Unveiling aortic stenosis: Insights, causes, diagnosis, and modern treatments

In his latest online article, Dr Vinay Kumar Bhatia gives us his insights into aortic stenosis. He talks about what it is, the causes, the severity of this condition, diagnosis, and treatments available.

What is aortic stenosis and what causes this condition?

To explain aortic stenosis effectively, let's talk about the heart's valves. Imagine the heart having four valves that help control how blood moves through its right side. One of these valves is called the aortic valve, which is like a gatekeeper regulating how blood flows from the heart to the body. These valves work quite hard, opening and closing about 70 to 80 times every minute, all day, every day of your life.

Because these valves are always on the move, they can wear out over time. Aortic stenosis occurs when the aortic valve becomes worn out, and it can't open fully or close properly. This might block the blood flow leaving the heart or let blood leak back into the heart.

People experiencing aortic stenosis can have different levels of trouble. They might feel short of breath, especially when they're active, and sometimes they might sense discomfort in their chest. They could also get dizzy or even faint. But here's the thing: this issue often stays hidden for years, getting worse bit by bit. When symptoms finally pop up, it's a sign that aortic stenosis has gotten pretty serious.

So, it's really important for individuals with symptoms like shortness of breath, dizziness, or chest discomfort to see a doctor. If the doctor hears an unusual sound called a "murmur" while listening to the heart of someone with these symptoms, they should take notice because it could mean aortic stenosis is present.

How serious is aortic stenosis?

Aortic stenosis is categorised into different grades based on the degree of wear and tear on the heart valve. We commonly classify it as mild, moderate, or severe, and these terms are quite straightforward to understand. Severe aortic stenosis signifies a stage where the valve has reached a point where patients often experience symptoms. When the valve has been severely affected, meaning it's considerably worn out, intervention becomes a critical consideration. Without appropriate action, the condition is likely to progress beyond this point, potentially leading to unfavourable outcomes or significant events like fainting or increased strain on the heart and circulation. In cases of severe aortic stenosis, it becomes imperative to conduct a thorough examination to explore available treatment options.

How is aortic stenosis diagnosed?

If we look back around 50 years, when someone had severe aortic stenosis, whether they had symptoms or not, the main way to treat it was with open heart surgery. Aortic stenosis is like a mechanical problem with the heart valve, and while medications could help with symptoms like trouble breathing, they couldn't actually fix the worn-out valve itself.

So, the only real solution was to replace the valve through surgery. Back then, this surgery involved opening up the chest, which was a big deal, especially for older patients in their 80s or 90s. Not everyone was able to handle such a major operation. But here's where things get interesting: in the last 10 to 20 years, there have been significant changes. Now we have a procedure called transaortic valve implantation (TAVI), which is way less invasive. This procedure allows us to replace the problematic valve without needing to do the full open-heart surgery. It's a big advancement, especially for patients who might not be well-suited for the more intense surgery. So, for doctors and healthcare providers, it's really important to be aware of aortic stenosis when they're treating patients. And it's not just about knowing, but also making sure the diagnosis is accurate. This new procedure has opened up opportunities for more patients to receive treatment for this serious condition.

What treatments are available for severe aortic stenosis?

The treatments are designed to help specific patients, so getting the right diagnosis is really important. A heart ultrasound is used to look at the heart valve and take measurements. This is the main test to check for aortic stenosis. Once the diagnosis is clear, patients go through a thorough check-up. This usually includes looking at the blood vessels around the heart to make sure there are no other problems. If someone has lung issues, their lung function might be tested too. This whole process involves a team of experts, like doctors who are good at reading images, surgeons, and doctors who do the implanting.

There are three main decisions made: first, confirming how serious the condition is; second, deciding if it's a good idea to do something about it based on the patient's health and background; and third, picking the best way to replace the aortic valve. Some patients might need the old-style surgery where the chest is opened up, while others might be able to get a new valve through a smaller incision, which is less invasive. The choice depends on what's best for the patient.

When the new way of putting in the valve was first used, doctors watched patients closely over a long time to make sure everything went well. Now, we know that this method works really well for severe aortic stenosis. So, for patients who are right for it, the procedure is done, and the right kind of doctor takes care of them. Surgeons do the surgery, and special heart doctors called interventional structural cardiologists do the less invasive procedure.

Dr Vinay Kumar Bhatia is a distinguished cardiologist with over 10 years of experience. You can schedule an appointment with Mr Bhatia on his Top Doctors profile.