Aortic Stenosis: Narrowed Heart Valve, Symptoms and Next Steps

What it involves

The MedlinePlus encyclopedia explains that the aorta is the main artery carrying blood out of the heart, and blood enters it through the aortic valve. In aortic stenosis the valve does not open fully, which decreases the blood flow from the heart. It can be present from birth, but most often it develops later in life.

Who this is for

• Adults told they have a heart murmur who have never had it looked into.
• Patients with chest tightness, breathlessness or unusual tiredness when they exert themselves.
• People who feel faint or weak, or have passed out, during activity.
• Older adults, since MedlinePlus says aortic stenosis occurs in about 2% of people over 65.

What to expect

• Questions about chest discomfort, breathlessness, dizziness and fainting, and what brings them on
• A physical exam that includes listening to the heart and checking the pulse in the neck and your blood pressure
• An EKG at the Loxahatchee and West Palm Beach offices and blood work, which the practice offers
• A referral for a heart ultrasound (echocardiogram) and to a heart specialist when those are needed

What narrows the valve

MedlinePlus says aortic stenosis mainly happens through a buildup of calcium deposits that narrow the valve, which mostly affects older people. Calcium builds up sooner in people born with an abnormal or bicuspid valve, and rarely after chest radiation. Rheumatic fever, which can follow strep throat or scarlet fever, is another cause, though valve problems take 5 to 10 years or longer to develop and rheumatic fever is rare in the United States. It occurs more often in men than in women.

Why it takes time to notice

The encyclopedia explains that as the valve narrows, the left ventricle has to work harder, its walls thicken, and that can lead to chest pain. As pressure continues to rise, blood may back up into the lungs, and severe narrowing can limit the blood reaching the brain and body. Because most people feel nothing early on, the diagnosis is often made when a provider hears a murmur, and the heart murmur guide explains what different murmurs mean and when one needs follow-up.

Symptoms and what they look like day to day

Chest discomfort that is tight or squeezing, breathlessness on exertion and tiredness are the classic signs. Breathing problems with effort are also covered in the shortness of breath guide, and an unexplained racing or fluttering heartbeat is covered in the atrial fibrillation guide. Fainting with activity deserves particular attention, and the fainting guide explains how a provider sorts out the causes of passing out. Tell your provider whether symptoms come only with exertion, because that detail helps point to the heart.

How it is diagnosed

MedlinePlus says a heart murmur, click or other abnormal sound is almost always heard through a stethoscope, and the pulse in the neck may be faint or blood pressure low. Aortic stenosis is most often diagnosed and then monitored with a transthoracic echocardiogram, a heart ultrasound. Other tests can include an electrocardiogram, exercise stress testing, left heart catheterization, a heart MRI and a transesophageal echocardiogram. The practice offers an EKG at the Loxahatchee and West Palm Beach offices; the echocardiogram and other heart tests are done through a cardiology referral.

Treatment and monitoring

The encyclopedia says regular checkups with a provider may be all that is needed if symptoms are not severe, and that checkups should include a health history, a physical exam and an echocardiogram. People with severe narrowing may be told not to play competitive sports. Medicines treat symptoms of heart failure or abnormal rhythms, and high blood pressure should be treated; the cardiomyopathy guide describes another heart muscle problem that can cause similar breathlessness. Surgery to repair or replace the valve is often done when symptoms develop, and a less invasive balloon procedure or a transcatheter valve replacement may be used.

When to be seen and when it is an emergency

MedlinePlus says to contact your provider if you have symptoms of aortic stenosis, and right away if you have been diagnosed and symptoms get worse or new ones develop. Call 911 for chest pain that does not ease with rest, fainting, severe breathlessness, or chest pain with sweating, nausea or pain spreading to the arm or jaw. The chest pain guide explains how to decide between calling and booking a visit. Severe narrowing can limit the blood reaching the brain, so never drive yourself to the ER with these symptoms.

Sources

• MedlinePlus Medical Encyclopedia: Aortic stenosis
• MedlinePlus: Heart Valve Diseases