Dr. Mark F. Sasse recently joined Alabama Cardiovascular Group (ACG) and the Grandview Medical Center medical staff, and he brings 15 years of experience in the field of interventional cardiovascular medicine.
Q: Why is aortic stenosis an important topic to discuss?
A: Aortic stenosis is one of the most common valvular heart problems in the elderly. The frequency of the disease is approximately 2 in every 100 people over the age of 65, and 3 in every 100 people over the age 75. After the onset of symptoms, survival is only 2-3 years with a high risk of sudden death if left untreated.
Q: What causes aortic stenosis?
A: It is caused by calcium and fibrous material deposition in the valve leaflets, which leads to stiffening of the valve and subsequent narrowing of the opening for blood flow out of the heart. The risk factors for development of aortic valve disease are similar to those for atherosclerosis (hardening of the arteries), and include increasing age, hypercholesterolemia, hypertension, smoking and diabetes. Also, some patients are born with a two leaflet valve instead of a three leaflet valve. It is also known as a bicuspid valve. This form of aortic stenosis usually presents earlier in life. However, in some patients with this condition, aortic stenosis can present later in life. The valve narrows because the two leaflets wear out quicker than the normal three leaflet valve.
Q: What symptoms are associated with aortic stenosis?
A: The classic presentation is heart failure, chest pain and/or syncope. These presenting symptoms are signs of more advanced disease. However, because this is a long standing condition to which patients adapt to, more subtle symptoms may be more common. The symptoms can be just progressive fatigue, mild shortness of breath, change in exercise tolerance or just a general reduction in all activities. The elderly may not notice a change in symptoms because they limit their activities based on the way they feel and may not necessarily label it a symptom.
Q: How is it diagnosed?
A: The history taken by an astute health care provider is essential, focusing on any changes in the physical activity of the patient. A physical exam is also essential. Detecting a murmur, which is an audible sign of narrowing of the valve, alerts the clinician to a potential valve problem. However, the best confirmatory testis an echocardiogram (ultrasound of the heart), which is the most effective method for diagnosing aortic stenosis.
Q: How is it treated?
A: There is no medical treatment for aortic stenosis. A trial of cholesterol lowering medications to help prevent progression of aortic stenosis did not demonstrate a slowing of the narrowing of the valve. The only proven treatment is valve replacement. There are two methods of valve intervention: One is surgical replacement via open heart surgery, or the TAVR procedure (transcatheter aortic valve replacement). This a less invasive option that has excellent evidence for treatment of the elderly with aortic stenosis. Both options are available for elderly patients depending on the number of medical problems each individual patient possesses.
