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Aortic valve stenosis is a narrowing of the aortic valve. The aortic valve allows blood to flow from the heart's lower left chamber (ventricle) into the aorta and to the body. Stenosis prevents the valve from opening properly, forcing the heart to work harder to pump blood through the valve. This causes pressure to build up in the left ventricle and thickens the heart muscle.
Your heart can make up for aortic valve stenosis and the extra pressure for a long time. But at some point, it won't be able to keep up the extra effort of pumping blood through the narrowed valve. This can lead to heart failure.
Problems that can cause aortic valve stenosis include:
Aortic valve stenosis is a slow process. For many years, even decades, you will not feel any symptoms. But at some point, the valve will likely become so narrow (often one-fourth of its normal size) that you start having problems. Symptoms are often brought on by exercise, when the heart has to work harder.
As aortic valve stenosis gets worse, you may have symptoms such as:
If you start to notice any of these symptoms, let your doctor know right away. If you have symptoms, your doctor will likely recommend a valve replacement. By the time you have symptoms, your condition probably is serious. If you have symptoms, you also have a high risk of sudden death.
Most people find out they have it when their doctor hears a heart murmur during a regular physical exam. To be sure of the diagnosis, your doctor may want you to have an echocardiogram, which can show moving pictures of your heart. You may have other tests to help your doctor judge how well your heart is working.
If you have mild or moderate aortic valve stenosis and you don't have symptoms, your doctor will see you regularly to check your heart. You probably will not have surgery until your stenosis is severe or until the benefits of surgery outweigh the risks.
If you have severe stenosis, you probably need a valve replacement. Valve replacement can be done with an open-heart surgery or a minimally invasive procedure. Some young people or pregnant women may have another procedure called balloon valvuloplasty to enlarge the valve opening.
If you have severe stenosis but don't have your valve replaced, you have a high risk of dying suddenly or developing heart failure. Replacing your valve can help you have a more normal life span and improve your quality of life.
Your doctor will probably recommend some lifestyle changes to keep your heart healthy. He or she may advise you to:
Health Tools help you make wise health decisions or take action to improve your health.
Learning about aortic valve stenosis:
Living with aortic valve stenosis:
Most people who have aortic valve stenosis are born with a normal, healthy aortic valve but develop aortic stenosis late in life. Aging and calcium buildup cause the leaflets of the valve to thicken and harden, preventing the valve from opening properly. Typically, stenosis develops slowly over many years.
Most young people and teens who have aortic valve stenosis developed it from a congenital heart defect. The most common heart defect that causes aortic stenosis is a bicuspid aortic valve.
Some people may develop aortic stenosis after having rheumatic fever.
You probably won't have any symptoms if you have mild or moderate aortic valve stenosis, because your heart can make up for the stenosis. You may begin to notice symptoms if the pressure buildup in the heart becomes severe or if blood flow to the heart and the rest of the body is reduced. You may have symptoms when you exercise or do something strenuous, because your heart has to work harder.
Symptoms may include:
Certain medical problems or conditions make it more likely that you will develop aortic valve stenosis:
Other things that increase the risk for aortic valve stenosis include:
Call your doctor immediately if you have any of the symptoms of aortic valve stenosis, such as:
Your family doctor may diagnose aortic valve stenosis during a routine checkup. Other health professionals who also may discover aortic valve stenosis during a physical exam include:
A physical exam and review of your medical history are important first steps in diagnosing aortic valve stenosis. If you have stenosis but no symptoms, your doctor will likely find the condition during a routine exam or a checkup for another health problem. A distinctive heart murmur is usually the first clue that leads a doctor to suspect aortic valve stenosis.
During the physical exam, the doctor will:
An echocardiogram (echo) can confirm your symptoms and tell your doctor how severe stenosis is, how well your left ventricle is working, and whether there are problems with other valves.
It's also an important test to help monitor aortic valve stenosis over time.
Every 3 to 5 years
Every 1 to 2 years
Every 6 to 12 months
Treatment for aortic valve stenosis is replacement of the aortic valve.
Valve replacement is recommended based on many things including how severe the stenosis is, whether you have symptoms, and how well your heart is pumping blood. It is typically recommended when a person has severe stenosis. If you have severe stenosis, especially with symptoms, valve replacement is usually required. If you don't have your valve replaced after your stenosis is severe, you have a high risk of dying suddenly or developing heart failure. Valve replacement can relieve symptoms, improve your quality of life, and help you have a more normal life span.
Balloon valvuloplasty is a less invasive procedure that might be done for some people, including children, teens, or young adults in their 20s. For more information, see Surgery.
You may need medicine to prevent or treat a heart infection or to help manage heart failure, which is the most common complication of aortic valve stenosis. For more information, see Medications.
Aortic valve stenosis tends to get worse over time. So you need to decide what kind of care you want at the end of your life.
It can be hard to have talks with your doctor and family about the end of your life. But making these decisions now may bring you and your family peace of mind. Your family won't have to wonder what you want. And you can spend your time focusing on your relationships.
You will need to decide if you want life-support measures if your health gets very bad. An advance directive is a legal document that tells doctors how to care for you at the end of your life. This care includes electronic devices that are used for heart failure, such as pacemakers. You also can say where you want to have care. And you can name someone who can make sure your wishes are followed.
For more information, see the topic Care at the End of Life.
How you will feel and how aortic valve stenosis will affect your life will vary greatly depending on whether you have symptoms and the treatment decisions you make. Your doctor will probably suggest lifestyle changes to help keep your heart and body healthy.
Medicines aren't used to treat aortic valve stenosis. But you may need medicines to prevent and treat complications from the condition. Or you may need to take medicines if you have your valve replaced.
If you have an artificial valve, you may need:
You may need other medicines if you develop other problems, such as arrhythmias or heart failure. For more information, see the topic Heart Failure.
Your doctor will likely recommend valve replacement if you have severe stenosis, especially if you have symptoms.
Aortic valve replacement surgery is typically an open-heart surgery. In an aortic valve replacement surgery, the damaged valve is removed and replaced with an artificial valve (mechanical or tissue).
View a slideshow on aortic valve replacement surgery.
If you decide to have surgery, you and your doctor will decide which type of valve is right for you. For help with this decision, see:
Transcatheter aortic valve replacement is a way to replace an aortic valve without open-heart surgery. It is a minimally invasive procedure that uses catheters in blood vessels to replace the aortic valve with a specially designed artificial valve. It might be done for a person who can't have surgery or for a person who has a high risk of serious problems from surgery.
If you are going to have valve replacement surgery, your doctor may suggest that you have a coronary angiogram/catheterization test. This test can show if you have blockages in your coronary arteries (as part of coronary artery disease). If you have serious blockages, your doctor may want to do a coronary artery bypass surgery at the same time as the valve replacement surgery. For more information, see Aortic Valve Stenosis: Treatment When You Have Other Heart Diseases.
Balloon valvuloplasty is a less invasive procedure than surgery. It may be an option for some people who have aortic valve stenosis. Although the heart valve is not replaced, the narrowed opening is made larger.
CitationsNishimura RA, et al. (2014). 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, published online March 3, 2014. DOI: 10.1161/CIR.0000000000000031. Accessed May 1, 2014.Other Works ConsultedFreeman RV, Otto CM (2011). Aortic valve disease. In V Fuster et al., eds., Hurst's The Heart, 13th ed., vol. 2, pp. 1692–1720. New York: McGraw-Hill.Nishimura RA, et al. (2014). 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, published online March 3, 2014. DOI: 10.1161/CIR.0000000000000031. Accessed May 1, 2014.Nishimura RA, et al. (2017). 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease. Circulation, published online March 15, 2017. DOI: 10.1161/CIR.0000000000000503. Accessed March 15, 2017.Oakley RE, et al. (2008). Choice of prosthetic heart valve in today's practice. Circulation, 117(2): 253–256.Whelton PK, et al. (2017). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Journal of the American College of Cardiology, published online November 13, 2017. DOI: 10.1016/j.jacc.2017.11.006. Accessed November 20, 2017.Whitlock RP, et al. (2012). Antithrombotic and thrombolytic therapy for valvular disease: Antithrombotic therapy and prevention of thrombosis, 9th ed.—American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2, Suppl): e576S–e600S.
ByHealthwise StaffPrimary Medical ReviewerRakesh K. Pai, MD, FACC - Cardiology, ElectrophysiologyMartin J. Gabica, MD - Family MedicineE. Gregory Thompson, MD - Internal MedicineAdam Husney, MD - Family MedicineElizabeth T. Russo, MD - Internal MedicineKathleen Romito, MD - Family MedicineSpecialist Medical ReviewerMichael P. Pignone, MD, MPH, FACP - Internal Medicine
Current as ofDecember 19, 2017
Current as of: December 19, 2017
Author: Healthwise Staff
Medical Review: Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology & Martin J. Gabica, MD - Family Medicine & E. Gregory Thompson, MD - Internal Medicine & Adam Husney, MD - Family Medicine & Elizabeth T. Russo, MD - Internal Medicine & Kathleen Romito, MD - Family Medicine & Michael P. Pignone, MD, MPH, FACP - Internal Medicine
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