Aortic valve disease includes aortic valve stenosis (AVS) and aortic insufficiency (or regurgitation). In the first disorder, the aortic valve gets thick and narrow (stenotic), so the heart must work harder to send blood through the valve. Less blood gets through to the body. The health care provider may hear an abnormal heart sound (heart murmur) with a stethoscope. In aortic insufficiency, the valve doesn’t close well, so some blood that was just pumped out leaks back. Over several years, the left ventricle (bottom heart chamber) gets too big because of the extra blood and becomes less efficient in pumping blood.
Causes include congenital heart disorders in children. In adults, endocarditis (bacterial heart infection), aging-related calcium deposits on the valve, and rheumatic fever can damage aortic valves. Rarer causes include radiation, rheumatoid arthritis, trauma, and other diseases (Paget’s and Fabry’s diseases, end-stage kidney disease).
AVS symptoms develop when valve narrowing is severe. They include chest pain or tightness, fainting, dizziness, tiredness, shortness of breath, palpitations (feeling a rapid, fluttering heartbeat), and heart murmur. People with chronic aortic insufficiency may not have symptoms for years. As it gets worse, similar symptoms occur. Other signs and symptoms include rapid or irregular pulse and swollen ankles and feet.
For diagnosis, the health care provider uses the medical history and physical examination. The health care provider can hear a heart murmur, which is an extra or unusual sound of blood flowing through the valve during the heartbeat. The health care provider will usually order electrocardiography (ECG), chest x-ray, and echocardiography. Two-dimensional echocardiography with Doppler is best for checking for AVS. In this test, sound waves are used to take heart pictures. Exercise test and cardiac catheterization may also be done if surgery is being considered.
People with mild to moderate conditions and no symptoms may just need regular checkups.
Drugs are usually initially used to treat symptoms of AVS. Surgery is performed in more severe cases. It includes aortic valve replacement and balloon valvuloplasty. Balloon valvuloplasty uses a soft, thin tube (catheter) tipped with a balloon to stretch the valve opening.
People with symptoms of aortic valve insufficiency generally need surgery. However, surgery (valve repair or replacement) may also be done even when no symptoms occur if there is evidence of worsening aortic insufficiency on echocardiogram. Certain drugs (vasodilators) can help relieve symptoms and prevent complications.
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Copyright © 2016 by Saunders, an imprint of Elsevier, Inc.
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