Aortic stenosis
Also called: AS, Calcific aortic valve disease
The aortic valve narrows and stiffens, usually from calcium build-up with age, so the heart must work harder to push blood into the aorta. Once symptoms appear, the valve needs replacing.
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About 2–5% of people over 75.
What happens in the body
Progressive calcification of the valve leaflets restricts opening. The left ventricle thickens to overcome the pressure load, eventually failing.
Causes
- Age-related calcification (most common)
- Bicuspid aortic valve (congenital, presents earlier)
- Rheumatic heart disease
Risk factors
- Older age
- Bicuspid valve
- Hypertension, high cholesterol, smoking, kidney disease
Symptoms
- Breathlessness on exertion
- Chest pain (angina)
- Dizziness or fainting on exertion
- Fatigue
- Heart murmur found on examination
Diagnosis — tests and examinations
- Ejection systolic murmur radiating to the neck
- Echocardiography (valve area, gradients)
- ECG
- CT scan to plan valve replacement
- Exercise testing in apparently asymptomatic severe AS
Treatment
Medicines and medical treatment
- No medicine slows the valve narrowing; treat blood pressure and heart failure symptoms carefully
- Regular echocardiographic follow-up
Operations and procedures
- Transcatheter aortic valve implantation (TAVI) through a leg artery
- Surgical aortic valve replacement (mechanical or tissue valve)
- Balloon valvuloplasty as a bridge
Self-care, home remedies and lifestyle
- Avoid very strenuous exertion once severe
- Good dental hygiene to lower endocarditis risk
- Report new symptoms promptly
Possible complications
- Heart failure
- Sudden death
- Arrhythmias
- Infective endocarditis
Prevention
- Treating cardiovascular risk factors may help; bicuspid valves need lifelong surveillance
Outlook
Severe symptomatic AS is fatal within a few years without valve replacement; after replacement, life expectancy returns towards normal.
When to see a doctor
See a doctor for exertional breathlessness, chest pain or fainting, especially if you have a known murmur.
Sources and further reading
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