Aortic Stenosis

What is aortic stenosis?

Aortic stenosis is the short form of aortic valve stenosis and describes a congenital or acquired heart valve disease. In aortic stenosis, the aortic valve, the valve between the left ventricle and the aorta, is pathologically narrower than in healthy individuals. Typical is a progressive calcification of the valve pockets of the aortic valve, which make the tissue of the heart valve increasingly stiff and immobile.

In a stenosis, the valve is pathologically altered to such an extent that it no longer opens completely. Consequently, the flow of blood through the heart valve into the aorta is impaired. Progressive stenosis of the aortic valve can have serious consequences and must therefore be clarified by a doctor.

The causes

Aortic stenosis can be congenital or develop during life (acquired aortic valve stenosis). Most aortic stenoses are acquired and are a common disease in older age. It is also known as denegerative aortic valve stenosis.

Age-related stenosis is mainly caused by wear processes such as calcification. An unhealthy lifestyle, with fatty food and a lot of meat, causes permanently elevated blood lipid levels and promotes the development of aortic valve stenosis. Rheumatic fever and endocarditis can leave scarred tissue on the aortic valve and thus cause stenosis. The congenital form of aortic stenosis is hereditary.

The symptoms

In the case of low aortic stenosis, no symptoms are usually noticeable. If the stenosis becomes stronger, affected patients often complain of dizziness, occasionally they suffer from fainting (syncope). The symptoms dizziness and fainting arise due to insufficient blood flow to the brain as a result of the aortic stenosis.

If the aortic valve is severely stenosed, severe symptoms such as angina pectoris (tightness of the chest) and dyspnoea (difficulty breathing) occur. Angina pectoris is an attack-like pain in the chest caused by a short-term reduced blood flow to the heart. Chest pain can be of varying intensity and may feel dull, stabbing, burning or heavy.

The tightness of the chest is often accompanied by a feeling of suffocation. Dyspnoea, shortness of breath, is the subjective feeling of not being able to get enough air. Those affected then breathe in more frequently, so that the breathing rate increases significantly.

Angina pectoris and shortness of breath are generally very unspecific symptoms, for which many cardiovascular diseases can be considered. A cardiac examination with thorough auscultation is important to make the right diagnosis. Patients with a pronounced aortic valve stenosis often feel flabby and tired.

The diagnosis

A thorough examination is necessary to diagnose aortic valve stenosis. During the clinical examination, the cardiologist often notices a low blood pressure amplitude with a sluggish pulse rate increase. A cardiac apex may be palpable.

It is important to listen to the heart (auscultation), during which a typical heart murmur can be heard. m to confirm the diagnosis, further examinations are usually performed. An X-ray thorax provides information about an enlargement of the heart (due to increased heart work) and about calcification of the aortic valve.

The ECG (electrocardiogram) shows typical signs of aortic stenosis, and a cardiac ultrasound examination (echocardiography) provides a very good assessment of heart valves and heart function. In addition, a cardiac catheter examination can be performed, which can also be used as an invasive therapy method. Auscultation is an important diagnostic tool that can confirm the suspicion of aortic valve stenosis.

One auscultates with a stethoscope over the thorax. During auscultation, specific points are listened to where the sounds and noises of the various heart valves are projected. In aortic valve stenosis there is a characteristic heart murmur which can be heard loudest between the second and third ribs to the right of the sternum.

In cardiology, the heart murmur is described as a spindle-shaped, rough systolic with radiation into the carotid arteries and punctum maximum in the 2nd intercostal space to the right of the sternum (parasternal). Experts may be able to hear an “early systolic ejection click” and, in the case of an immobile aortic valve, a quieter second heart sound. If aortic stenosis occurs together with aortic valve insufficiency, a so-called early diastolic decrescendo is present.

As a non-medical practitioner, it is worth noting that when the cardiologist listens to the chest, he often hears a sound above the aortic valve that is specific for a narrowing of the heart valve. A corresponding heart murmur makes the suspicion of aortic valve stenosis more severe and usually requires further diagnosis. A cardiac echo (echocardiography, cardiac ultrasound) is an examination performed with an ultrasound device over the thorax (transthoracic echocardiography) or over the esophagus (transesophageal echocardiography). It is a method that allows the heart valves to be thoroughly analyzed and valve defects such as aortic valve stenosis to be detected. The echocardiographic findings also serve to evaluate the severity of the stenosis.