Aortic Valve Disease

Aortic Valve Stenosis

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Symptoms

Aortic stenosis may not produce immediate symptoms or signs. The first sign is usually an abnormal heart sound, or heart murmur, which may develop months or even decades before other signs and symptoms. Aortic stenosis ranges from mild to severe. As the valve narrows, more signs and symptoms develop and can include:

• Chest pain (angina) or tightness
• Feeling faint or fainting with physical exertion (exercise)
• Dizziness
• Fatigue, especially during times of increased activity
• Shortness of breath, especially with physical exertion
• Heart palpitations — sensations of a rapid, fluttering heartbeat
• Swollen ankles and feet

Causes

Aortic valve stenosis obstructs the way blood normally flows through the heart. Causes may be:

Calcium buildup on the valve
With age, heart valves may accumulate deposits of calcium (aortic valve calcification). Calcium is a mineral found in your blood. As blood repeatedly flows over the aortic valve, deposits of calcium can accumulate on the valve's leaflets. These deposits may never cause any problems. However, in some people — particularly those with a bicuspid aortic valve — calcium deposits result in stiffening of the valve leaflets. This stiffening narrows the aortic valve. This cause of aortic stenosis is most common in people older than 60, and symptoms often don't appear until age 70 or 80.

Rheumatic fever
This complication of strep throat was once a common childhood illness in the United States. Rheumatic fever may result in scar tissue forming on the aortic valve. Scar tissue can narrow the aortic valve and lead to aortic stenosis. Scar tissue can also create a rough surface on which calcium deposits can collect, contributing to aortic stenosis later in life. Rheumatic fever may damage more than one heart valve, and in more than one way. A damaged heart valve may not open fully or close fully — or both. Many older adults in the United States were exposed to rheumatic fever as children. Rheumatic fever is still prevalent in underdeveloped countries.

Congenital heart defect
Rarely, some babies are born with an already narrowed aortic valve. Others are born with an aortic valve that has only two flaps (leaflets) — not three. Known as a bicuspid aortic valve, this deformity may not cause problems until adulthood, when the valve may begin to narrow or leak and may need to be repair or replacement. Having a bicuspid aortic valve requires regular evaluation by a physician to watch for signs of valve malfunction. Parents of a newborn, infant or child with aortic stenosis may have many questions and concerns. In most cases, physicians don't know why a heart valve fails to develop properly, and it isn't something the parents could have prevented.