Aortic Stenosis

GENERAL INFORMATION:

What is aortic valve stenosis? Aortic (ay-OHR-tik) valve stenosis (ste-NOH-sis) is also called aortic stenosis or AS. It is a disease of the aortic valve in the heart. Valves act as doors between the heart chambers (rooms). They open and close to direct blood flow through the heart. The aortic valve lies between the left ventricle (lower chamber) and the aorta.

The aorta is a blood vessel that supplies blood to your head and your body, including the heart muscles. The aortic valve is made up of three cusps (flaps) attached to the aortic ring. The cusps come from the sides and top of the valve and meet in the middle. As the heart beats, the aortic valve opens to let blood flow into the aorta. When the heart rests between beats, the aortic valve should close to keep blood from flowing back.

Aortic stenosis happens when the cusps get thicker and stiffer. Stenosis means the valve opening gets smaller. When you have aortic stenosis, your heart works harder to push blood through the thick, stiff aortic cusps. Over time, the cusps cannot open wide enough to allow adequate blood to flow from your heart into your aorta.

What causes aortic valve stenosis? Some people with aortic stenosis were born with a problem with the aortic valve in their heart. The valve may have one or two cusps instead of three. The cusps may be deformed and only partly close.

As people get older, calcium can build up and make the cusps thicker and stiffer. This leads to AS.

An infection called rheumatic fever may also cause heart valve damage and AS.

What are the signs and symptoms of aortic valve stenosis? Both children and adults can have aortic stenosis. Often there are no signs of the disease until you are 40 years or older. The most common signs and symptoms of aortic stenosis are:

• Chest pain.
  
  
• Dizziness.
  
  
• Fainting.
  
  
• Shortness of breath during exercise or activities like climbing stairs.

• Fast and irregular heart beat.
  
  
• Fatigue (feeling tired more than the usual).
  
  
• Heart murmur (abnormal heart sound) when caregivers listen to your heartbeat.
  
  
• Trouble breathing especially when lying flat or with just one pillow. You may be awakened from sleep due to trouble breathing.

• 12-lead ECG: This test, also called an EKG, helps caregivers look for damage or problems in different areas of the heart. Caregivers may need to prepare your skin by shaving off some hair, or cleaning it with a gritty lotion. Sticky pads are placed on your chest, arms, and legs. Each sticky pad has a wire that is hooked to a machine or TV-type screen. A short period of electrical activity in your heart muscle is recorded. Caregivers will look closely for certain problems or changes in how your heart is working. This test takes about 5 to 10 minutes. It is important that you lie as still as possible during the test. You may need this test more than once.
  
  
• Cardiac catheterization: This is a test to see how well your heart is working. Your arteries (blood vessels) may also be checked to see if they are blocked. A special tube is threaded into your heart through a blood vessel in your leg or arm. Dye may be given so x-ray pictures of your arteries show up better on a TV-like screen.
  
  
• Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.
  
  
• Echocardiogram:
  
  
  
  
  • This test is also called an echo. It is a type of ultrasound, using sound waves to show pictures of the size and shape of your heart. An echo also looks at how your heart moves when it is beating. These pictures are seen on a TV-like screen.
    
    
  • This test is done while lying down on your back. Clear jelly will be squirted on your chest to help the ultrasound sensor slide easily. The sensor will be rubbed across your chest to see your heart from different angles. You may hear a barking or whooshing noise, which is the sound of your blood flow. Caregivers may ask you to pedal a bike during the test (exercise echo) or you may get medicine before the test to increase blood flow to your heart muscle (stress echo). This test can tell how well your heart is pumping. An echo can also find problems, such as fluid around the heart or problems with your heart valves.

• Surgery: Surgery is the only treatment to cure aortic stenosis. The procedures may include an aortic valve replacement, aortic valve repair or aortic balloon valvuloplasty. Ask your caregiver for more information about these procedures.
  
  
• Medicines: Medicines are given to prevent further damage to the aortic valves that may lead to other problems. Other medicines may be given to treat symptoms.
  
  
  • Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria.
    
    
  • Aspirin: This is medicine that may be given to help thin the blood to keep blood clots from forming.
    
    
  • Cholesterol medicine: This type of medicine is given to help decrease (lower) the amount of cholesterol (fat) in your blood.
    
    
  • Diuretics: This medicine is often called "water pills". Diuretics help your body get rid of extra fluid (edema) in your legs and ankles. This medicine may also help get rid of extra fluid in your lungs or around your heart. It may also decrease your blood pressure. You may urinate more often when taking diuretics.
    
    
  • Heart medicine: This medicine may be given to make your heart beat stronger or more regularly. There are many different kinds of heart medicines. Talk with your caregiver to find out what your medicine is and why you are taking it.

• Limit activity: Your caregiver may tell you not to exercise as much or as hard as usual. This will depend on how bad your aortic stenosis is and your symptoms. You may have to decrease or stop doing some activities even if you do not have symptoms.
  
  
• Diet:
  
  
  
  
  • Eat a variety of healthy foods every day. Your diet should include fruits, vegetables, breads, dairy products, and protein (such as chicken, fish, and beans). Eating healthy foods may help you feel better and have more energy.
    
    
  • Ask your caregiver if you should be on a special diet. You may be told to eat foods that are low in fat or cholesterol. You may also be told to limit the amount of salt you eat. Special cookbooks can make it easier to plan low fat and low salt meals.
    
    
  • Weighing too much can make your heart work harder and can cause serious health problems. Talk to your caregiver about a weight loss plan if you are overweight.

• American Heart Association National Center
  7272 Greenville Avenue
  Dallas, TX 75231-4596
  Phone: 1-800-242-8721
  Web Address: http://www.americanheart.org
  

• National Heart, Lung and Blood Institute
  Health Information Center
  P.O. Box 30105
  Bethesda, MD 20824-0105
  Phone: 1-301-592-8573
  Web Address: http://www.nhlbi.nih.gov/health/infoctr/index.htm