffer, so it won’t fully open.
Heart defect from birth: A normal aortic valve has three flaps, or cusps, that fit snugly together. Some people are born with an aortic valve that has one, two, or even four cusps. The heart can function just fine this way for years.
But as you move into adulthood, the abnormal valve is more likely to get stiffer and not open as well. This type of congenital heart defect can be treated by repairing or replacing the valve.
Rheumatic fever: Though this complication from strep throat or scarlet fever isn’t nearly as common as it once was, it can still pose a threat. Rheumatic fever can scar the aortic valve. Scar tissue makes it easier for calcium to build up on the valve.
When you have mild aortic valve stenosis, you may never feel any symptoms. It can often take a long time for symptoms to become more noticeable. Gradual signs of a weakening heart can sometimes be overlooked.
For serious cases, there are some symptoms worth noting. They include:
- Shortness of breath, especially during exercise
- Chest pain or tightness
- Feeling faint or lightheaded
- Heart palpitations (rapid or fluttering heartbeat)
- Heart murmur (an extra beat in between your usual heartbeats)
Sometimes a family member or a friend will notice a change in your behavior or energy level before you become aware of it.
Who Is More Likely to Get This?
Older adults are much more likely than younger people to get aortic stenosis. This is because calcium buildup on the valve tends to happen over many years.
Also, if you’ve had rheumatic fever or you are dealing with ongoing kidney disease, you may have a greater chance of having a problem with your aortic valve.
Being born with an abnormal aortic valve means you may have aortic valve stenosis later in life.
When your aortic valve won’t open normally, your heart can’t pump all the blood building up inside it.
This can cause blood to back up elsewhere in the heart, and even back into the lungs. To make up for this problem, your heart muscle will try to pump harder to get that blood to the body.
Some of the complications that can result from an overworked heart include:
For many people, a routine checkup reveals the first sign of aortic valve stenosis. A doctor listening to your heart with a stethoscope may hear a “whooshing” sound or an extra heart beat sound. This is known as a heart murmur. It often indicates valve trouble, but not always.
After a full exam and a review of your medical history, your doctor may order a few tests. They include:
Echocardiogram: This imaging test uses sound waves to create a picture of your heart’s structure. An echocardiogram can often tell whether your valve has thinned.
Electrocardiogram: This measures electrical activity in the heart. It can help your doctor find out where there has been any heart failure, possibly caused by aortic valve stenosis.
Exercise stress test: During the test, you will walk briskly on a treadmill or ride a stationary bicycle to increase your heart rate. If you don’t have symptoms, seeing how your heart responds to exercise can help your doctor diagnose aortic valve stenosis, as well as other heart problems.
Cardiac catheterization: If there is not yet enough evidence, your doctor may ask you to have this procedure. During it, your doctor threads a thin, flexible tube into your arm. A special dye and an X-ray “movie” show a more detailed look at your heart’s valves and chambers.
If you’re not having symptoms and your heart is otherwise healthy, you usually don’t need to treat mild aortic stenosis. It may be something that your doctor keeps tabs on with regular checkups.
When medications aren’t enough to keep things in check, a couple of options include:
Aortic valve replacement: It’s done with mechanical valves made of metal or with valve tissue from cows, pigs, or human donors.
Your surgeon may replace the valve using traditional open-heart surgery, during which they make a cut down your chest wall and open your rib cage.
Or they may go with a catheter procedure called transcatheter aortic valve replacement (TAVR). TAVR is a less invasive procedure, meaning your surgeon uses much smaller cuts than with open-heart surgery. People usually have an easier time recovering and have less discomfort with this procedure.
Which one you and your surgeon decide to go with depends on the details of your specific case.
Balloon valvuloplasty: This procedure is usually for infants and kids with aortic valve stenosis. It’s less effective for adults.
In the procedure, a doctor guides a catheter (a long, flexible tube) through a blood vessel and into the heart. At the tip of the catheter is a deflated balloon. When the tip reaches the valve, the balloon is inflated, pushing open the stiff valve and stretching the cusps.
What to Expect After Aortic Valve Procedures
Your recovery from aortic valve stenosis treatment depends on the type of procedure and how healthy you were beforehand.
Every case is different, but most people spend roughly a week in the hospital and can return to an office job in 4 to 6 weeks. You might need more time off work if your job requires you to be very active. If you have a less-invasive procedure, you may need less recovery time, both in the hospital and at home.
Right after surgery
You’ll be in an intensive care unit (ICU). No matter what procedure you choose, you’ll wake up in an ICU, probably with a breathing tube in your throat. The tube comes out as soon as your doctors are sure you’re breathing well on your own. That’s usually within a couple of hours. You’ll get pain medicine to help keep you comfortable.
You’ll need to do deep breathing and coughing to clear your lungs. This is an important part of your recovery, but it can hurt after surgery. You’ll probably get a pillow to hold to your chest to help ease the pain.
Staff will track all your vital signs. You’ll hear a lot of beeping machines.
When you’re ready, you’ll move from the ICU to another area of the hospital. This is sometimes called a step-down unit. You can usually have more visitors once you’ve moved.
Your hospital stay
Within days, you should be out of bed for longer and longer periods. You’ll be eating and drinking, going to the bathroom, and taking short walks around the hospital.
If you have drainage tubes in your chest, those come out a day or so after surgery. The process may be slightly painful but shouldn’t be too bad.
Before you go home, you should be spending most of the day out of bed. Some hospitals set specific goals -- such as walking 150 feet and climbing a flight of stairs -- that you must reach first.
You’ll need someone to drive you home and help care for you during the first part of your recovery.
Your doctors will let you know how to care for your surgical cuts, or “incisions.” It’s OK to take showers.
Activity is an important part of your recovery. You can’t undo the repair by walking. It’s good to gradually push your limits. Your doctor will give you guidelines on ramping up your exercise. You’ll need to avoid lifting heavy objects for the first few weeks.
You may feel some pain in your chest, back, neck, or shoulders. If your appetite is off or food tastes strange, that’s normal. Your body might have trouble controlling your temperature, so you could feel unusually hot or cold at times. These are all symptoms that will go away.
Your sleep may not be great after surgery. That’s common. And you might need a nap in the middle of the day for the first few weeks you’re home. Your energy level should gradually get better.
If you’re very aware of your heartbeat, that’s normal. If you have a mechanical replacement valve, you may hear a clicking sound in your chest. That’s just the valve opening and closing.
Getting back to normal
Driving. Your doctor will help you decide when it’s safe to drive again, usually around 3 weeks after your operation. If you’ve had open-heart surgery, though, remember that your breastbone is still healing and is very vulnerable in an accident.
Work. When you go back to work is up to you. It depends on how your recovery is going and how demanding your job is. You might be able to return after 3 or 4 weeks, or you might need to take more time.
Sex. As with any other physical activity, you can start having sex again when you feel well enough. Be cautious about trying to support your weight on your arms, though.
Depression. Some people become depressed during recovery from heart surgery. Staying active can help. But you should let your doctor know of any concerns about your moods. Even a few sessions of counseling might help, and there are medicines for this.
Diet. Your doctor may give you a specific diet to follow. If not, eating in a way that’s heart-healthy -- lots of vegetables, lean proteins, whole grains instead of processed grains (think brown rice instead of white), and limiting added sugars, sodium, and saturated fat -- is good for your whole body.
Exercise. Your doctor will give you guidelines on exercise. You should aim to get at least 150 minutes of activity a week. That’s 30 minutes a day, 5 days a week.
You can’t always stop aortic valve stenosis from happening. For instance, there’s nothing you can do about a heart defect from birth. But high blood pressure, high cholesterol, and obesity are linked with aortic valve stenosis, and those are issues you can control.
And if you ever have strep throat, be sure to treat it with a full round of antibiotics to prevent it from becoming rheumatic fever.
If you get rheumatic fever, it can also be treated with antibiotics.
The better you can manage some of these issues and the earlier you act on your symptoms, the less your chances of developing valve problems one day.
Tips for Living With Aortic Valve Stenosis
You’ll want to take special care of your heart. There are steps you can take, in addition to the treatment plan your doctor recommends, to keep your heart as healthy as you can. The goal is to manage the condition well.
Go to all your planned doctor visits. How often you check in with your doctor will depend on the symptoms you have and how far along your condition is. If it’s moderate or severe, you may need to see your cardiologist twice a year. If it’s mild, you may need only a yearly exam and an echocardiogram every 1 or 2 years.
Take your meds. Follow your doctor’s orders and take any drugs exactly as prescribed. These medicines can help keep your heart from working too hard and can prevent blood clots and infections.
Stay active, safely. Working out is good for your heart, even if you have aortic stenosis. First, check with your doctor about what’s OK to do. Ask if there are any physical activities you should avoid. You’ll also want to know how long your heart rate can safely be raised and if you need to track how high it gets during a workout.
Ask questions. Notice new or changing symptoms? Don’t ignore them. Call your doctor with any concerns that you may have.
Care for your teeth and gums. Aortic stenosis makes infective endocarditis, a severe infection of the heart lining and valves, more likely. It’s caused by bacteria getting into your bloodstream -- even through your gums. To prevent this, brush your teeth twice each day and get regular cleanings. Let your dentist know that you have aortic stenosis.
Don’t put off surgery. Your doctor may advise surgery to repair or replace your damaged valve. This may sound daunting, but most people find that their symptoms improve. Without treatment, your chance of heart failure -- which means your heart doesn’t pump blood as well as it should -- will rise.
Get support. If a heart condition makes you feel anxious or depressed, talking about these concerns may make you feel better. Confide in loved ones or ask your doctor to refer you to a counselor.
Get to a healthy weight. Being overweight or obese puts a strain on your heart. If most of your fat is around your waist rather than your hips, your risk for health problems rises even more. Writing down the foods you eat and when you exercise can help you spot unhealthy patterns you need to change.
Work to manage your stress. Everyone feels anger, sadness, and anxiety from time to time. But if they’re out of control, it can take a toll on your emotional and physical health. You need healthy ways to relax, such as exercise, meditation or prayer, spending time with loved ones, and laughing more. Talking with a counselor can also help.
Watch what you eat. Aim for a diet that’s rich in whole grains, lean protein, fruits, and vegetables. Eating more meals at home will help you build better eating habits. When you can, avoid highly processed foods. Many products that come in a bag or box tend to have sodium, sugar, and unhealthy fats that you can do without.
Manage other health conditions. If you also have diabetes and other types of heart disease, make it a priority to take care of those conditions.
Cut down on drinking. Alcohol can raise the amount of some fats in your blood. It can also boost your blood pressure and put more strain on your heart. Limit yourself to no more than one glass of beer or wine a day if you’re a woman and two glasses if you’re a man.
Quit smoking. The chemicals in tobacco smoke harm your blood vessels and keep your heart from working as well as it should. Talk to your doctor about ways you can break this habit. Many hospitals and local community groups offer free classes or support groups to help you meet your goal. If you’ve tried to quit before, that’s OK. Keep trying, and ask your doctor what you might do differently this time to help this change stick.