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Aortic Valve Stenosis is a condition caused by the narrowing of the hearts aortic valve. This congenital heart defect is very common among people in the U.S., as over 200,000 cases are noted per year (Mayo Clinic, pg. 28). This condition presents itself with many signs and symptoms, and can eventually cause many issues if left untreated. The good thing about this condition, though, is that with a proper diagnosis and understanding, it can be treated and repaired with the help of a cardiovascular doctor (Mayo Clinic, pg. 42).
When experiencing symptoms related to that of aortic valve stenosis, it is important for sufferers to understand the cause and reason behind the symptoms and signs they are experiencing. Although aortic valve stenosis seems like a rather anatomical problem, there actually is quite a pit of pathophysiology behind the disease. As described by the Mayo Clinic, pathophysiology is the disordered physiological processes associated with disease or injury (Mayo Clinic, pg. 2).
To truly understand just what the heart is going through when presented with aortic valve stenosis, it is important to understand how a normal heart without AVS should actually function. In a normal heart, all four valves should properly open and close when there is an increase or decrease in pressure, during diastole and systole to ensure that the blood is flowing through the heart properly (CCN-Cary, pg. 7). Between early and mid diastole, blood flows through the tricuspid and mitral valves into the right and left ventricles to make sure there is enough blood being regulated (CCN-Cary, pg. 7). After that, during late diastole, the right and left atria fully contract which leads us into early systole. During the early stage of systole, ventricular pressure increases which forces the mitral and tricuspid valve to properly close. When the pressure of the ventricles increase, all four valves close for a small amount of time in response to ventricular contraction, also known as isovolumetric contraction. After all of this, the pulmonic and aortic valves should open. “During mid systole, when ventricular pressures exceed pulmonic and aortic pressures, the pulmonic and aortic valves are forced to open, and blood is ejected into the pulmonary vasculature and aorta” (CCN- Cary, pg. 6). When blood is ejected into the pulmonary vasculature and the aorta, the pulmonic and aortic valves should close right after that. This brings us to late systole where the ventricular muscle slowly begins to untwist and relax. This ensures that the pressure against the pulmonic and aortic valves close properly and effectively but the normal heart into isovolumetric relaxation (Cary, pg. 8).
With aortic valve stenosis, there are a few elements of pathophysiology behind this disease that causes the actual narrowing of the heart’s aortic valve, in which case is the problem for this congenital heart defect and makes this heart differ from the processes of a normal heart. The pathophysiology of this heart defect starts in the four valves of the human heart which include the mitral valve, tricuspid valve, the pulmonary valve and the aortic valve (HealthLine, pg. 48). Attached to these four valves are little flaps, or cusps, that open and close each time your heart beats. It is possible for the valves to unsuccessfully open and close properly, which can damage your heart by disrupting blood flow. With the disruption of blood flow in the heart, the heart can potentially become impaired during the process of pumping blood (HealthLine, pg. 53). In aortic valve stenosis, the aortic valve that lies between the left ventricle and the aorta is narrowed; because of this, the left ventricle struggles a lot harder at pumping a precise amount of blood to the aorta, which then goes on to deliver filtered blood to the rest of the body. When this happens, it physiologically can thicken and enlarge the left ventricle, and make that side work about 4 times harder than a healthy heart would work. When it begins to work so much harder than normal, it can not only weaken the left ventricle and the heart as a whole, but it can eventually lead to severe heart problems, and in serious cases, heart failure (HealthLine, pg. 67).
As a result of the complications caused by aortic valve stenosis, patients with AVS become very dependent on the atrial kick (the contraction of the atria during ventricular diastole) to ensure they maintain correct stroke volume and cardiac output. When a patient with AVS has a loss of atrial kick resulting, fluid or blood volume overload might create pulmonary congestion, hypotension and even angia (CCN- Cary, pg. 8). Along with pulmonary congestion, it is possible for a patient with AVS to have atrial arrhythmias (irregular flutter or heartbeat) which might result from calcific infiltrates from the aortic valve (CCN- Cary, pg. 9). So, it is really important to understand the symptoms and get yourself checked to ensure proper diagnosis and individualized care/ effective treatments.
Although AVS is in fact a congenital heart defect, most people are not born with aortic stenosis, but are born with a damaged aortic valve. Later in life is when aortic valve stenosis can actually present itself, and it can come on strong with several signs and symptoms, or not many at all. Some people with AVS have reported experiencing no symptoms from this condition, but those that do present with symptoms, complain of a wide variety of things.
Symptoms of aortic valve stenosis include breathlessness (caused by the overworking of the heart), chest pains (caused by rapid valve motions), edema (caused by decreased oxygen), fainting, heart palpitations or feelings of heavy heartbeats, heart murmur, and even a decrease in activity and energy levels (caused by your body’s inability to pump blood in the heart fast enough) (JACC, pg. 2). With any of these symptoms, a clear diagnosis will be appropriate before starting the necessary treatment. When symptoms of AVS present later in life, it is important to have this condition treated as it can progressively get worse with time. But, before treatment can begin, a proper diagnosis must be given by your doctor. There are a couple of ways to diagnose this condition; some of which are more common than others.
One method of diagnosis is an echocardiogram, this test uses sound waves to watch the rhythm of your heart in motion. An echocardiogram when used to diagnose AVS is specifically looking for the size and shape of your heart, thickness of the heart, movement of your heart’s walls, the heart’s pumping strength, if the heart valves are working correctly, if blood is leaking backwards through your heart valves (regurgitation), if the heart valves are too narrow (stenosis), and if there is a tumor or infectious growth around your heart valves relating to AVS (JACC, pg. 4).
Other possible methods of diagnosis include an electrocardiogram, a chest x-ray, exercise tests or even sometimes stress tests, CT scans or MRIs, and in some severe cases, cardiac catheterization (Mayo Clinic, pg. 12). Diagnosing AVS is not super, especially using any of these methods. Although, an echocardiogram is the most common and oftentimes, the most effective.
After receiving a proper diagnosis of aortic valve stenosis, luckily, there are several ways to effectively treat the condition as well. Many cases are not severe enough to require treatment, but if they do, open heart surgery is the proper treatment for this condition. During this pretty invasive procedure, surgeons will replace the narrowed aortic valve that is failing to open properly (aortic valve stenosis) (Mayo Clinic, pg. 15). During the procedure, the surgeon will make an incision on the breastbone or sternum, and go in to completely remove the affected valve. After it is removed, the surgeon will replace it with a healthy valve which can be either a mechanical (handmade valve out of titanium or body safe plastics) or a biological valve (transplanted from someone with a healthy aortic valve)(Mayo Clinic, pg. 17). The prognosis proves to be mild, treatable, and moderate (CCN- Cary, pg 14).
According to the Mayo Clinic for Healthy Hearts, among 2,441 patients who received the surgery for AVS experienced complications within 30 days (WebMD, pg. 44). Some complications include gastrointestinal issues, neurological complications, and many severe falls were also reported. Some more severe cases included a paravalvular leak (a gap between the prosthetic valve and the native annular tissue, PVL results in regurgitation of blood from downstream to upstream chamber), and a greater left ventricular mass (buildup of benign cells that can’t properly disperse due to prolonged narrowing of the valve) at 30 days post op (WebMD, pg. 48).
In conclusion, although aortic valve stenosis is a congenital heart defect, it is important to note it does not start out that way. In the early years, it starts out as an aortic valve abnormality, which later in life has the potential to develop into valve stenosis. It ultimately starts with the narrowing of the aortic valve, which causes the left ventricle to struggle to pump an adequate amount of blood to the aorta and the rest of the body, which ultimately can cause a lot of serious problems with your heart, including in some severe cases, heart failure. When these symptoms happen, and you start to show physical signs, it is important to be checked out by a physician to ensure a proper diagnosis. With the proper diagnosis or aortic valve stenosis, a treatment can be properly put in place and you can move forward with the recovery from this heart defect. Although this condition can be very scary and potentially cause several risks with you heart and overall health, the condition is fortunately treatable.
- “Incidence, Predictors, and Prognostic Impact of Late Bleeding Complications After Transcatheter Aortic Valve Replacement” Journal of the American College of Cardiology.24 Dec 2014. Web. 22 July 2019. http://www.onlinejacc.org/content/64/24/2605.abstract
- “Aortic Valve Disease.” The Mayo Clinic for Healthy Hearts.” 14 May 2018. Web. 22 July 2019. https://www.mayoclinic.org/diseases-conditions/aortic-valve-disease/
- “Aortic Valve Stenosis.” HealthLine Major Health. 24 Jan 2018. Web 22 July 2019. https://www.healthline.com/health/aortic-stenosis
- “What Is Aortic Valve Stenosis?” WebMD Health A-Z. 4 June 2014. Web. 22 July 2019. https://www.webmd.com/heart-disease/aortic-valve-stenosis
- “Aortic Stenosis: Pathophysiology, Diagnosis, and Medical Management of Nonsurgical Patients.” Critical Care Nurse for High Acuity Health (Theresea Cary). 12 Feb 2016. Web. 22 July 2019. http://ccn.aacnjournals.org/content/
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