Diseases & Conditions

Aortic Stenosis


Overview, Causes, & Risk Factors

Aortic stenosis is a narrowing of the opening of the aortic valve. The aortic valve is a flap-like opening located between the left side of the heart and the aorta. The aorta is the main artery carrying blood from the heart.

What is going on in the body?

The heart is divided into two halves, right and left. Each side has a pumping chamber, called a ventricle. The left ventricle receives blood from the lungs. During a heartbeat, the left heart chamber squeezes, generating enough pressure to open the aortic valve. Blood from the left side is then pumped into the aorta and out into the body. When aortic stenosis has occurred, the opening of the valve is narrower than normal. This reduces the amount of blood flow to the body.

What are the causes and risks of the condition?

The causes of aortic stenosis include:

  • calcium deposits that harden, or calcify, the valve
  • congenital heart disease from heart defects present at birth
  • scarring of the valve from rheumatic heart disease

  • Symptoms & Signs

    What are the signs and symptoms of the condition?

    Common symptoms of aortic stenosis include:

  • coughing at night
  • fainting, especially with physical activity
  • fatigue
  • shortness of breath that worsens at night or with exertion
  • visual impairments
  • The coronary arteries, which carry oxygen to heart muscles, may be deprived of blood. That can cause heart pains called stable angina or unstable angina. This type of pain has been described as a tightness, squeezing, or pressing sensation in the middle of the chest. The pain commonly extends into the left shoulder and down the arm.

    The severity of symptoms is not always related to the severity of the disease. In fact, people sometimes die suddenly from aortic stenosis without having had symptoms.


    Diagnosis & Tests

    How is the condition diagnosed?

    Diagnosis of aortic stenosis begins with a history and physical exam. The healthcare provider also may do one or more of these tests:

  • cardiac catheterization
  • chest X-ray
  • echocardiogram with or without color Doppler studies
  • electrocardiogram (EKG)

  • Prevention & Expectations

    What can be done to prevent the condition?

    In many cases, nothing can prevent aortic stenosis. Proper treatment of rheumatic fever with antibiotics can prevent damage to the aortic valve.

    What are the long-term effects of the condition?

    As the aortic valve slowly narrows, it deprives body organs of blood. Serious long-term effects may include:

  • congestive heart failure, a condition in which the weakened heart is unable to pump enough blood throughout the body
  • coronary heart disease
  • enlargement of the left ventricle, which cuts down the output of the heart still more
  • pulmonary edema, or congestion in the lungs
  • sudden death
  • What are the risks to others?

    Aortic stenosis is not contagious, and poses no risk to others.


    Treatment & Monitoring

    What are the treatments for the condition?

    A goal of treatment is to allow the heart to get more blood into general circulation. Various medicines can help improve overall blood supply to the body and the heart. They can also help reduce the person's symptoms.

    In some cases, surgery is recommended to correct the aortic stenosis. Balloon valvuloplasty is a technique that lowers the pressure across the valve by slightly enlarging the opening. This is usually done when someone is not stable enough for corrective surgery. More often, heart valve surgery is performed to correct the problem with the aortic valve.

    What are the side effects of the treatments?

    Medicines used to treat aortic stenosis can cause a variety of side effects. Surgery can cause bleeding, infection, or allergic reaction to anesthesia.

    What happens after treatment for the condition?

    Successful replacement of the valve restores normal blood flow. The long-term outcome is usually very good. Artificial valves wear out over a period of years. Their function is monitored, and the valves are replaced as necessary. Some artificial valves require that the person take:

  • antibiotics before and after surgeries or dental work to avoid serious heart infections
  • blood-thinning drugs to avoid blood clots, such as deep venous thrombosis
  • How is the condition monitored?

    An individual with aortic stenosis will have regular visits with the healthcare provider. The provider may order regular electrocardiograms and echocardiograms to detect any signs of deterioration. Any new or worsening symptoms should be reported to the provider.


    Attribution

    Author:Eric Berlin, MD
    Date Written:
    Editor:Crist, Gayle P., MS, BA
    Edit Date:09/14/01
    Reviewer:Gail Hendrickson, RN, BS
    Date Reviewed:09/17/01

    Sources

    Merck Manual 1999

    Current Medical Diagnosis and Treatment 1996

    Harrison's Principles of Internal Medicine 1991

    Heart Disease: A Textbook of Cardiovascular Medicine, Braunwald, E., 1980