When the heart’s aortic valve narrows, a condition called aortic valve stenosis occurs. That is the technical name for a narrowing that prevents the valve from fully opening, a situation which blocks the blood flow from the heart into the aorta. The result is the heart works much harder to pump blood to the rest of the body, causing it to eventually weaken.

The condition, sometimes shortened to aortic stenosis, is sometimes a sign that surgery may be needed to replace the valve. Without such surgical intervention in severe cases, serious heart problems will develop.

There are five important considerations for any person suffering from aortic stenosis to know:

1. There is a range of possible levels of aortic valve stenosis, ranging from mild to severe.
2. Surgery is not necessary in all cases.
3. While medications can’t cure aortic stenosis, symptoms can be eased, postponing surgery.
4. There is nothing you can do to prevent the problem. It is congenital or caused by body chemistry.
5. Many symptoms of heart problems mimic those of aortic valve stenosis.

SYMPTOMS

Symptoms of severe aortic valve stenosis include chest pain or tightness in the chest; getting light-headed or fainting on exertion, shortness of breath with even mild exertion, extreme fatigue, particularly during times of increased activity; and heart palpitations, usually manifested in a rapid heartbeat. In severe cases, the ankles and feet will swell.


If left untreated, patients with severe cases may wind up with heart failure.

Aortic stenosis has subtle warning signs in the earliest stages, and many patients don’t realize their problems or symptoms at first. Many patients learn of the issues during routine physical exams, when an abnormal heart murmur is typically the first sign of trouble.  

Although older people are more likely to develop problems, infants and young children can have aortic stenosis. Many of them will show no symptoms save for chest pain following vigorous exercise.

WHAT CAUSES IT

Several conditions can cause the problem. Most likely it is a congenital heart defect. The aortic valve has three tightly fitting flats of triangular-shaped tissue called leaflets. Some younger people can be born with less, and the issue may not be discovered until adulthood, when the valve begins to lag or leak.  If it is discovered earlier, the patient will have to be regularly evaluated by a doctor in order to detect any worsening of the valve issue. Because it is a birth defect, medical professionals are not sure why the issue develops.

The aortic stenosis condition can also be caused by a calcium build-up on the valve. As we age, calcium can accumulate in small deposits, including on the aortic valve leaflets. While some build-up is normal with this condition and may not cause problems, an increase in age means greater accumulation of calcium, and the resulting weaker heart condition can morph into the aortic stenosis condition. The aortic stenosis is more common in men over age 65 and women over age 75.

Rheumatic fever can also be an issue that causes aortic valve stenosis. A complication that stems from strep throat infections, rheumatic fever can leave scar tissue on the aortic valve. The weight of that scar tissue can narrow the valve and lead to aortic valve stenosis. It can also leave a surface that calcium can accumulate on, doubling the risk factors as the afflicted ages.


Rheumatic fever can damage more than one heart valve at a time and can harm it in several ways - the valve may not close properly or may not fully open. While rheumatic fever is a relatively rare condition in the United States, some older adults have had it as children. and travel to a third world country brings a risk of contracting it in countries where medical care is lax.

Finally, aortic valve stenosis can develop as a result of chronic kidney disease. The impurities of the body, including calcium, are not efficiently processed, leading to aortic valve issues.

DIAGNOSIS

A complete physical exam is usually the pathway where complaints of chest pains can lead to a diagnosis of aortic valve stenosis. But there will usually be several tests administered to confirm the diagnosis and get an accurate picture of the severity of the issue.

Among the tests that may be administered:

1. Echocardiogram - This uses sound waves to produce a heart image and is the primary test used to diagnose aortic valve stenosis. Sound waves are directed toward the heart using a device (The transducer) held to the patient’s chest. The sound waves will reflect back and be processed to provide an electronic image of your heart in action. These will be used to closely watch the heart and heart valves in action, and may be used over several examinations to see the progression of the condition. In some cases, the patient may be sedated while a transducer is guided into the esophagus to get a more detailed pictures of the heart.  
2. Electrocardiogram (ECG) -- In this test, you are wired with electrode patches attached to the skin. These monitor the electrical impulses of the heart, which are recorded. The ECG, as it’s known, can tell if the ventricle is thickened or enlarged, a common problem with aortic valve stenosis.
3. Chest X-rays - In some cases, a doctor may order a chest X-ray to see the shape and size of the heart. This can also indicate whether the left ventricle is enlarged and whether calcium deposits are affecting the aortic valve.  
   

4. Cardiac Catheterization - If the other tests aren't providing a clear picture of what’s going on in the heart, the doctor may order a thin tube (catheter) to be inserted through the arm or groin, then guided to an artery in the heart.
5. Angiogram - This is done in conjunction with the injection of dye into the arteries, helping an X-ray show any blockages that may be present and whether the condition of aortic stenosis is at work

There are other measurements, including exercise tests that are monitored, CT scans and magnetic resonance imaging scans that can be used to monitor the heart.

While any issue with the heart requires serious medical attention, a diagnosis of aortic valve stenosis is not a death sentence. Medications can help with symptoms, and you may go years without needing surgery if the condition is mild. As long as a doctor is keeping a close eye on the issue, many patients can live a relatively normal life.