good to know says: Aortic stenosis happens when a valve in your heart starts to narrow and it means your heart will have to work harder to pump blood to the body. Mild aortic stenosis may not cause any symptoms except tiredness and can be treated with medication such as diuretics. However, the narrower the valve becomes, the more serious the symptoms. Chest pain, dizziness, fainting and palpitations can all occur. Surgery to widen or replace the valve is fairly common and is usually very successful. You?ll also be given antibiotics to prevent infection.
For a full medical explanation of the causes, symptoms and treatments of aortic stenosis from patient.co.uk, read on
The heart has four chambers - two atria and two ventricles. The walls of these chambers are mainly made of special heart muscle. During each heartbeat both of the atria contract first to pump blood into the ventricles. Then both ventricles contract to pump blood out of the heart into the arteries. There are one-way valves between the atria and ventricles, and between the ventricles and the large arteries coming from the heart. The valves make sure that when the atria or ventricles contract, the blood flows in the correct direction.
The aortic valve lies between the left ventricle and the aorta. The aorta is the main artery that takes blood from the heart to the body. The aortic valve has three flaps or 'cusps'. Blood flows through the valve when the left ventricle contracts at the early part of the heartbeat. When the left ventricle relaxes the aortic valve closes and the mitral valve opens to allow more blood into the ventricle ready for the next heartbeat.
Aortic stenosis means that when the aortic valve opens, it does not open fully. It is narrowed ('stenosed') when it is open. Therefore, there is a partial restriction of blood flow from the left ventricle into the aorta. Basically, the more narrowed the valve, the less blood that can get through, the more severe the problem is likely to be. In some cases, aortic stenosis occurs at the same time as aortic regurgitation. (See separate leaflet called 'Aortic regurgitation'.)
Age related calcification of the valve
This is the common cause. Deposits of calcium build up in the valve in some older people. It is not clear why this happens. This 'calcification' makes the valve stiff and open less easily. It can be mild and cause little narrowing. However, in time it can become more severe.
Rheumatic fever
Rheumatic fever is a condition that sometimes occurs during an infection with a bacterium (germ) called the streptococcus. You body makes antibodies to the bacterium to clear the infection. However, in some people the antibodies also 'attack' various parts of the body, in particular the heart valves. Inflammation of a valve may develop which can cause permanent damage and lead to thickening and scarring years later.
Other causes
Other causes of aortic stenosis are uncommon and include:
If the narrowing is mild and you have no symptoms, then you may not need any treatment. If you develop symptoms or complications, various medicines may be advised to ease the symptoms. However, surgery is usually advised in most cases when symptoms develop.
Medication may be advised to help ease symptoms of heart failure if heart failure develops. For details see separate leaflet called 'Heart Failure'. For example:
If you need surgery, a surgeon will advise on which is the best option for your situation.
Dental treatments: until recently, it has also been advised that people with heart valve disease should take antibiotic cover when they have dental treatment. However, a guideline published in 2006 from the British Society for Antimicrobial Chemotherapy (BSAC) says that this is not needed in most situations. Their information aimed at patients says:
"A BSAC group of experts has spent a lot of time carefully looking at whether dental treatment procedures are a possible cause of infective endocarditis (IE) [sometimes called bacterial endocarditis (BE)], which is infection of the heart valve. After a very detailed analysis of all the available evidence they have concluded that there is no evidence that dental treatment procedures increase the risk of these infections.
Therefore it is recommended that the current practice of giving patients antibiotics before dental treatment be stopped for all patients with cardiac abnormalities, except for those who have a history of healed IE, prosthetic heart valves and surgically constructed conduits.
The main reasons for this are the lack of any supporting evidence that dental treatment leads to IE and the increasing worry that administration of antibiotics may lead to other serious complications such as anaphylaxis (severe allergy) or antibiotic resistance.
The advice from the BSAC is that patients should concentrate on achieving and keeping a high standard of oral and dental health, as this does reduce the risk of endocarditis. Help for this will be provided by your Dental Professional."
However, this guideline is controversial. It has caused a lot of debate, especially from some cardiologists (heart doctors) and dentists who maintain that antibiotic cover is still needed for dental procedures. See references below for details of some articles that deal with this controversy. Your own doctor or dentist will advise for your own particular circumstance.
Some cases are mild and cause no symptoms. If you develop symptoms they tend to become worse over the years. Medication may ease symptoms, but cannot reverse a narrowed valve.
Surgical treatment has greatly improved the outlook in most people who have more severe stenosis. Surgery to widen or replace the valve has a very good success rate. The outlook is good if the valve is treated before the heart becomes badly damaged.
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