What is aortic valve stenosis?

Aortic valve stenosis is a problem with the aortic valve in your heart. The aortic valve is located between the lower left side of your heart and the big blood vessel (aorta) that carries blood to the rest of your body. Before each beat, the left side of your heart fills with oxygen-rich blood that has passed through your lungs. Then your heart muscle squeezes to push blood into your aorta and out to the rest of your body. When blood pushes against the aortic valve, the valve opens. At the end of the squeeze, the valve closes tightly, so that no blood flows backwards into your heart.

When you have aortic valve stenosis, the valve opening is narrow and does not open all the way. When this happens, your heart must work harder to pump blood to your body. This makes the heart larger and thicker. It may become stiff and stop working properly.

What is the cause?

Several things can cause aortic valve stenosis:

• A buildup of calcium on the valve. Calcium is a mineral that is very important for bone health and heart health. Calcium goes into your blood, and in some people, calcium builds up on the valve as blood flows through it. Why this happens in some people but not others is not known.
• Being born with an abnormal aortic valve that is partly stuck together. This stops the valve from opening normally. If this birth defect is very severe, it needs treatment at a very young age. If the defect is not as severe, you may need valve replacement surgery later in life.
• Scarring of the aortic valve by rheumatic fever or other diseases.

What are the symptoms?

With mild stenosis there are usually no symptoms, but aortic valve stenosis usually worsens with time. After the age of 60 you may start having symptoms. The first symptom is usually shortness of breath when you are physically active. With more severe valve blockage, you may have fainting spells. You may also have chest pain.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Your provider will use a stethoscope to listen for the sound of a heart murmur caused by the blocked valve.

Tests may include:

• A chest X-ray
• An ECG (also called an EKG or electrocardiogram), which measures and records your heartbeat. You may have an ECG while you are resting or while you exercise on a treadmill.
• An echocardiogram, which uses sound waves (ultrasound) to see how well your heart is pumping and to look at the valves
• A Doppler exam, which uses sound waves (ultrasound) to look at the blood flow in your blood vessels
• Heart catheterization, which uses a small tube called a catheter inserted into a blood vessel, dye, and X-rays to show how blood flows through the aortic valve

How is it treated?

In the early stages of the disease, you may not need treatment. If you start having symptoms, you may need surgery. Children may have surgery to open a fused valve. Adults are more likely to have valve replacement surgery. Two types of artificial heart valves are available:

• Mechanical valves are made completely from man-made materials. When you have a mechanical valve, you must take blood-thinning drugs for the rest of your life to reduce the risk of blood clots. The main advantage of mechanical valves is that they usually last 20 years or more.
• Biological valves are made from human or animal tissue. The main advantage of a biological valve is that you do not need to take blood-thinning drugs for the rest of your life. These valves usually last up to 15 years.

Surgery to replace the aortic valve can improve both the quality and length of your life.

How can I take care of myself?

Follow the full course of treatment prescribed by your healthcare provider.

A healthy lifestyle may also help:

• Eat a healthy diet. Ask your provider about the benefits of talking to a dietician to learn what you need in a healthy diet.
• Try to keep a healthy weight. If you are overweight, lose weight.
• Stay fit with the right kind of exercise for you.
• Limit caffeine.
• Learn to manage stress. Ask for help at home and work when the load is too great to handle. Find ways to relax, for example take up a hobby, listen to music, watch movies, or take walks. Try deep breathing exercises when you feel stressed.
• If you smoke, try to quit. Talk to your healthcare provider about ways to quit smoking.
• If you want to drink alcohol, ask your healthcare provider how much is safe for you to drink.
• Try to get at least 7 to 9 hours of sleep each night.

Ask your healthcare provider:

• How and when you will hear your test results
• How long it will take to recover
• What activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup.

Tell all healthcare providers you see that you have aortic valve stenosis. Damaged, abnormal, or artificial heart valves are more likely to get infected by bacteria, which can cause severe problems. Antibiotics can prevent this. Ask your healthcare provider if you should take an antibiotic before any kind of dental work or surgery. This includes having your teeth cleaned or procedures involving the bladder, vagina, or rectum.

How can I help prevent aortic valve stenosis?

Aortic valve stenosis may be caused by rheumatic fever. See your healthcare provider if you have a sore throat without other symptoms or if you have been exposed to strep throat. Treating strep throat infections with antibiotics can usually prevent rheumatic fever.