Aortic Stenosis

Home » Aortic Stenosis » Signs and Symptoms, Diagnosis

Questions to Ask Your Cardiac Care Team
(Free Handout)

Signs and Symptoms

Most patients with aortic stenosis develop one or more of these three classic symptoms: shortness of breath, passing out, and chest pain. Thickening of the walls of the left ventricle causes the ventricle to become stiff and unable to relax between contractions. When this happens, the pressure in the left ventricle rises and blood can "back up" into the lungs, interfering with normal absorption of oxygen from the lungs into the bloodstream. This may cause shortness of breath, which worsens as the left ventricle becomes increasingly impaired.

The aortic valve may become so constricted (stenotic) that it can open only slightly, drastically reducing the amount of blood that flows into the aorta and throughout the body. In some cases, the flow of oxygen-rich blood to the brain may not be enough to sustain normal brain function. When this occurs, patients may briefly lose consciousness, or pass out. Losing consciousness is called syncope.

Patients with aortic stenosis may also experience chest pain, pressure, or discomfort (called angina or angina pectoris), caused by an insufficient supply of oxygen to the heart. As the left ventricle thickens and works harder to expel blood through the stenotic aortic valve, its demand for oxygen increases. To compound the problem, aortic stenosis reduces blood flow to the heart itself as well as to the rest of the body (the coronary arteries and other arteries of the body originate from the aorta). Thus, while the heart's demand for oxygen increases, its supply of oxygen-rich blood decreases, causing angina.

Complication
The turbulent blood flow across the stenotic aortic valve predisposes the valve to infection. Infection of a heart valve is called endocarditis. Patients with aortic stenosis who are to undergo a dental or medical procedure in which there is the risk for bacteria to enter the blood should inform their dentist or physician of their condition. These patients may require an antibiotic prior to undergoing the procedure. Administering antibiotics to prevent valve infection is called endocarditis prophylaxis.

Endocarditis prophylaxis may be administered prior to the following:

• Certain dental procedures (e.g., extractions, cleaning)
• Certain invasive imaging procedures (e.g., bladder cystoscopy)
• Surgery

Diagnosis

The symptoms of shortness of breath, passing out, and chest pain (angina), suggest a diagnosis of aortic stenosis. However, these symptoms may be caused by many other conditions and it is necessary for a physician to confirm the diagnosis by a physical examination, an echocardiogram, and/or cardiac catheterization.

Some patients may not develop symptoms, and aortic stenosis may be suggested by the incidental discovery of a heart murmur, which the physician hears through a stethoscope when listening over the chest. A heart murmur is a characteristic rumbling sound produced by turbulent blood flow through a stenotic aortic valve. The physician also checks the pulse of the carotid arteries in the neck, which is characteristically diminished in intensity, and listens to the lungs for audible signs of fluid accumulation, which are additional indicators of aortic stenosis.

When aortic stenosis is suspected, an echocardiogram (cardiac echo) is usually performed. Echocardiogram uses a microphone-like device to transmit and receive sound waves that travel through the chest wall to the heart, and then are reflected back. The reflected sound waves are translated into images of the heart, including the aortic valve, chambers, and walls.

Echocardiogram also is used to calculate the degree of stenosis by measuring the pressure change between the left ventricle and the aorta, and to assess thickening of the walls, the pumping function, and the amount of dilation (increased diameter) of the left ventricle.

A normal aortic valve opening is at least 2 cm. In mild aortic stenosis, the valve opens 1.0–1.3 square cm; in moderate aortic stenosis, the open valve area ranges from 0.8–0.9 square cm; and in severe aortic stenosis, the open aortic valve area is calculated to be less than 0.8 square cm.

If the degree of aortic stenosis remains unclear after physical examination and echocardiogram, cardiac catheterization is performed. In this procedure, a catheter is passed through an artery in the leg (femoral artery) up the aorta, across the aortic valve, and into the left ventricle. This catheter is used to measure the pressure in the left ventricle and in the aorta, and to calculate the pressure gradient across the stenotic aortic valve. The degree of stenosis is calculated by measuring the flow of blood in the body.

© 1998-2008 Healthcommunities.com, Inc. All Rights Reserved.

Aortic Stenosis Resources

	Join Our Aortic Stenosis Forum Do you have a question, want to share medical advice, or just need to discuss your situation with someone else having a similar experience? The healthchannels forum is a resource for everyone to share and discuss their health and medical needs with others.	Advertising Disclaimer
	Living with...Share your story Do you have a personal health story that you would like to share with others? As a source of free patient education, our goal is to provide our users with trustworthy information and support from others. That's why we've started our "Living with..." sections.
	Our "Living With..." support pages are a place to share experiences about living with a certain condition, disease, disorder, or illness and for loved ones of those dealing with health-related issues. Many people, especially when newly diagnosed, find comfort in knowing that others are having a similar experience. Help others by sharing your story. View stories already submitted.
	Stay Updated Sign up for our newsletter and receive important updates on the medical conditions that are most important to you.
Advertising Disclaimer To quickly access health information from your website's browser, download Healthcommunities.com's healthchannels toolbar. Advertising Disclaimer