ADAM Health Encyclopedia

Aortic stenosis

Definition

Aortic stenosis is the narrowing or obstruction of the heart's aortic valve, which prevents it from opening properly and blocks the flow of blood from the left lower chamber of the heart to the aorta. The aorta is the main artery leaving the heart.

Alternative Names

Causes

As the aortic valve becomes more narrow, the pressure increases inside the left heart ventricle. This causes the left heart ventricle to become thicker, which decreases blood flow and can lead to chest pain. As the pressure continues to increase, blood may back up into the lungs, and you may feel short of breath. Severe forms of aortic stenosis prevent enough blood from reaching the brain and rest of the body. Lightheadedness and fainting can result.

Aortic stenosis may be present from birth (congenital), or it may develop later in life (acquired). Children may have other congenital conditions.

Aortic stenosis is caused by many disorders. One common cause in adults is rheumatic fever, a complication of untreated strep throat. Calcification of the valve can also cause this condition. In this case, the condition is usually not seen until a person reaches their 70s.

Aortic stenosis is not very common. It occurs more often in men than in women.

Symptoms

• Breathlessness with activity
• Chest pain, angina-type
  • Under the chest bone, may move to other areas
  • crushing, squeezing, pressure, tightness
  • Pain increases with exercise, relieved with rest
• Fainting, weakness, or dizziness with activity
• Sensation of feeling the heart beat (palpitations)

Children born with aortic stenosis may show symptoms of shock, poor feeding, failure to thrive, and shortness of breath.

Note: People with aortic stenosis may not have any symptoms until later in the course of the disease.

Exams and Tests

The health care provider will be able to feel a vibration or movement when placing the hand over the heart. A heart murmur, click, or other abnormal sound is almost always heard through a stethoscope. There may be a faint pulse or changes in the quality of the pulse in the neck. A change in neck pulse is called pulsus parvus et tardus.

Infants and children may be extremely tired, sweaty, and have pale skin and fast breathing. They may also be too small for their age.

Blood pressure may be low.

The following tests may be performed:

• Chest x-ray
• Doppler ultrasonography
• ECG
• Echocardiogram
• Exercise stress testing
• Left cardiac catheterization
• MRI of the heart
• Transesophageal echocardiogram (TEE)

Treatment

If there are no symptoms or symptoms are mild, you may only need to be monitored by a health care provider. If symptoms are moderate to severe, you may need to stay in the hospital. Infants and children may need immediate surgery.

Patients with aortic stenosis are usually told not to play competetive sports, even if they don't have symptoms. If symptoms do occur, strenuous activity must be limited.

Patients who have breathing problems, fainting spells, or chest pain or pressure with activity, should see a cardiologist every 3 to 6 months.

Drugs used to help control symptoms include digoxin and diuretics ("water pills").

Surgery to repair or replace the valve is the preferred treatment for adults or children who have symptoms. Even if symptoms are not very bad, the doctor may recommend surgery. Some high-risk patients are poor candidates for heart valve surgery.

A less invasive procedure called balloon valvuloplasty may be done in adults or children instead. This is a procedure in which a balloon is placed into an artery in the groin, advanced to the heart, placed across the valve, and inflated. This may relieve the obstruction caused by the narrowed valve.

Infants and children may have various forms of surgery. If the diagnosis is isolated aortic stenosis, the pulmonary valve may be used to replace the aortic valve.

Outlook (Prognosis)

Aortic stenosis can be cured with surgery, although there may be a continued risk for irregular heart rhythms, which can sometimes cause sudden death. The person may be symptom-free until complications develop. Without surgery, a patient who has signs of angina or heart failure may do poorly.

Persons with aortic stenosis, particularly moderate and severe forms, should not participate in strenuous activities, such as competitive sports.

Possible Complications

• Left ventricular hypertrophy (enlargement) caused by the extra work of pushing blood through the narrowed valve
• Left-sided heart failure
• Arrhythmias
• Endocarditis

When to Contact a Medical Professional

Call your health care provider if you or your child have symptoms of aortic stenosis. For example, call if you or your child have a sensation of feeling the heart beat (palpitations) for more than a short period of time.

Also contact your doctor if you have been diagnosed with this condition and your symptoms get worse or new ones develop.

Prevention

Treat strep infections promptly to prevent rheumatic fever, which can cause aortic stenosis. This condition itself often cannot be prevented, but some of the complications can be.

Notify the health care provider or dentist about any history of heart valve disease before treatment for any condition. Any dental work, including cleaning, and any invasive procedure can introduce bacteria into the bloodstream. This bacteria can infect a weakened valve causing endocarditis.

Follow the health care provider's treatment recommendation for conditions that may cause valve disease. Notify the provider if there is a family history of congenital heart diseases.

Otto CM, Bonow RO. Valvular heart disease. Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. St. Louis, Mo: WB Saunders; 2007: chap 62.

Karchmer AW. Infective Endocarditis. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 8th ed. St. Louis, Mo: WB Saunders; 2007: chap. 63.