Diseases

Aortic Stenosis – Causes, Symptoms & Treatment

Aortic stenosis

In aortic stenosis , the transition between heart and aorta is narrowed due to heart valve damage. The heart has to work harder to pump blood through the constriction and will suffer long-term damage if left untreated.

What is aortic stenosis?

Aortic stenosis is a heart valve defect that narrows the outflow tract of the left ventricle. As a result of the narrowing ( stenosis ), there is pressure on the left heart, which in many cases leads to left heart failure .

Symptoms of aortic stenosis are dizziness, shortness of breath and syncope (fainting) during exertion, cardiac arrhythmias and angina pectoris attacks. Depending on the localization of the stenosis, a distinction is made between three forms of the disease. The so-called valvular stenosis is characterized by narrowing of the aortic valve (typical aortic stenosis).

In a supravalvular stenosis, the narrowing is above the aortic valve. The so-called subvalvular stenosis is caused by a membranous thickening of the outflow tract or a hypertrophic obstructive cardiomyopathy (thickening of the muscles of the left ventricle).

causes

In general, a distinction is made between degenerative (acquired) and congenital (congenital) aortic stenoses. Congenital stenoses are mostly due to morhological anomalies (malformations) of the heart valve.

The affected valve can consist of only two leaflets (bicuspid aortic valve) instead of three, which only allow a small opening. Those affected between the ages of 40 and 60 usually suffer from acquired valve stenosis. This can manifest as a result of rheumatic fever or bacterial endocarditis (inflammation of the inner lining of the heart).

In those affected from the age of 60, the disease can be traced back to aortic sclerosis (calcifying valve stenosis or senile form) in the majority of cases. Additional risk factors for acquired aortic stenosis are smoking , renal insufficiency (reduced kidney function), hypercalcaemia (elevated calcium concentration in the blood), high blood pressure and diabetes mellitus .

Symptoms, Ailments & Signs

In the worst case, aortic stenosis can lead to the death of the person concerned. However, this case usually only occurs if the aortic stenosis is not treated. Since this does not lead to self-healing, those affected are dependent on treatment in any case. The patients primarily suffer from severe dizziness and also from shortness of breath .

In serious cases, this can lead to a loss of consciousness, which can also injure the person concerned. Loss of consciousness can also occur without physical exertion. Due to aortic stenosis, many of those affected also suffer from cardiac arrhythmias and thus cardiac pain .

If left untreated, this eventually leads to permanent damage to the heart and sudden cardiac death . The surrounding vessels are also damaged by the aortic stenosis, so that further disease can develop without treatment. The patients often appear exhausted and tired, although this tiredness cannot be counteracted with the help of sleep. The patient’s resilience is also significantly reduced. In many cases, the limitations in everyday life also lead to psychological problems, so that patients with aortic stenosis are dependent on psychological treatment.

Diagnosis & History

In the auscultation, a murmur (systolic heart murmur ) can be heard in the contraction phase due to the changed hemodynamics (flow dynamics of the blood ). In terms of differential diagnosis, aortic stenosis must be differentiated from mitral valve insufficiency , pulmonary stenosis and ventricular septal defects by further examinations.

An echocardiography can reveal left ventricular hypertrophy and a fibrotically thickened or calcified valve with reduced mobility. In addition, a chest X-ray shows a dilated aorta (aortic dilation and elongation). The valve opening area and the pressure gradient can be determined by means of color Doppler echocardiography and heart catheter examination .

Initially, aortic stenosis is mostly asymptomatic. The first symptom is usually exertional dyspnea (exercise-related shortness of breath) with syncope . Since the upstream sections of the heart have to exert more force to pump the blood through the constriction into the systemic circulation, the heart muscle thickens as it progresses and requires more oxygen. However, the coronary vessels supplying them are located after the narrowing.

There is reduced blood flow and further damage to the heart muscle (left-sided heart failure). About one fifth of those affected die as a result of sudden cardiac death from ventricular fibrillation or AV blockage (atrioventricular conduction disorder). For those affected who have undergone surgery, the 10-year survival rate is more than 65 percent. If left untreated, the prognosis for aortic stenosis is poor.

complications

Complications that can occur as a result of untreated aortic stenosis are ultimately caused by the impeded flow of blood through the aortic valve. The congenital or later acquired reduced cross-sectional area in the area of ​​the aortic valve causes reduced supply to the entire body, including the brain.

This is especially noticeable after physical exertion. Shortness of breath, exhaustion and short-term fainting spells (syncope) can be the result. On the other hand, the heart tries to compensate for the reduced supply of arterial blood to the body by increasing the pumping capacity of the left ventricle. As a result, the heart muscle in the left ventricle thickens and requires more oxygen.

As a rule, however, this does not work because the supplying coronary arteries only branch off behind the stenosis. In addition to dizziness, shortness of breath and brief fainting spells, untreated aortic stenosis typically leads to other complications such as cardiac arrhythmias and coronary heart disease as a result of undersupply. The most common cardiac arrhythmia in this context is the so-called atrial fibrillation.

In uncoordinated, high-frequency atrial contractions, this is not immediately life-threatening, but it leads to a significant loss of performance and can be very uncomfortable. The complications described above can be largely avoided by treating the aortic stenosis. Apart from the risk of the operation and the requirement that you may have to take anticoagulants ( blood thinners ) for life, no other complications are to be expected.

When should you go to the doctor?

If you experience cardiac arrhythmias, dizziness or swelling in your limbs, you should consult your family doctor or a cardiologist immediately. If there is a concrete suspicion of aortic stenosis, the doctor can carry out an echocardiography and rule out the disease or determine it beyond doubt. Ideally, the disease is diagnosed at an early stage, i.e. with the first symptoms such as increasing shortness of breath, anxiety and chest tightness. Anyone who notices these symptoms should speak to their family doctor directly.

In the early stages, aortic stenosis can usually be corrected before serious complications develop. At the latest when swelling of the ankles and lower legs, severe shortness of breath and heart palpitations occur, a doctor’s visit is necessary. Although complications have often arisen by then, serious illnesses such as blood clots and heart failure can still be avoided. In general, aortic stenosis should be diagnosed and treated as early as possible. Even after the treatment, you should consult your cardiologist regularly. This allows abnormalities to be clarified promptly and serious consequences to be avoided.

Treatment & Therapy

The treatment strategy for aortic stenosis depends on the severity of the disease. In the case of mild and asymptomatic stenoses, initially conservative drug therapy with diuretics and digitalis ( cardiac glycosides ) may be sufficient.

Those affected should generally avoid heavy physical exertion. Endocarditis prophylaxis is indicated to reduce the risk of bacterial infection of the damaged valves. This includes that those affected seek medical advice as soon as possible at the first sign of an infectious disease (including fever ) in order to be able to initiate antibiotic therapy at an early stage if necessary. In addition, antibiotic therapy should be carried out prior to surgical interventions (including dental operations) to avoid infection .

With the majority of those affected, a surgical intervention is unavoidable in the further course to avoid left ventricular failure. In the case of acquired stenoses in particular, a valve replacement operation is usually carried out. Mechanical prostheses made of plastic or metal, biological prostheses (usually prepared pig valves) or human valve transplants can be used as valve replacements.

If artificial valves are used, lifelong anticoagulation (medicinal anticoagulation) is required. In addition, in the case of congenital stenoses, balloon dilation of the aortic valve via a cardiac catheter may be indicated. Here, the damaged flap is stretched and at the same time overgrown flaps are blown open. In children with congenital aortic stenosis, the damaged valves are increasingly removed and replaced by the body’s own pulmonary valves.

Unlike artificial valves, these grow in the normal rhythm with the child’s organism and enable normal stress and sporting activities after the operation. The transplanted pulmonary valves are replaced with foreign human valves (homograft). In all cases, regular follow-up examinations are required.

Outlook & Forecast

People who suffer from aortic stenosis often have no symptoms for years. If symptoms then occur, consequential damage to the heart has often already developed. In most cases, the patients also suffer from various concomitant diseases such as anemia, hypertension or COPD , which overlaps with the heart symptoms.

If an aortic stenosis is not treated, this can lead to serious consequences, since blood clots can form on the calcified aortic valve due to blood flow and travel to the brain. If they block a vessel there, the blood supply is cut off and the patient suffers a stroke . Untreated aortic stenosis can also lead to cardiac arrhythmia, ventricular fibrillation and even death.

With surgical treatment, however, the prognosis for aortic stenosis is very good. However, the prognosis varies from patient to patient, as it depends on the general condition or the severity of the disease and any concomitant diseases. The prognosis has been significantly improved by replacing the aortic valve, so that older patients in particular with aortic stenosis are now as old as people who do not suffer from aortic stenosis.

prevention

The best possible prophylaxis for degenerative stenoses is to reduce the risk factors. On the one hand, nicotine consumption should be avoided and, on the other hand, diseases such as rheumatic fever, diabetes mellitus, endocarditis, renal insufficiency and high blood pressure should be treated adequately and at an early stage. Congenital aortic stenosis, on the other hand, cannot be prevented.

aftercare

Severe forms of aortic stenosis require surgery, which entails regular follow-up examinations. An important point of contact is the general practitioner. He arranges blood tests and electrocardiograms. Sometimes a cardiologist is called in for follow-up care.

Examinations are carried out at short intervals immediately after the operation. After several years without symptoms, an annual follow-up examination is sufficient. Mild forms of aortic stenosis, on the other hand, do not require any special therapy. Patients should only avoid physical exertion. Immunity to heart problems does not build after treated aortic stenosis. This forces those affected to be less careful in everyday life.

The patient himself plays an important part. He must perceive the warning signs of his body and consult a doctor if necessary. Fever, infections and bleeding tendencies in particular can affect the heart. Endocarditis is a risk after heart surgery.

It can lead to death if left untreated. In everyday life you should avoid stress and, if necessary, cut back on your career. Cigarette consumption is considered to be extremely harmful to the heart. You should therefore avoid nicotine altogether. During the initial diagnosis, a doctor provides information about the everyday consequences.

You can do that yourself

A diagnosed aortic stenosis, synonymous with aortic valve stenosis, is assigned to one of three degrees of severity: mild, moderate or severe. While general symptoms such as shortness of breath on exertion, fainting spells or pain in the chest area cannot be overlooked in the moderate and severe grades of severity, there are usually no subjective symptoms recognizable in the case of mild aortic valve stenosis.

Despite the valve defect, sporting activities to strengthen and stabilize the cardiovascular system are recommended. In the case of mild aortic stenosis, there are no restrictions on exercise, provided there are no other symptoms during exercise. In the case of moderate aortic valve stenosis, endurance sports should be practiced without uncontrollable peak loads. Hiking, Nordic walking, cycling, swimming and playing golf on courses that are as level as possible are particularly suitable.

Most ball sports that involve peak loads that are difficult to control are not well suited. The stress on the cardiovascular system and physical training as a self-help measure lead to an improved general condition. However, it is very likely that the activities probably have no influence on the further course of the disease.

If there is a high-grade valve stenosis, physical activity is hardly possible because the performance limitations are too serious and any performance demands can lead to acute problems. In severe cases of aortic stenosis, neither self-help measures nor drug treatment are effective, so that suitable surgical or corrective interventions should be considered.

Website | + posts

Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.