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:
- Chest pain caused by poor blood flow to the heart muscle
- Fainting (because you aren’t getting enough blood to your brain)
- Heart failure -- a weakened heart that doesn’t pump well
- Arrhythmias -- abnormal heart rhythms caused by irregular blood flow through the heart
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 she makes a cut down your chest wall and opens your rib cage.
Or she 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.
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.