Aortic valve stenosis (often referred to as aortic stenosis) occurs when the aortic valve in your heart becomes narrow or blocked. It interferes with the normal flow of blood out of the heart, causing heart damage, serious health problems, and even death. Because it restricts blood flow and limits the amount of oxygen your body receives, you may feel chest pain, difficulty breathing, and dizziness.

The severity of the condition determines aortic stenosis treatment. The valve may need to be repaired or replaced surgically. Severe aortic valve stenosis may be fatal if not treated.

Who is affected by aortic valve stenosis?

Aortic stenosis is more common in older adults and becomes more common after age 65. Some diseases can also cause its development in people when they reach middle age. In rare cases, children may be born with an aortic valve defect that causes aortic stenosis.

How common is aortic stenosis?

Aortic stenosis is Australia’s most common valve condition, with prevalence increasing as the population ages. Up to 100,000 Australians are thought to be living with a severe form of aortic stenosis. Unfortunately, many people don’t know they have the disease until it causes symptoms or a screening or diagnostic test detects the condition.

What causes aortic stenosis?

Aortic stenosis

Source: What is aortic stenosis?

The aortic valve is one of the heart’s four valves. This particular valve is the last of four valves through which blood passes before being pumped back into your body. The aortic valve usually has three flaps, called leaflets, that open to allow blood to pass through and close tightly to prevent blood from flowing back into the final cavity.

When there isn’t enough blood flowing through the aortic valve, it’s called anaemia. Sometimes, the valve cannot close tightly, causing blood to flow in the wrong direction – called reflux. Either of these problems means too much blood left in the heart’s last chambers. The pressure in this chamber causes your heart to work harder than usual, possibly damaging the heart.

Adult aortic stenosis has three primary causes in adults:

Wear due to age

Over time, calcium can build up on valves — similar to the effect cholesterol has on blood vessels with atherosclerosis — restricting blood flow. Living habits are also affected if and when narrowing occurs. This type of stenosis most commonly occurs after age 65.

Damage caused by infection

When bacteria from untreated infections enter your bloodstream, they can build up on your heart valves, causing your immune system to damage the valves on its own. This is more likely to happen with strep throat or scarlet fever, which, when left untreated, can cause rheumatic fever. This disease can damage your heart valves and is commonly seen in people over 50. It can take years or decades before damage to your heart valves becomes apparent.

Caused by other genetic or chronic diseases

Other rare conditions that can cause aortic stenosis are Paget’s disease of the bones, kidney failure, and familial hypercholesterolemia. Aortic stenosis is also associated with autoimmune or inflammatory diseases such as lupus and rheumatoid arthritis.

How is aortic stenosis diagnosed?

If aortic stenosis is suspected, your GP may refer you to a cardiologist. A cardiologist will usually diagnose this condition based on your symptoms (if any) and may suggest one or more of the following diagnostic tests:

Physical examination

Doctors check the legs and ankles for swelling and may listen to the heartbeat. Doctors often hear a heart murmur using a stethoscope, a vital sign of aortic stenosis.

Electrocardiogram (ECG or EKG)

It uses sensors attached to the skin on the chest to measure the heart’s electrical activity.

Chest X-ray, angiography, or cardiac CT scan

Each of these methods uses x-rays to look inside the body. CT images also use a computer to enhance the image. Angiography or cardiac CT examinations also use a contrast agent visible on X-rays or CT. The contrast agent allows the specialist to see the structure of the heart and surrounding blood vessels.

Echocardiogram

This test uses ultrasound to give your healthcare provider a picture of the inside of your heart. A particular type of echocardiogram is the transesophageal echocardiogram – where a device is inserted through the mouth into the oesophagus (which runs just behind the heart). This method allows the provider to see the heart more closely than an echocardiogram.

Running a stress test

This test measures heart function during activity. This test helps determine whether you have aortic stenosis and its severity.

Cardiac catheter

A device is inserted into one of the arteries (usually the femoral artery near the groin) and threaded up to the heart so that a specialist can look inside the heart to determine if you have aortic stenosis.

Cardiac MRI

This imaging method provides a detailed scan of the heart. Instead of using radiation like X-rays or CT scans, MRI uses powerful magnetic fields to create pictures inside the body.

Prevention

Ways to prevent aortic stenosis include the following:

1. Take measures to prevent rheumatic fever: Seek medical attention if you have a sore throat. A sore throat is usually easily treated with antibiotics. If left untreated, a sore throat can develop into rheumatic fever. The prevalence of rheumatic fever is higher in children and young adults.

2. Keep your heart healthy: Ask your doctor about your risk factors for heart disease and how to prevent or treat it. These include high cholesterol, obesity, and hypertension. These risk factors may be associated with aortic stenosis.

3. Tooth and gum care: There may be a relationship between infected gums (gingivitis) and infected heart tissue (endocarditis). Inflammation of heart tissue caused by infection can narrow arteries and exacerbate aortic stenosis.

When should I contact my doctor?

If you decide not to seek treatment, or have not yet done so, contact your doctor if any of the following occur:

1. If new symptoms of aortic stenosis develop or if one of the symptoms suddenly worsens.

2. When your symptoms interfere with your life.

Message from Heartscope Specialist Group

Initiating a conversation with your doctor at an early stage regarding your risk of aortic stenosis can have a significant impact on your life. Aortic stenosis is a complex issue, but advancements in surgical and catheter-based technologies have greatly improved our ability to treat this condition. If you experience symptoms of aortic stenosis, it is crucial to speak with your doctor or consider scheduling an appointment with the Heartscope Specialist Group for a discussion.