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Aortic stenosis


Alternative Names:

Aortic valve stenosis; Left ventricular outflow tract obstruction; Rheumatic aortic stenosis; Calcium aortic stenosis

Causes, incidence, and risk factors:

As the aortic valve becomes more narrow, the left ventricle has to increase pressure to pump blood out through the valve. To do this extra work, the muscles in the ventricle walls become thicker, which can lead to chest pain.

As the pressure continues to rise, blood may back up into the lungs. Severe forms of aortic stenosis prevent enough blood from reaching the brain and the rest of the body.

Aortic stenosis may be present from birth (congenital), but usually it develops later in life (is acquired). Children with aortic stenosis may have other congenital conditions.

In adults, aortic stenosis usually occurs due to calcium deposits that narrow the valve. This is called calcific aortic stenosis, and it generally affects older people. 

The other common cause is rheumatic fever, a condition that may develop after strep throat or scarlet fever. Valve problems do not develop for 5 - 10 years or longer after rheumatic fever occurs. Rheumatic fever is increasingly rare in the United States.

Calcification of the valve happens sooner in patients who are born with abnormal aortic or bicuspid valves. In rare cases, calcification can also occur more quickly in patients who have received radiation treatment to the chest.

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

Symptoms:

People with aortic stenosis may have no symptoms until late in the course of the disease. The diagnosis may have been made when the health care provider heard a heart murmur and performed tests.

Symptoms of aortic stenosis include:

  • Breathlessness with activity
  • Chest pain, angina-type
    • Crushing, squeezing, pressure, tightness
    • Pain increases with exercise, is relieved with rest
    • Pain is felt under the chest bone but may move to other areas, most often the left side of the chest
  • Fainting, weakness, or dizziness with activity
  • Sensation of feeling the heart beat (palpitations)

In infants and children, symptoms include:

  • Becoming easily tired with exertion (in mild cases)
  • Failure to gain weight
  • Poor feeding
  • Serious breathing problems that develop within days or weeks of birth (in severe cases)

Children with mild or moderate aortic stenosis may get worse as they get older. They also run the risk of developing a heart infection (bacterial endocarditis).

Signs and tests:

The health care provider will be able to feel a vibration or movement when placing a 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 (this is called pulsus parvus et tardus).

Blood pressure may be low.

The following tests may be performed:

  • Chest x-ray
  • Doppler echocardiography
  • ECG
  • Exercise stress testing
  • Left cardiac catheterization
  • MRI of the heart
  • Transesophageal echocardiogram (TEE)
Expectations (prognosis):

Without surgery, a person with aortic stenosis who has angina, fainting (syncope), or signs of heart failure will usually do poorly.

Aortic stenosis can be cured with surgery. After surgery there is a risk for irregular heart rhythms, which can cause sudden death, and blood clots, which can cause a stroke. There is also a risk that the new valve will develop problems (become narrowed or leaky) and will need to be replaced.

Complications:
  • Angina (chest pain)
  • Arrhythmias
  • Endocarditis
  • Fainting (syncope)
  • Left-sided heart failure
  • Left ventricular hypertrophy (heart wall thickening) caused by the extra work of pushing blood through the narrowed valve
Calling your health care provider:

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

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

References:

Bonow RO, Carabello BA, Chatterjee K, de Leon AC Jr., Faxon DP, Freed MD, et al; 2006 Writing Committee Members; American College of Cardiology/American Heart Association Task Force. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients with Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2008;118:e523-e661.

Carabello BA. Valvular heart disease. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 75.

Nishimura RA, Carabello BA, Faxon DP, et al. ACC/AHA 2008 guideline update on valvular heart disease: focused update on infective endocarditis: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2008;52(8):676-685.

Otto CM, Bonow RO. Valvular heart disease. In: Bonow RO, Mann DL, Zipes Dp, Libby P, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. St. Louis, Mo: WB Saunders; 2011:chap 66.


Review Date: 6/4/2012
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

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