Aortic Valve Disease

Overview

Aortic valve disease is a type of heart valve disease. It occurs when the valve between the lower left heart chamber (left ventricle) and the main artery to the body (aorta) doesn't work properly. This valve helps regulate blood flow in the heart. Aortic valve disease includes two primary types: aortic valve stenosis and aortic valve regurgitation. Aortic valve stenosis happens when the flaps (cusps) of the aortic valve become thick and stiff, or they fuse together. This causes the valve opening to become narrow, reducing or blocking blood flow from the heart to the rest of the body. Aortic valve regurgitation occurs when the aortic valve doesn't close properly, causing blood to flow backward into the left lower heart chamber (ventricle). As a result, your heart may not efficiently pump blood to the rest of your body, leading to symptoms such as fatigue and shortness of breath. Risk factors for aortic valve disease include age, genetics, infections, high blood pressure, and injury to the heart. Severe cases may require surgery to repair or replace the aortic valve. Symptoms can vary from mild to severe, depending on the severity of the valve's narrowing or dysfunction.

Understanding the disease

Symptoms

Symptoms of aortic valve disease may include:

• Whooshing or swishing heart sound (heart murmur)
• Chest pain or tightness
• Dizziness
• Fainting
• Fatigue after activity or having less ability to be active
• Irregular heartbeat
• Shortness of breath, particularly during vigorous activity or when lying down
• Not eating enough (mainly in children with aortic valve stenosis)
• Not gaining enough weight (mainly in children with aortic valve stenosis) As aortic valve regurgitation worsens, additional symptoms may include:
• Shortness of breath with exercise or when you lie down
• Fatigue and weakness, especially when you increase your activity level
• Heart murmur
• Irregular pulse (arrhythmia)
• Lightheadedness or fainting
• Chest pain (angina), discomfort or tightness, often increasing during exercise
• Sensations of a rapid, fluttering heartbeat (palpitations)
• Swollen ankles and feet

Risk Factors

Risk factors for developing aortic valve disease include:

1. Older age: Calcium deposits can build up on the aortic valve as people age, causing the valve to stiffen and become narrow.
2. Heart valve problems present at birth (congenital heart defects): Some people are born with a missing, extra, or fused valve flap, increasing the risk of aortic valve regurgitation.
3. Rheumatic fever: This complication of strep throat can cause aortic stenosis, a type of valve disease. If you have heart valve disease due to rheumatic fever, it's called rheumatic heart disease. If not, it's called nonrheumatic heart disease.
4. Inflammation of the lining of the heart's chambers and valves (endocarditis): This life-threatening condition is usually caused by infection and can damage the aortic valve.
5. Certain heart conditions: Other heart valve conditions, such as aortic valve stenosis, high blood pressure, and other heart disease risk factors can increase the risk of developing aortic valve disease.

Development

Aortic valve disease can develop due to age-related changes to the heart, infections, high blood pressure, and injury to the heart. Age-related changes, such as the buildup of calcium deposits on the valve, can cause the aortic valve to stiffen and become narrow. Infections, such as rheumatic fever, can lead to aortic stenosis. High blood pressure can also contribute to the development of aortic valve disease. Injury to the heart, such as from a heart attack, can damage the aortic valve and lead to aortic valve disease.

Assessment and Diagnosis

Triage

If you suspect aortic valve disease, you should see a healthcare provider if you have signs or symptoms such as shortness of breath, fatigue after activity, or sensations of a pounding or an irregular heartbeat. If you experience sudden chest pain, seek emergency medical help immediately. A healthcare provider may refer you to a cardiologist for further evaluation and treatment if necessary.

Diagnosis

To diagnose aortic valve disease, a healthcare provider will typically conduct a physical exam and ask questions about the patient's signs and symptoms and medical history. A healthcare provider may listen for a whooshing or swishing sound (heart murmur) using a stethoscope. If present, further evaluation by a heart specialist (cardiologist) may be recommended. Various tests may be conducted to diagnose aortic valve disease, including echocardiogram, electrocardiogram (ECG or EKG), chest X-ray, and exercise tests or stress tests. These tests help determine the severity and cause of the aortic valve disease.

Management and Treatment

Complications

Potential complications of aortic valve disease may include blood clots, stroke, heart failure, heart rhythm problems (heart arrhythmias), and death due to sudden cardiac arrest. Proper diagnosis and treatment can help reduce the risk of these complications.

Prevention

Aortic valve disease cannot be completely prevented, but you can take certain steps to reduce your risk. Some possible ways to prevent or manage aortic valve disease include:

1. Preventing rheumatic fever: If you have a sore throat, see your healthcare provider. Untreated strep throat can lead to rheumatic fever, which can contribute to aortic valve disease. Strep throat is easily treated with antibiotics.
2. Keeping your heart healthy: Talk to your healthcare provider about risk factors for heart disease and how to prevent or manage them. These risk factors may include high blood pressure, obesity, and high cholesterol levels, which can increase the risk of aortic valve disease.
3. Taking care of your teeth and gums: There may be a link between infected gums (gingivitis) and infected heart tissue (endocarditis). Inflammation of heart tissue caused by infection can narrow arteries and worsen aortic valve disease.
4. Preventing conditions that can raise your risk of aortic valve regurgitation: Rheumatic fever, high blood pressure, and other health conditions like chronic kidney disease, lupus, and Marfan syndrome can increase the risk of aortic valve regurgitation. Remember, proper diagnosis and treatment can help reduce the risk of complications associated with aortic valve disease.

Treatment

Treatment for aortic valve disease depends on the type and severity of the condition. For aortic valve stenosis, treatment may involve surgery to repair or replace the narrowed or damaged valve. For aortic valve regurgitation, treatment may also involve surgery, although in some cases, medical management and monitoring may be sufficient. Proper diagnosis and treatment can help reduce the risk of complications, such as blood clots, stroke, heart failure, heart rhythm problems, and sudden cardiac arrest. Consult a healthcare professional for personalized advice on treatment options.

Preparing for medical consultation

To prepare for an appointment for aortic valve disease, follow these steps:

1. Be aware of pre-appointment restrictions: When you make the appointment, ask if there's anything you need to do beforehand.
2. Write down your symptoms: Include any symptoms you've experienced, even if they seem unrelated to heart valve disease.
3. Gather personal information: Prepare to share your family history of heart disease and any major stresses or recent life changes.
4. List your medications: Create a list of all medications, vitamins, and supplements you take.
5. Bring a support person: Consider bringing a family member or friend to help you remember information you receive during the appointment.
6. Be prepared to discuss diet and exercise: Ready yourself to discuss your current diet and exercise habits with your healthcare provider, as well as any challenges you might face in starting or increasing physical activity.
7. Write down questions: Prepare a list of questions to ask your healthcare provider, such as the best treatment options, alternatives to the primary approach suggested, and potential side effects of any medications or procedures. Remember to tailor your discussion with your healthcare provider to your specific situation and concerns.