Aortic Stenosis

Aortic stenosis or aortic valve stenosis as the name indicates the narrowing of the aortic valve of the heart. The aorta is the main artery carrying out oxygenated blood out of the heart. When blood enters the aorta from the heart’s left ventricle it passes through the valve known as the aortic valve.

aortic stenosis

Narrowing of the aortic valve and when a passage of blood flow through valve decreases this condition is termed as aortic stenosis.

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When aortic valve is obstructed, the heart needs more energy to work harder to pump blood to other parts of the body. With time this extra work by the heart limits the amount of blood it can pump and may weaken the heart muscle, and leading to symptoms such as fatigue and dizziness.

The aortic valve normally consists of three leaflets.  When there is a contraction of left ventricle it forces blood through the valve to the aorta and then to the rest of the body.  In normal conditions when left ventricle pumps blood out the aortic valve opening closes completely to stop coming back of blood to left ventricle but when aortic stenosis occur aortic valve do not close completely and the pumping of blood does not occur adequately and due to this pressure in the ventricle increases. In starting of this condition the left ventricle compensates by thickening its walls in order to maintain adequate pumping pressure. The most common type of hypertrophy seen in aortic stenosis is concentric hypertrophy, in which the walls of LV are equally thickened.

In the later stage of the disease, the left ventricle dilates the wall to thin and systolic function deteriorates.
Age / Sex of Aortic Stenosis

Aortic stenosis is rare in infancy. Patients who are suffering from congenital bicuspid aortic valve develop symptoms in later age.
In cases where rheumatic aortic stenosis occurs presents symptoms after the sixth decade of life.

Which Factors Lead To Aortic Stenosis?

Risk factors are as follows
• A deformed aortic valve- in some individuals they are born with a congenital narrowed aortic valve or develop aortic valve stenosis later in life because they were born with a bicuspid aortic valve with two flaps instead of three.
• Age-Aortic valve stenosis risk increase with age and the buildup of calcium deposits on heart valves.
• Previous rheumatic fever- Rheumatic fever can lead to stiffness of flaps and fuse, with time which leads to aortic valve stenosis.
• High blood pressure.
• High cholesterol.
• Type 2 diabetes.
• Smoking.

The other causes which can lead to the formation of aortic stenosis are as follows
• Age-related progressive calcification of a normal aortic valve.
• Calcification of a congenital bicuspid aortic valve.
• Post-inflammatory to acute rheumatic fever.
• Hyperlipoproteinemia.
• Uremia.

Signs and Symptoms

• Chest pain (angina) or tightness.
• Shortness of breath.
• Feeling faint or fainting with exertion.
• Fatigue, especially during times of increased activity.
• Heart palpitation- a sensation of a rapid, fluttering heartbeat.
• Heart murmur.

Heart failure can occur due to aortic stenosis and following symptoms will appear
• Fatigue.
• Shortness of breath.
• Swollen ankles and feet.
Other symptoms related to aortic stenosis are as follows
• Pulsus alternans.
• Ejection click- It is present in individuals especially children and young adults with congenital aortic stenosis.
• Systolic murmur.

It Is Important To Diagnose The Aortic Stenosis But how?

Following tests are helpful
• Serum electrolytes level.
• Cardiac Biomarkers.
• Complete blood count.
• Electrocardiography- Serial ECG can demonstrate the progression of aortic stenosis.
• Chest radiography.
• Cardiac catheterization.
• Coronary angiography.
• Radionuclide ventriculography.
• Exercise stress testing.

Differential diagnosis of Aortic Stenosis

• Acute coronary syndrome.
• Mitral regurgitation.
• Mitral stenosis.
• Mitral valve prolapsed.
• Myocardial infarction.
• Shock, hypovolemic.
• Supravalvaaortic stenosis.
• Congenital subvalvular aortic stenosis.
• Hypertrophic obstructive cardiomyopathy.

Risk Factors Of Aortic Stenosis

Unchecked cases of aortic valve stenosis can lead to life-threatening heart problems
• Chest pain (angina).
• Fainting (Syncope).
• Heart failure.
• Irregular heart rhythms.
• Cardiac arrest.

Treatment for Aortic Stenosis

Surgical procedures help in treating aortic stenosis. Therapies to repair or replace the aortic valve include
• Balloon valvuloplasty.
• Aortic valve replacement.
• Transcatheter aortic valve replacement.
• Surgical valvuloplasty.

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