I was recently diagnosed with aortic stenosis after my doctor heard a slight heart murmur and referred me for an echocardiogram. I don't have any symptoms, so the cardio-logist recommended that I get periodic echocardiograms to monitor the condition. Is there anything else I can — or should — do?
Aortic stenosis — also called aortic valve stenosis — occurs when the one-way valve inside the heart's largest vessel, the aorta, stiffens and becomes clogged with calcium deposits. As a result, the valve doesn't open as easily. During a heartbeat, as the heart's main pumping chamber (the left ventricle) contracts, pressure builds up behind the aortic valve. This creates the turbulent blood flow that a doctor can hear through a stethoscope.
Often, the first symptom of aortic stenosis is a little shortness of breath during activity. For example, you might notice that it's a little harder to walk up a flight of stairs or carry groceries, especially if you don't exercise regularly. However, the symptoms tend to come on gradually, so people don't always recognize them. Also, some people unconsciously adapt their behavior to avoid exertion. So to be on the safe side, I recommend getting an exercise stress test with an echocardiogram (heart ultrasound) to make sure you're not experiencing early symptoms of aortic stenosis. During these tests, you're closely monitored while walking on a treadmill to see whether symptoms or signs of trouble occur during moderate exercise.
Repeat echocardiograms every six to 12 months will reveal if your left ventricle is growing larger or your heart function is worsening, so be sure to stick to the schedule your cardiologist recommends. And be alert to possible symptoms, which can include feeling tired after physical activity, fatigue, heart palpitations, chest pain, and fainting spells.
Unfortunately, neither lifestyle nor medications can slow or reverse aortic stenosis. The only treatment option is replacing the valve. Once, open-heart surgery was the only way to do this. But a procedure called transcatheter aortic valve replacement (TAVR) offers a less-invasive alternative with an easier, shorter recovery. The approach delivers a collapsed replacement valve through a thin, flexible tube (catheter) that the doctor inserts at the top of the thigh and slides up through the blood vessels into the aorta.
Currently, this specialized — and more expensive — procedure is approved only for people at high or intermediate risk for a bad outcome with valve surgery (for example, older, frail people with other health problems). Yet more people may qualify for TAVR in the future, including those at low risk from surgery. A large study is comparing TAVR with periodic echocardiograms and symptom monitoring in people with severe aortic stenosis without symptoms.
— by Deepak L. Bhatt, M.D., M.P.H.
Editor in Chief, Harvard Heart Letter
