Aortic stenosis is a valvular heart disease that affects blood flow from the heart to the rest of the body. It is characterized by narrowing of the opening of the aortic valve, located between the left ventricle (the heart’s main pumping chamber) and the aorta (the main artery that carries blood to the body). This valve controls the flow of blood from the heart to the aorta, the body’s main artery. The narrowing makes it harder to pump blood, forcing the heart to work harder. This can weaken the heart over time and cause various health problems.
Symptoms of aortic stenosis
The symptoms of aortic stenosis can vary widely, from mild to severe, and may even be absent in the early stages. Many people with mild or moderate aortic stenosis do not experience symptoms for years. However, as the disease progresses, the symptoms may become more noticeable and include:
Chest pain (angina):
it is caused by a lack of adequate blood flow to the heart muscle.
Fainting (syncope):
caused by reduced blood flow to the brain.
Shortness of breath (dyspnea):
especially during exercise due to fluid buildup in the lungs.
Fatigue:
a feeling of extreme tiredness, even after minimal effort.
A feeling of fast or irregular heartbeats (palpitations).
perception of strong, fast, or irregular heartbeats.
The severity and presentation of symptoms can vary significantly from person to person. Some people may not experience any symptoms until the stenosis is severe.
Classification of aortic stenosis
To determine the severity of aortic stenosis and guide treatment, a classification is used based on the degree of valve narrowing, the speed of blood flow through the valve, and the pressure gradient between the left ventricle and the aorta. This classification helps doctors to determine the level of urgency of treatment.
Mild: the narrowing of the valve is minimal and generally does not cause significant symptoms.
Moderate: the narrowing is more significant and may begin to cause symptoms, especially during physical exercise.
Severe: the narrowing is severe and generally causes noticeable symptoms, even at rest.
Critical: the narrowing is extremely severe and requires urgent treatment.
Causes of aortic stenosis
Aortic stenosis develops due to changes in the structure and function of the aortic valve. These changes can be congenital or acquired throughout life. The most common causes are:
Rheumatic fever: it is a rare complication of an untreated streptococcal infection, such as strep throat. Rheumatic fever can cause inflammation and damage to the heart valves, including the aortic valve. Over time, chronic inflammation can cause scarring and narrowing of the valve, leading to aortic stenosis. Although rheumatic fever was a common cause of aortic stenosis in the past, its incidence has decreased significantly thanks to the use of antibiotics to treat streptococcal infections.
Calcification: calcification of the aortic valve is the most common cause of aortic stenosis in adults, especially in people over 65 years of age. This process involves the gradual accumulation of calcium deposits on the valve leaflets. The pathophysiology of valvular calcification is complex and similar to atherosclerosis, which affects the arteries. Inflammation, oxidative stress, and endothelial dysfunction are believed to play a significant role in the development of calcification. Over time, calcium deposits harden the valve leaflets, reducing their flexibility and preventing them from opening and closing properly. This obstructs blood flow through the valve, forcing the heart to work harder.
Congenital bicuspid aortic valve: it is a congenital anomaly in which the aortic valve has two leaflets instead of the usual three. This condition is present in approximately 1–2% of the population. Genetics plays an important role in the development of a bicuspid aortic valve, although the exact cause is not fully understood. Several genes have been identified that may be involved. The bicuspid valve is more prone to calcification and the development of aortic stenosis at an earlier age than the normal tricuspid valve. The increased mechanical stress on the two leaflets may contribute to premature degeneration and calcification.
Aortic stenosis, if left untreated, can lead to various complications that affect the health of the heart and the body in general. It is important to know these possible complications in order to understand the importance of early diagnosis and treatment. Some of these complications are:
Heart failure.
Abnormal heart rhythms (arrhythmias).
Endocarditis.
Stroke.
Sudden cardiac death.
Diagnosis of aortic stenosis
The diagnostic process for aortic stenosis involves a series of tests and assessments to determine the presence and severity of the condition. An accurate diagnosis is essential to determine the most appropriate treatment.
Physical examination: the initial evaluation usually begins with a complete physical examination. During cardiac auscultation with a stethoscope, the doctor may detect a systolic murmur, a characteristic sound produced by the turbulent flow of blood through the narrowed aortic valve. The intensity and characteristics of the murmur can provide clues about the severity of the stenosis.
Electrocardiogram (ECG): this test records the electrical activity of the heart and may show signs of left ventricular hypertrophy (thickening of the heart muscle of the left ventricle), which is a common response to aortic stenosis. The ECG can also detect cardiac arrhythmias. However, the ECG is not specific for aortic stenosis, and it may be normal in mild cases.
Chest X-ray: a chest X-ray may show an enlarged heart, which may be a sign of aortic stenosis. It may also show calcification of the aortic valve.
Echocardiogram: this is the most important test for diagnosing aortic stenosis. It uses sound waves to create images of the heart and valves, allowing the doctor to evaluate the structure and function of the aortic valve. Doppler echocardiography, a specialized form of echocardiography, measures the speed of blood flow through the aortic valve, helping to determine the severity of the stenosis. A transesophageal echocardiogram can also be used, in which a probe with a transducer is inserted into the esophagus to obtain more detailed images of the aortic valve. At HM Hospitales, we have advanced echocardiography technology, including transesophageal echocardiography and 3D echocardiography, for an accurate diagnosis.
Cardiac catheterization: it is an invasive procedure that is used less frequently in the diagnosis of aortic stenosis, generally when echocardiogram results are inconclusive or additional information about the coronary arteries is needed. During this procedure, a thin, flexible catheter is inserted into an artery in the leg or arm and guided to the heart. A contrast agent is injected to visualize the coronary arteries and the chambers of the heart. Cardiac catheterization provides accurate information about the pressure gradient across the aortic valve and left ventricular function.
Treatments for aortic stenosis
Treatment options for aortic stenosis vary depending on the severity of the condition and the presence of symptoms. The goal of treatment is to relieve symptoms, improve heart function, and prevent complications.
Regular follow-up: in mild or asymptomatic cases, the doctor may recommend regular follow-up with echocardiograms to monitor the progression of the stenosis. The frequency of follow-up will depend on the severity of the stenosis and the presence of other risk factors.
Medications: medications can be used to control symptoms associated with aortic stenosis, such as high blood pressure, angina, and heart failure. Commonly used medications include diuretics, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, and calcium channel blockers. However, it is important to note that no medication can cure aortic stenosis or reverse valve narrowing.
Surgical aortic valve replacement (SAVR): it is an open-heart surgical procedure in which the damaged aortic valve is removed and replaced with a prosthetic valve. Prosthetic valves can be mechanical (made of synthetic materials) or biological (derived from animal or human tissue). Mechanical valves are more durable, but require lifelong anticoagulation. Biological valves do not require long-term anticoagulation, but they have a limited lifespan.
Transcatheter aortic valve replacement (TAVR): TAVR is a less invasive procedure than SAVR. A catheter is inserted into an artery, usually in the groin, and advanced to the aortic valve. A new valve is implanted inside the damaged aortic valve through the catheter. TAVR is an option for patients at high surgical risk or who are not candidates for open-heart surgery.
The choice between SAVR and TAVR is based on a careful assessment of the patient’s individual characteristics, including age, general health status, and aortic valve anatomy.
Remember that this article is for informational purposes only and does not replace professional medical advice. If you suspect you have aortic stenosis, consult a specialist to obtain an accurate diagnosis and an appropriate treatment plan tailored to your needs.
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