Aortic valve stenosis — Know It All!

Editorial

All you need to know about Aortic valve stenosis.

Know your ailment well, so you can manage it better!!

Here we come with Aortic valve stenosis today!

What is Aortic valve stenosis?

Aortic valve stenosis is also known as Aortic stenosis.

Aortic stenosis (AS) occurs when, due to the inability of the aortic valve leaflets to completely open during systole, the aortic valve orifice is greatly lowered. This results in an effective rise in post load, left ventricular hypertrophy, and signs of congestive heart failure ultimately. Angina, syncope and dyspnea are the classical triad of signs of aortic stenosis. Once signs arise, the mortality from aortic stenosis increases significantly. There is no surgical therapy to halt or reverse the progression of the condition and the ultimate cure is aortic valve repair (AVR).

What are the causes of Aortic valve stenosis?

There are four valves in your heart which keep blood flowing in the right direction. The mitral valve, tricuspid valve, pulmonary valve and aortic valve contain these valves. During each heartbeat, each valve has flaps (cusps or leaflets) that open and shut once. The valves often do not open or shut correctly, interfering with the flow of blood into the heart, and possibly impairing the capacity to pump blood through the bloodstream.

The aortic valve between the lower left heart chamber (left ventricle) and the main artery supplying blood from the heart to the body (aorta) is shortened in the case of aortic valve stenosis (stenosis).

The left ventricle must operate harder as the aortic valve is shortened to pump an adequate volume of blood into the aorta and onward to the remainder of the body. This will cause it to thicken and expand the left ventricle. Eventually, the heart’s extra function will damage the left ventricle and the heart as a whole, potentially contributing to heart disease and other complications.

Due to several reasons, aortic valve stenosis may occur, including:

Congenital Heart Defect

Three closely fitting, triangular-shaped tissue flaps called cusps constitute the aortic valve. Some infants are born with an aortic valve which, instead of three, has only two (bicuspid) cusps. People with one (unicuspid) or four (quadricuspid) cusps can also be born, but these are unusual.

Until maturity, this condition does not cause any complications, after which point the valve may start shrinking or leaking and may need to be fixed or replaced.

Getting a congenital defective aortic valve requires a doctor’s routine examination to check for symptoms of valve complications. Doctors don’t know when a heart valve fails to develop correctly in most situations, but it’s not something you should have skipped.

Accumulation of calcium in the valve.

With age, heart valves can accumulate calcium deposits (aortic valve calcification). A mineral contained in the blood is calcium. When blood flows over the aortic valve constantly, calcium deposits will build up on the cusps of the valve. These deposits of calcium are not associated with taking calcium pills or consuming calcium-fortified liquids.

No issues can ever be created by these deposits. In certain individuals, however, calcium deposits result in stiffening of the cusps of the valve, especially those with a congenitally abnormal aortic valve, such as a bicuspid aortic valve. The aortic valve is shortened by this stiffening which can occur at a younger age.

However, aortic valve stenosis is most frequent in older adults, and is associated with rising age and the deposition of calcium deposits on the aortic valve. It normally does not cause signs after 70 to 80 years of age.

Rheumatic Fever:

Rheumatic fever can be a symptom of strep throat infection which can result in scar tissue developing on the aortic valve. Scar tissue alone can narrow the aortic valve and lead to stenosis of the aortic valve. Scar tissue can also provide a rough surface on which calcium deposits can develop, leading later in life to aortic valve stenosis.

More than one heart valve can be affected by rheumatic fever, often in more than one way. A compromised heart valve, or both, could not open entirely or shut completely. While rheumatic fever is rare in the United States, as infants, some older adults had rheumatic fever.

What are the symptoms of Aortic valve stenosis?

Below are the main signs of aortic stenosis:

  • Pain in the chest (angina),
  • (Syncope) fainting, and
  • Breath shortages (due to heart failure).

The first symptom is premature death in a low number of patients with aortic stenosis, usually after strenuous exertion.

It is unclear the precise cause for the sudden death. It may be due to heart rhythm irregularities that are secondary to insufficient blood supply through the coronary arteries of the heart through the shortened aortic valve. Due to lack of blood flow to the coronary arteries, particularly during strenuous exercise, inadequate oxygen to the inner lining of the heart muscle occurs. Chest pain and probably irregular cardiac beats are caused by the loss of oxygen in the heart muscles.

In one-third of cases, chest pain is the first symptom and ultimately occurs in one-half of aortic stenosis patients. In people with aortic stenosis, chest pain is the same as chest pain (angina) experienced by coronary artery disease patients. Pain is defined as pressure below the breast bone caused by exertion and eased by rest in both of these situations. Chest pressure is due to insufficient blood flow to the heart muscles because of reduced coronary arteries in people with coronary artery disease. Chest pain frequently arises without the intrinsic weakening of the coronary arteries in people with aortic stenosis. To drive blood into the shortened aortic valve, the thickened heart muscle must pump under elevated pressure. Which raises the need for heart muscle oxygen in excess of the availability of blood, creating chest pain (angina).

Aortic stenosis-related fainting (syncope) is commonly associated with exertion or enthusiasm. These factors induce blood vessel relaxation (vasodilation) of the body, reducing blood pressure. In aortic stenosis, to compensate for the decrease in blood pressure, the heart is unable to increase performance. Blood supply to the brain, however, is diminished, inducing fainting. Fainting may also occur when an erratic heart rhythm reduces cardiac production (arrhythmia). After successful treatment, following the onset of chest pain or syncope signs, the total life expectancy is less than 3 years.

The most ominous symptom is shortness of breath from respiratory failure. It represents the inability of the heart muscle to compensate for aortic stenosis’s intense pressure load. Owing to the added pressure needed to fill the left ventricle, shortness of breath is caused by increased pressure in the blood vessels of the lungs. Shortness of breath happens initially only during exercise. Shortness of breath happens at rest as the condition progresses. It is impossible for patients to lie flat without being out of oxygen (orthopnea). Without care, following the onset of heart disease due to aortic stenosis, the total life expectancy is 6 to 24 months.

What are the risk factors of Aortic valve stenosis?

Risk factors of aortic valve stenosis include:

  • Older age
  • Certain heart conditions present at birth (congenital heart disease) such as a bicuspid aortic valve
  • History of infections that can affect the heart
  • Having cardiovascular risk factors, such as diabetes, high cholesterol and high blood pressure
  • Chronic kidney disease
  • History of radiation therapy to the chest

What are the complications of Aortic valve stenosis?

Aortic valve stenosis can cause complications, including:

  • Heart failure
  • Stroke
  • Blood clots
  • Bleeding
  • Heart rhythm abnormalities (arrhythmias)
  • Infections that affect the heart, such as endocarditis
  • Death

How is Aortic valve regurgitation diagnosed?

Your doctor can review your signs and symptoms, examine your medical history, and perform a physical examination in order to diagnose aortic valve stenosis. To decide whether you have a heart murmur that may suggest an aortic valve problem, your doctor may listen to your heart with a stethoscope. You can be examined by a specialist specialised in cardiac disorders (cardiologist).

To diagnose your condition and decide the cause and seriousness of your condition, your doctor may prescribe several tests. Tests can involve:

Echocardiography.

In order to create video clips of the heart in action, this test uses sound waves. Specialists place a wand-like instrument (transducer) on the chest during this examination. This examination may be used by physicians to measure the heart chambers, aortic valve, and blood flow through your heart. When he or she believes you have a heart valve condition, a doctor usually uses this examination to assess the condition.

This examination will help physicians look closer at the state of the aortic valve and the condition’s cause and severity. It will also help physicians decide whether you have problems or extra heart valves.

To get a closer look at the aortic valve, doctors can perform another form of echocardiogram called a transesophageal echocardiogram. In this test, a small transducer is inserted down the tube leading from your mouth to your stomach at the end of the tube (esophagus).

Electro-cardiogram (ECG).

The wires (electrodes) attached to pads on your skin measure the heart’s electrical activity in this test. An ECG can diagnose the heart’s swollen chambers, heart attack and irregular heart rhythms.

X-ray chest.

A chest X-ray will help the doctor decide whether your heart is swollen, which can lead to stenosis of the aortic valve. It will also indicate whether you have a swollen heart-leading blood vessel (aorta) or some build-up of calcium in your aortic valve. Doctors will also help assess the state of the lungs via a chest X-ray.

Stress tests.

Exercise tests allow physicians to see whether, during physical exercise, you have signs and symptoms of aortic valve dysfunction, and these tests will help assess the seriousness of the illness. Medications that have similar effects to exercising on the heart can be used if you are unable to exercise.

Computerized tomography (CT) heart scan.

To create accurate pictures of the heart and heart valves, a cardiac CT scan incorporates a set of X-rays. Doctors can use this test to determine your aorta’s size and look more closely at your aortic valve.

Cardiac MRI.

To produce accurate pictures of the heart, a cardiac MRI uses magnetic fields and radio waves. It is possible to use this procedure to evaluate the seriousness of the disease and to measure the size of your aorta.

Catheterization in heart disease. This procedure is not commonly used to detect the illness of the aortic valve, but can be used where other examinations are insufficient to diagnose or assess the severity of the disorder.

Your doctor threads a small tube (catheter) into a blood vessel in your arm or groin and leads it to an artery in your heart during this operation.

Via the catheter, doctors will administer a dye that makes the arteries become visible on an X-ray (coronary angiogram). This gives the doctor a detailed view of the vessels of the heart and how the heart functions. Within the heart chambers, it can even assess the pressure.

What is the treatment for Aortic valve stenosis?

Aortic valve stenosis treatment depends on the disease’s severity, whether you experience signs and symptoms, and whether your condition is getting worse.

Your doctor can control your condition with daily follow-up appointments if your symptoms are mild or you are not experiencing symptoms. Your doctor may prescribe that you make improvements to your healthier lifestyle and take drugs to relieve symptoms or to minimise your risk of complications.

In order to stabilise or restore the diseased aortic valve, you can finally require surgery. Your doctor may prescribe surgery in some cases, even though you are not having symptoms. Doctors can perform aortic valve surgery at the same time as you have another heart operation.

Surgery is normally done by a cut (incision) in the chest to patch or replace an aortic valve. There could be less aggressive options available and you will be reviewed by the doctor to decide whether you are a candidate for these procedures.

If you have aortic valve stenosis, recommend having a multidisciplinary team of cardiologists and other physicians and medical staff qualified and knowledgeable in the diagnosis and management of heart valve disease diagnosed and treated at a medical facility. To assess the most effective medication for your illness, this team will consult closely with you.

Choices for surgery include:

Aortic valve repair

Biological valve replacement

Surgeons seldom patch an aortic valve for the treatment of aortic valve stenosis, and aortic valve stenosis usually involves the removal of an aortic valve. Surgeons can detach valve flaps (cusps) that have fused in order to repair an aortic valve.

Balloon valvuloplasty

Doctors may perform a procedure to fix a valve with a narrow opening using a long, thin tube (catheter) to (aortic valve stenosis). In this operation, referred to as balloon valvuloplasty, a doctor implants a catheter into the artery in the arm or groyne with a balloon on the tip and directs it to the aortic valve. Then the doctor doing the operation inflates the balloon, which extends the valve’s opening. Then the balloon is deflated and the balloon and catheter are removed.

In infants and children, the treatment may treat aortic valve stenosis. In adults who have had the operation, though, the valve continues to close again, so it is generally only done in adults who are too ill for surgery or who are waiting for a valve repair, since they normally require additional operations over time to manage the shortened valve.

Aortic valve replacement

Mechanical valve replacement

To treat aortic valve stenosis, aortic valve replacement is also required. Your surgeon removes the weakened valve during aortic valve repair and replaces it with a mechanical valve or valve made of animal, pig or human heart tissue (biological tissue valve).

Over time, biological tissue valves degenerate and can potentially need to be replaced. In order to avoid blood clots, people with mechanical valves will continue to take blood-thinning drugs for life. Your doctor will discuss the advantages and risks of each form of valve with you and discuss which valve may be best for you.

Transcatheter aortic valve replacement (TAVR)

Doctors can perform a less invasive procedure to repair a narrowed aortic valve, called transcatheter aortic valve replacement (TAVR). For people known to be at moderate or high risk of complications from surgical aortic valve repair, TAVR can be an alternative.

Doctors inject a catheter into your leg or chest in the TAVR and aim it to your heart. A new valve is then implanted and directed to the heart by the catheter. The valve can be extended by a balloon, or several valves may self-expand. Physicians remove the catheter from the bloodstream while the valve is inserted.

A catheter operation can also be performed by doctors to instal a new valve into a failed biological tissue valve which is no longer operating properly. Other catheter operations need to be studied to restore or replace aortic valves.

How to prevent yourself from getting Aortic valve stenosis:

Any potential ways of avoiding stenosis of the aortic valve include:

Take precautions to stop the rheumatic fever. By making sure that you visit a doctor anytime you have a sore throat, you can do this. Rheumatic fever may turn into untreated strep throat. Fortunately, with antibiotics, strep throat can usually be easily treated. In children and young adults, rheumatic fever is more widespread.

Addressing coronary heart disease risk factors. That includes high blood pressure, obesity, and elevated levels of cholesterol. This causes may be connected to aortic valve stenosis, so if you have aortic valve stenosis, maintaining your weight, blood pressure, and cholesterol levels under control is a smart idea.

Take note of the gums and teeth. Infected gums (gingivitis) and infected heart tissue may have a link (endocarditis). Heart tissue inflammation caused by infection can widen arteries and aggravate stenosis of the aortic valve.

Your doctor may prescribe that you restrict strenuous exercise to prevent overworking your heart until you know that you have aortic valve stenosis.

References:

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https://www.healthline.com/health/aortic-stenosis

https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-problems-and-causes/problem-aortic-valve-stenosis

https://www.medicinenet.com/aortic_stenosis/article.htm

https://www.webmd.com/heart-disease/aortic-valve-stenosis#1

https://www.healio.com/cardiology/learn-the-heart/cardiology-review/topic-reviews/aortic-stenosis/introduction-and-etiology

https://emedicine.medscape.com/article/150638-overview

https://www.mayoclinic.org/diseases-conditions/aortic-stenosis/symptoms-causes/syc-20353139