Definition:
Aortic stenosis is a valvular heart condition in which the aortic valve is abnormal such that blood flow is restricted from the left ventricle to the aorta. Consequently, there is increased pressure in the left ventricle to compensate for this restriction to allow adequate blood flow to the rest of the body, and this pressure overload causes the left ventricle to hypertrophy (increase thickness in the walls). Causes include: congenital aortic stenosis (valve has only 2 leaflets instead of 3), senile calcific aortic stenosis (from degeneration and calcium deposits on valve due with aging), and rheumatic aortic stenosis (with history of rheumatic fever).
Symptoms:
- Angina - chest pain; 50% of patients with this symptom die within 5 years of onset unless valve is replaced
- Syncope - fainting spell with exercise; patients with this symptom die within 2-3 years of onset unless valve is replaced
- Heart Failure - symptoms include shortness of breath on exertion, shortness of breath while lying flat, and shortness of breath that cause one to wake up at night; patients with this symptom die within 1-2 years of onset unless valve is replaced
Diagnosis:
- Physical Examination - a systolic "crescendo-decrescendo" murmur heard on stethoscope exam
- Chest X-Ray - may be able to see calcification of aortic valve, heart size normal
- EKG - to evaluate for left ventricle hypertrophy
- Echocardiography - estimates the degree of stenosis and left ventricle function
- Cardiac catheterization - used for diagnosis and severity of the disease by measuring pressure gradient across valve
Treatment:
- Medications - diuretcs and digitalis (for temporary relief only)
- Balloon valvuloplasty - to increase size of valve, used for temporary relief
- Aortic valve replacement - in patients with symptoms and increased pressure gradient. See Aortic valve repair in Procedures for details.
