Aortic Valve Stenosis – Diagnosis and Treatment
Diagnosis
Aortic stenosis means the aortic valve in the heart does not fully open. This makes it hard for blood to move from the left ventricle to the body.
A doctor starts by asking about symptoms, such as chest pain, shortness of breath, fainting, or tiredness. They also check the medical history for any risk factors or family history of heart valve disease.
A health professional listens to the heart with a stethoscope. If a narrowed heart valve exists, a murmur may indicate it. Blood pushes through the tight valve, creating a whooshing noise.
Doctors pay close attention to the type and timing of the murmur, as it can give clues about how severe the aortic stenosis is.
Ways to Confirm Aortic Valve Narrowing
Doctors use a few key tests to find out if a person has aortic stenosis and how bad it is. Here are the main tools and tests:
Echocardiogram
- This test uses sound waves to make moving pictures of the heart. These pictures show how well blood moves through the heart and out the aortic valve.
- Different kinds exist:
- Transthoracic Echocardiogram (TTE): The usual type, done by moving an ultrasound device over the chest.
- Transesophageal echocardiogram (TEE): The doctor puts a thin tube with a probe down the throat, which gives a closer look at the heart.
- Echocardiograms show the shape and movement of the valve leaflets. They also reveal if the left ventricle has thickened (left ventricular hypertrophy) from working too hard.
- The test can also spot other issues, like a bicuspid aortic valve or leaking (regurgitation).
Electrocardiogram (ECG/EKG)
- Small patches track the heart’s electrical signals from the chest and limbs.
- This test helps find skipped beats, thickened heart muscles, or signs of damage due to valve disease.
Chest X-ray
- An X-ray image helps doctors check if the heart is bigger than normal (which can happen when the ventricle works harder).
- It can also show calcium buildup on the aortic valve and signs of heart failure, such as fluid in the lungs.
Exercise Stress Test
- The person may walk on a treadmill or pedal a stationary bike while the heart’s activity is monitored.
- The test checks for symptoms of aortic stenosis—like chest pain or dizziness—during activity, and sees how well the heart copes with stress.
- For those unable to exercise, doctors may give medicine that makes the heart pump faster, simulating exercise.
Cardiac CT Scan
- This test uses many X-ray pictures to create a detailed view of the heart and the aortic valve.
- A cardiac CT scan shows how much calcium is on the aortic valve and checks if the aorta or valve has any unusual shapes or sizes.
Cardiac MRI
- Powerful magnets and radio waves create detailed images of the heart and valves.
- It helps show the size of the aorta and provides extra details about how severe the stenosis is.
Cardiac Catheterization
- Doctors use this less often, but sometimes need it if other tests are not clear.
- A thin tube is slid through a blood vessel in the groin or arm to the heart.
- This test measures pressure in the heart chambers and can locate blockages in the heart arteries before heart surgery.
How Doctors Sort the Stages of Valve Disease
Doctors sort aortic valve disease into four stages, based on symptoms and how much the valve is affected:
| Stage | Description |
|---|---|
| A | At risk (factors for aortic stenosis are present) |
| B | Mild or moderate valve changes, no symptoms |
| C | Very severe narrowing, but no symptoms yet |
| D | Severe disease with clear symptoms |
Doctors use symptoms, test results, and changes in blood flow to place someone into a stage. This helps create a plan for treatment or referrals to cardiology.
Treatment
Medicine-Based Approaches
For people with aortic valve narrowing, medicine can play a key role. Medications may help manage symptoms and lower the risk of other heart problems. Some common types of drugs used include:
- Blood pressure medicines (like beta-blockers or ACE inhibitors) to control high blood pressure and reduce the heart’s workload.
- Medicines for irregular heartbeats to help keep a normal rhythm, which may be important for people with atrial fibrillation.
- Diuretics (water pills) to help the body get rid of extra fluid, lessening swelling in the legs and lungs.
- Drugs to prevent blood clots if the person has a mechanical valve.
Doctors base the choice of medicines on each patient’s health and other conditions such as heart failure, coronary artery disease, or hypertension.
Medications alone do not cure aortic valve stenosis, but they can help a person feel better and lower risks.
Important points about medicine management:
| Medicine Type | Main Purpose | Example Situations |
|---|---|---|
| Blood pressure medicines | Reduce strain on the heart | Hypertension, heart failure |
| Anti-arrhythmic drugs | Control irregular heartbeats | Atrial fibrillation |
| Diuretics | Remove extra fluid, reduce swelling | Heart failure symptoms |
| Anticoagulants | Prevent blood clots | Mechanical valve, atrial fibrillation |
Patients should take medicines as directed and attend regular checkups. Lifestyle steps, like not smoking, eating heart-healthy foods, and staying active, can also offer benefits alongside medicines.
Surgical and Minimally Invasive Procedures
When symptoms become more noticeable, or the aortic valve is severely narrowed, doctors often recommend surgery or other procedures.
The main treatments involve either repairing the current valve or replacing it with a new one. The type of procedure depends on a person’s age, health, and other heart issues, such as endocarditis or congenital heart defects.
Key treatment options include:
Balloon Valvuloplasty
A cardiologist uses a thin tube called a catheter to place a small balloon into the narrowed valve. When the balloon inflates, it stretches the opening to improve blood flow.
Balloon valvuloplasty is often recommended for infants and children, or adults who can’t have surgery. The results are temporary in adults, as the valve often narrows again.
Aortic Valve Replacement
This is the most common and lasting treatment for severe valve stenosis. The surgeon removes the damaged valve and puts in a new one. Choices for replacement include:
Mechanical Valves
Made from strong materials, lasting for many years but needing lifelong blood thinners to prevent clots.
Biological (Tissue) Valves
Made from cow, pig, or human heart tissue, called homografts. These valves don’t last as long as mechanical ones but usually do not need lifelong anticoagulants.
Ross Procedure
The patient’s own lung (pulmonary) valve replaces the aortic valve, and a donated tissue valve replaces the pulmonary valve. This is more complex and used in select cases.
| Valve Type | Pros | Cons |
| Mechanical | Very durable | Needs lifelong blood thinner |
| Tissue (biologic) | No blood thinner | Wears out faster, may need replaced |
| Ross procedure | Uses own tissue, good growth in kids | Complex, not for everyone |
Transcatheter Aortic Valve Replacement (TAVR or TAVI)
This less invasive procedure is also called transcatheter aortic valve implantation. Doctors insert a new valve using a catheter through a small cut, usually in the groin.
TAVR allows the new valve to be placed inside the damaged valve without opening the chest. This option suits many older adults or people with high risks from open-heart surgery. Sometimes, TAVR repairs a tissue valve that has stopped working.
Traditional Open-Heart Surgery
Doctors may recommend this for people who need surgical aortic valve replacement and for certain patients with other heart diseases, like advanced coronary artery disease.
Recovery from open-heart surgery is longer than from a minimally invasive approach.
Rarely, doctors may try to repair the existing valve by separating joined valve leaflets (valve repair), but this method is not common for aortic valve stenosis.
Lifestyle and Home Strategies
Managing Pregnancy with Aortic Valve Concerns
Women with aortic valve problems, such as stenosis, need to plan carefully if thinking about having a baby. Talking with a healthcare provider before pregnancy is very important.
This helps them understand which medicines are safe and if any treatments are needed before getting pregnant.
Expectant mothers with this heart condition often need regular checkups to check for symptoms like shortness of breath, chest pain, fainting, or fatigue. Healthcare teams will often monitor for signs such as lightheadedness and syncope as well.
People who do not show symptoms (asymptomatic patients) still need close observation because trouble can start at any time.
Care tips during pregnancy may include:
- Regular doctor visits and extra heart tests
- Avoiding high-intensity activities that cause symptoms
- Careful use of medication, as some drugs may not be safe during pregnancy
Here is a quick reference table for common symptoms and what to watch for:
| Symptom | Should Notify Doctor? |
|---|---|
| Shortness of breath | Yes |
| Chest pain | Yes |
| Fainting | Yes |
| Fatigue | If severe or ongoing |
| Lightheadedness | If happens often |
| Syncope | Yes |
If a person’s aortic valve disease is severe, doctors may advise against becoming pregnant. The heart works harder during pregnancy, which can make symptoms worse or cause complications.
Getting Ready for Your Visit
Steps You Can Take Beforehand
It is important to prepare before meeting with a heart doctor. Patients should ask if there are any instructions to follow, such as not eating or drinking before certain tests.
Making a list of symptoms, even those that do not seem connected to the heart, helps ensure nothing is overlooked.
Bringing a written record of family medical history and any recent personal stresses is helpful. Patients should also write down all medications, vitamins, and supplements they currently take, including the exact amounts.
Taking a friend or family member along can be useful for support and to help remember important details. Writing down questions to ask during the visit can make the appointment more productive. These might include:
- What could be causing these symptoms?
- What tests are needed?
- What are the possible treatments?
- Which treatments are best for someone with a low surgical risk or high-risk patients?
- Are there alternatives to the suggested treatment?
- Should a specialist be involved?
- How can other health conditions be managed with this heart problem?
- If surgery is needed, which surgeon is recommended?
Here’s a simple table for quick preparation:
| What to Bring | Why It Matters |
|---|---|
| List of symptoms | Helps the doctor understand issues. |
| Family medical history | Detects possible inherited risks. |
| Medication & supplement list | Prevents drug interactions. |
| Questions for the doctor | Makes the visit more effective. |
What Your Doctor Will Likely Ask
The healthcare provider or heart team will usually ask when symptoms began and if they are constant or come and go. They may ask how severe the symptoms feel, and what makes them better or worse.
Other questions may include whether anyone else in the family has heart disease, if the patient has undergone any tests before, and how daily life is affected.
For conditions like aortic valve disease, the provider might discuss options such as atrial augmentation, surgery, or different treatments for high-risk or low-risk individuals.
Being prepared to answer honestly and provide as much detail as possible helps the heart team—often including cardiologists and other specialists—develop the best care plan.
