Aortic Stenosis | Dr Raghu


Grading Severity of Aortic Stenosis

Aortic valve stenosis is a serious disease that can lead to heart failure, strokes, and even death if left untreated. That makes timely diagnosis and treatment of the condition crucial. However, treatment of aortic stenosis depends on its severity.

Typically, the following parameters are used to determine the severity of aortic stenosis:

  • Pressure gradient – High gradient (HG; >/=40 mm Hg) or low gradient (LG; <40 mm Hg)
  • Blood flow – Normal flow (NF; SVi>35 ml/m2) or low flow (LF; SVi<35ml/m2)
  • Left ventricular ejection fraction (LVEF) – Preserved (>/=50%) or reduced (<50%)

Depending on the pressure gradient and blood flow parameters, aortic stenosis is graded as follows:

  • Normal flow-low gradient (NF-LG)
  • Normal flow-high gradient (NF-HG)
  • Low flow-high gradient (LF-HG)
  • Low flow-low gradient (LF-LG)

NF-HG is the most prevalent type of aortic stenosis and has well-established management protocols. Patients with NF-HG are also ideal candidates for aortic valve replacement. While LF-LG is fairly rare, it’s often associated with a poor prognosis.


Additionally, depending on progression, heart valve disease can be categorized into the following four stages:

  • Stage A (At risk) – Characterised by the presence of risk factors
  • Stage B (Progressive) – Mild or moderate valve disease with no noticeable symptoms
  • Stage C (Asymptomatic severe) – Severe valve damage with no noticeable symptoms
  • Stage D (Symptomatic severe) – Severe valve disease with noticeable symptoms

Doctors use a variety of diagnostic tests to evaluate the aforementioned parameters and determine the severity of aortic stenosis. If you experience symptoms like chest pain, heart murmur, or palpitation, it’s crucial to reach out to an experienced cardiologist and get the right treatment for aortic valve stenosis.

How Does One Diagnose Aortic Stenosis – ECG, ECHO, TEE, or CT aortogram?

Early diagnosis of aortic valve stenosis is crucial to prevent severe complications, such as arrhythmias, heart failure, stroke, and death. Also, it can help administer timely treatment, thus improving the patient’s prognosis and quality of life.

That’s why cardiologists use a series of tests to diagnose aortic valve stenosis and its underlying cause. When you visit the doctor, they’ll start by asking you about your symptoms and medical history. Also, they ask whether your family has a history of cardiovascular ailments. Next, they’ll use a stethoscope to detect the presence of the characteristic aortic stenosis murmur.

Additionally, your doctor will use one or more of the following tests for the complete diagnosis:

  • ECG (Electrocardiogram) – It’s one of the most preliminary tests that evaluate the heart’s electrical activity and helps doctors identify an irregular heartbeat and other abnormalities.
  • Echo (Echocardiogram) – It uses sound waves to generate images of the beating heart. It helps doctors examine how blood flows through each valve and determine the severity of aortic stenosis.
  • TEE (Transesophageal echocardiogram) – It’s a special type of echocardiogram in which an ultrasound probe is inserted into the esophagus and directed closer to the heart. It helps doctors take a closer look at the aortic valve and identify the underlying cause of aortic stenosis.
  • CT aortogram – It’s used to evaluate the blood supply to the upper body and identify conditions such as atherosclerosis.

Echocardiography (ultrasound) machine. doppler of aortic stenosis

Additionally, your doctor might recommend tests like cardiac catheterization and chest X-ray to get a complete picture of your cardiac health and plan the right course of treatment.

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      Basics of the Heart

      The heart is a vital organ of the human body. It pumps blood throughout your body and keeps you alive. It comprises cardiac muscle tissue. That means the heart can contract and relax  to squeeze blood out of the heart and into your body. It supplies blood to all organs, including the brain, kidneys, liver, and more. 

      The heart has four chambers divided by two walls called septa. The upper chambers are called the atria, and the lower chambers are called the ventricles.

      The atria receive blood from the veins and pump it into the ventricles through openings called valves. The tricuspid valve separates the right atrium from the right ventricle, and the mitral valve separates the left atrium from the left ventricle. There’s also a pulmonary valve that sits between the right ventricle and the pulmonary artery.

      Then there’s the aortic valve located between the left ventricle and the aorta. It prevents blood from leaking back into the left ventricle during the contraction phase of the heart’s pumping cycle.

      When your heart beats, it squeezes blood out through an opening in each chamber called an aortic valve into either a large artery (aorta) or one of its branches, the carotid arteries, before heading back down to smaller arteries throughout your body. When the heart pumps blood to other organs, oxygen will be picked up by red blood cells as they pass through capillaries.

      What Is the Aortic Valve, and Why Is It Important?

      Aotic Valve

      The aortic valve is one of the four valves in the heart. It is a flap of tissue that keeps blood flowing in one direction. It is located in the middle of the heart, between the left ventricle and the aorta, the main artery that supplies blood throughout the body. The aortic valve is a semilunar valve, meaning the flaps of the valve are crescent-shaped.

      The aortic valve comprises three sections called leaflets or cusps. Each cusp is made of collagen. Some people are born with only two cusps in the aortic valve. In such cases, it is known as a bicuspid aortic valve.

      The aortic valve opens when the heart contracts or squeezes and closes when the heart relaxes. It lets oxygen-rich blood flow from the left ventricle into the aorta for circulation throughout your body. 

      The aortic valve is crucial because it ensures that blood keeps flowing in the right direction from the heart. It prevents the backflow of blood from the aorta into your left ventricle.

      If the aortic valve doesn’t work properly, it can cause serious problems. A leaky or stiffened valve won’t open and close properly, which means that some blood flows backward into the left ventricle. It puts extra pressure on the heart and can lead to heart failure or stroke if severe enough.

      Which Diseases Affect the Aortic Valve?

      The aortic valve is a crucial part of the heart that keeps blood flowing in the right direction throughout the body. The two primary diseases that affect the aortic valve are:

      • Aortic valve stenosis
      • Aortic valve regurgitation

      In aortic valve stenosis the cusps (or flaps) of the aortic valve become stiff and thick, thus narrowing the valve opening. That, in turn, restricts blood flow from the heart’s left ventricle to the aorta and the rest of the body.

      Aortic valve stenosis is usually caused by pre-existing conditions, such as congenital heart defects, aortic valve calcification, and rheumatic fever. Chronic ailments, such as hypertension, endocarditis, and diabetes, and treatments like radiation therapy to the chest can also increase the risk of aortic valve stenosis.

      In aortic valve regurgitation, the flaps don’t close properly, causing a backflow of blood into the left ventricle. As with aortic valve stenosis, this condition is also caused by pre-existing ailments that affect the heart.

      Common symptoms of aortic valve disease include heart murmur, chest pain, dizziness, fatigue, irregular heartbeat, and shortness of breath. Treatment for these conditions depends on the severity of the disease and its underlying cause. If left untreated, both aortic valve stenosis and aortic valve regurgitation can lead to heart failure and other complications.

      According to the CDC, nearly 2.5% of the US population suffers from heart valve diseases. These conditions are more common in older people, with 13% of people born before 1943 experiencing them. Also, 1% to 2% of the US population is affected by the bicuspid aortic valve, with the condition being more common in men.

      If you experience any of the aforementioned symptoms, reach out to an experienced cardiologist for proper diagnosis and treatment.

      Aortic Stenosis: What Is It?

      symptoms of Aortic Stenosis

      Aortic stenosis is a heart valve disease affecting the aortic valve that connects the heart’s left ventricle (lower chamber) to the aorta (main artery). The aortic valve is responsible for ensuring that blood flows in one direction throughout the body.

      In aortic valve stenosis, the aortic valve flaps (or cusps) become stiff or thick due to calcium buildup in the valve or other underlying causes. It causes the valve opening to become narrow and restricts blood flow to the aorta. That, in turn, reduces or blocks the blood supply to vital organs, such as the liver, kidney, brain, etc.

      Symptoms of aortic valve stenosis include:

      • A whooshing or swishing heart sound (known as aortic stenosis murmur)
      • Chest pain or tightness
      • Fatigue and dizziness (particularly after physical activity)
      • Shortness of breath
      • Palpitations

      Depending on the underlying cause, there are two types of aortic stenosis – congenital and acquired. Congenital aortic stenosis is present from birth due to a defect in the valve’s formation. Acquired stenosis develops after birth due to other heart-related ailments, such as hypertension, endocarditis, rheumatic fever, and aortic valve calcification.

      The risk of aortic stenosis increases in older people. Also, people who have received radiation therapy to the chest are more vulnerable to the condition. 

      Treatment for aortic valve stenosis depends on the underlying cause and the severity of the condition. Many patients need surgery to repair the valve. If left untreated, aortic stenosis can lead to heart failure, stroke, arrhythmias, and even death. Therefore, it’s crucial to diagnose aortic valve stenosis and treat the condition at the earliest.

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          What is Aortic stenosis?

          Aortic stenosis is a disease where the valve between left ventricle and aorta is narrowed. Normally the left ventricle is the chamber which pumps blood to the entire body through the aortic valve. So if the aortic valve is narrowed either due to infection or age related degeneration it is called aortic stenosis. This is a disease of the elderly people usually beyond 50 years of age.

          What are the symptoms of aortic stenosis?

          When the disease is severity is mild people usually do not experience any symptoms. But is the disease is severe – even though the disease is severe in early phases the patient might not have symptoms. 

          So, early stages of aortic stenosis patient might not have any symptoms. Where as in the advanced stage of severe aortic stenosis the patients can develop can develop chest pain also called angina in medical terminology. So chest pain which increases on walking or any other form of exertion and gets relieved on rest or stopping of that activity is called angina. So patients with aortic stenosis because is unable to pump as per the requirements of the body (due to aortic valve narrowing) they experience angina. 

          The other symptom is breathlessness – on walking or on lying down flat the patient develops difficulty in breathing. This is referred to as dyspnea in medical terminology. So when ever a patient is having a fixed blood supply to various organs without increasing as per their needs there is pooling of blood in the heart. This pooled blood in the heart “reverses back” into the lungs which is responsible of breathlessness.

          Finally in advanced stages of aortic stenosis patients develop a sudden loss of consciousness with spontaneous recovery. These episodes of loss of consciousness are also called as syncope in medical terminology.

          So the predominant symptoms of aortic stenosis are chest pain, breathlessness and sudden loss of consciousness.

          At the same time patients with aortic stenosis will develop an impaired function of the heart also called heart failure. This heart failure need to necessarily present in severe heart failure but can also be seen in intermediate or moderately severe aortic stenosis. 

          Aortic stenosis and high blood pressure 

          Patients with aortic stenosis have reduced supply of blood to various organs of the body. Because of this it was believed that patients with aortic stenosis tend to have low blood pressure. This is not true regarding the current epidemic of aortic stenosis we are currently seeing. Currently most of the aortic stenosis patients are elderly in their 60s, 70s and 80s of age. So these patients because of the progression of the age and hardening of the blood vessels they develop high blood pressure or Hypertension in medical terminology. So patients with aortic stenosis are not spared from high blood pressure contrary to what we were believing till date and what we are seeing is a scenario of aortic stenosis patients having high blood pressure levels.

          What is the impact of this high blood pressure on a patient with severe aortic stenosis?

          Patients with high blood pressure and severe aortic stenosis develop a faster progression of the disease severity. So a patient of aortic stenosis with uncontrolled blood pressure can have a severe aortic stenosis at a much earlier age. 

          How can patients with aortic stenosis control their blood pressure?

          People with aortic stenosis and high blood pressure need to control their blood pressure using 3-4 different types of medicines. A good control of blood pressure is one of the first steps in retarding the progression of aortic stenosis. 

          Can people with aortic stenosis do exercise? 

          People with aortic stenosis tend to have a fixed cardiac output. This means – the aortic valve is narrowed and this narrowing limits the blood supply to various organs of the body. When there is a reduction in blood supply to various organs of the body – the first to be affected is the brain. This causes syncope or sudden loss of consciousness. 

          Exercise AS

          So when a person with severe aortic stenosis exercises vigorously then there is a reduction of blood supply to the brain causing sudden unconsciousness. This problem happens in people with an advanced or severe aortic stenosis. So people with severe or advanced aortic stenosis are advised not to participate in vigorous physical activity such as running, jogging or weight lifting etc. 

          But at the same time as we all know for the control of BP, blood sugar and cholesterol and effective control of heart failure are important steps for retarding the progression of aortic stenosis. So a mild to moderate severe intensity exercise is advised for control of the various co-morbidities in aortic stenosis. But at the same time a vigorous or severe intensity exercise is definitely not to be performed. Severe intensity exercise or competitive sports is a contra indication for aortic stenosis patients in medical terminology.

          Aortic stenosis

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              Dr. Raghu | Heart Specialist in Hyderabad
              Yashoda Hospitals, Sardar Patel Rd, behind Hari Hara Kala Bhavan, Kummari Guda, Shivaji Nagar, Secunderabad, Telangana 500003

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