Reference 1 – https://hopeforhearts.com.au/aortic-stenosis/Reference 2 – Otto, C. VALVE DISEASE: Timing of aortic valve surgery. Heart. 2000;84(2):211-218
Aortic stenosis is a gradually worsening condition where many of the signs and symptoms are incorrectly associated with the ageing process. It is thought that as few as 1 person in 3 with severe aortic stenosis is referred for treatment.1
Aortic stenosis is a condition that is mostly caused by a build-up of calcium in the leaflets of the aortic valve. Over time, these leaflets narrow and can lead to other changes in the heart as well as reducing the cardiac output, leading to symptoms. If diagnosed with severe aortic stenosis, the diseased valve may need to be replaced.2Reference - 1 heart valve disease Reference - 2 aortic stenosis
There are three “classic” symptoms of severe aortic stenosis that may be present. However, due to the slow structural changes to the heart that can occur over time, other symptoms are may also be present but can be dismissed due to patient “ageing”. These symptoms may be due to structural changes to the aortic valve that reduces blood flow from the heart, mostly due to a narrowing of the aortic valve area.
The three classic symptoms are:
Chest pain- which may occur when exerting or exercising. This can be due to decreased cardiac output and blood to the heart when required.
Shortness of breath – can occur when walking, performing housework or walking to the shops. This may also be due to a reduction in cardiac output caused by narrowing of the aortic valve
Dizziness or Fainting- this is also caused by a reduction in cardiac output and blood to the brain which can result in a patient collapsing or having a “fainting episode”
These symptoms may be relieved by rest and are often associated with people avoiding the activities that caused the symptoms. This is an important indicator in the progression of the condition and should be reported to the patient’s GP for consideration or referral.Reference - aortic stenosis diagnosis
The diagnosis if aortic stenosis may include a number of non-invasive tests that will identify the condition and determine the level of severity of the condition. Key information in patient history regarding levels of physical activity and specifically a decline in recent activity levels over the past 6-12 months may also be used to determine the progression of the condition.
A doctor will listen to your heart using a stethoscope to listen for a cardiac murmur. A murmur can identify abnormal blood flow through the diseased Aortic Valve. There are many causes for a murmur but the presence of a murmur may indicate other heart valve issues that need a referral to a Cardiac surgeon or a Cardiologist for their assessment.
A specially trained sonographer will place an ultrasound wand on the patient’s chest and a multidimensional image is created to identify any abnormal structures, such as calcified valves, thickened heart muscle walls and also look at the internal tendons that hold valves in place. It is also possible to measure valve size and the amount of blood that is moving through the valves which in turn helps determine the severity of the condition
Is a simple tool that may be helpful to identify if the patient has an enlarged heart, and look for other abnormalities that may cause symptoms of shortness of breath such as emphysema, asthma etc.
Treatment for aortic stenosis will involve many medical professionals who will decide together the best treatment option for each individual patient. Once a decision is made to replace the diseased aortic valve, the multidisciplinary heart team will decide which treatment option is best suited for each patient. Other factors such as general health, predisposing medical conditions and levels of activity also influence treatment selection.
This team will include (but not limited to):
Balloon valvuloplasty is considered a temporary treatment only. A balloon is introduced within the Aortic Valve and inflated to increase the blood flow through the diseased valve and hopefully reducing symptoms. This may be trialled to observe how the patient recovers and also if it an effective treatment option. 1
The traditional method to replace the diseased valve via either an open-heart procedure or a micro-incision in the patient’s chest. A replacement mechanical or tissue valve is used to replace the damaged Aortic Valve. This valve will begin working immediately and symptoms should reduce shortly after. SAVR may require a stay in the Intensive Care Unit and a number of days in hospital afterwards. 1
Is a newer and less invasive technique, similar to a Balloon Valvuloplasty, (where carefully selected patients) where a long catheter is introduced into the diseased Aortic Valve via the femoral artery (found in the groin). A balloon sits within the new tissue valve and is inflated whilst sitting within the diseased native valve. Once this balloon is inflated, the new valve expands and sits within the old valve, immediately functioning and relieving symptoms. Patients receiving this type of treatment may be discharged 24-48 hours after the procedure. This will vary for each patient and your heart team will discuss this with you.
Sometimes symptoms such as shortness of breath, chest pain and fatigue can be more than just signs of getting older, they could indicate a potentially life-threatening heart condition known as Aortic stenosis. The most common type of heart valve disease in the elderly. It is a progressive disease, which means it will get worse over time and this can be life-threatening if left untreated. Learn more about heart valve disease and aortic stenosis so you can talk to your doctor about your symptoms.
In the past, people suffering from severe aortic stenosis had limited options to replace an unhealthy aortic valve. But now, there are more treatment options, including transcatheter aortic valve implantation (TAVI) and open-heart surgery. Explore all of your treatment options.
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