AORTIC STENOSIS

Aortic stenosis is narrowing in the aortic valve, where blood leaves the left ventricle and enters the aorta. This narrowing causes the left ventricle to do more work. Like other muscles in the body forced to work hard, the ventricle thickens to generate more force. The abnormality in the valve may have several causes. Among young persons, it is usually from congenital abnormalities (those present at birth). Some persons are born with damaged valves or have a two-sided (bicuspid) aortic valve instead of a normal, three-sided valve.

Aortic stenosis may occur among 1% to 2% of the population. Rheumatic fever from streptococcal infections early in life or heart disease such as cardiomyopathy may damage the valve and affect normal or damaged valves later in life. The most common cause is calcium and cholesterol deposits on the valve that occur as we age. Aortic stenosis is about three times more common among men than among women.

Most persons with aortic stenosis have no symptoms early. If the valve narrows enough to create flow problems, you may have fatigue, fainting, chest pain, or symptoms of left heart failure, such as shortness of breath. As the left ventricle thickens, that side of the heart enlarges. A chest radiograph (x-ray) shows this abnormality. Your doctor hears a heart murmur in a specific area over the heart. A murmur is a sound made by the flow through an abnormal valve. An echocardiogram (ultrasound examination of the heart) is obtained to confirm the diagnosis and check the severity of the stenosis.

If you have no symptoms, the condition merely is checked each year. Because abnormal valves may be the targets of some bacterial infections, you should take antibiotics as prescribed before and after dental or surgical procedures. If the stenosis is mild, you may exercise moderately without many difficulties.

If the stenosis is moderate or severe or there are symptoms, you need to limit your exertion because overexertion can worsen symptoms quickly. You may need medications to help control the symptoms of heart failure or arrhythmias that may occur. An operation to replace the valve may be necessary.

The best treatment is to take all medications prescribed and to closely monitor for changes in symptoms. Antibiotics are necessary before and after dental or surgical procedures. Diuretics reduce the excess fluid in the blood. Taking diuretics may cause dehydration or electrolyte problems. Vasodilator medicines such as nitrates reduce the workload of the heart. These drugs may cause headaches or symptoms of low blood pressure such as fainting or lightheadedness. Digitalis (digoxin) used for heart failure helps the heart contract better. The level of this drug in the blood must be measured periodically with a laboratory test.

• Take your medications as directed.
• Stop smoking.
• Start a salt-restricted diet and lose weight if you have congestive heart failure.

• Do not neglect worsening symptoms.
• Do not forget to take your antibiotics before and after dental or surgical procedures.

• If easy exercise is becoming difficult. Rest until evaluated by your doctor.
• If symptoms of heart failure or heart disease occur, such as chest pain, shortness of breath, palpitations or rapid heartbeat, or fainting.

The American Heart Association has information on heart murmurs and heart valve defects. Call 1-800-242-8721 and ask for the literature department.




Aortic stenosis. (From LaFleur-Brooks ML: Exploring medical language–a student directed approach, ed 3, St Louis, 1993, Mosby. Used by permission.)

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