Aortic stenosis: How it feels when your heart is working overtime

Heart Health

by Amir Malik, MD, FACC, FSCAI

Feb 22, 2019

Aortic stenosis has an ominous ring to it, and for good reason. Constricting the body’s most vital artery can diminish your life — and shorten it. But there are more options than ever to relieve the stress on your heart from working overtime to keep your blood pumping.

What is aortic stenosis?

First, let’s define terms. Your aortic valve, which has three flaps called leaflets, allows blood to flow from your heart’s left ventricle into the aorta, which carries oxygen-rich blood into the body. Stenosis, a type of heart valve disease, occurs when the valve is narrowed, usually by calcium deposits that accumulate over time, although the condition can also develop from birth defects, rheumatic fever or radiation therapy.

Consequences progress from thickening of the heart muscle, to causing blood to back up in the lungs, to heart failure.

With that valve unable to open fully, your heart has to work harder to pump blood through. Over time, that stress weakens your heart. Consequences progress from thickening of the heart muscle, to causing blood to back up in the lungs, to heart failure.

You can live with the condition for a long time, unaware of any problem. But eventually, as your heart wears out, symptoms will surface, including:

  • Chest pain or tightness
  • Dizziness
  • Heart palpitations
  • Fatigue
  • Shortness of breath

Aortic stenosis is not a condition you should take lightly. If you do experience the above symptoms, it’s time to visit your primary care physician.

Related: How healthy is your heart? Take the quiz.

TAVR: A breakthrough intervention for aortic stenosis

After confirming aortic stenosis, usually through imaging tests or echocardiograms, your doctor will weigh treatment alternatives. At Baylor Scott & White Heart and Vascular Hospital, a multidisciplinary team of cardiologists, interventional cardiologists, cardiac surgeons and nurse practitioners determines and designs the best course of action for each patient, with the same goal: improving and extending your life.

Moderate cases may simply warrant monitoring and medication, along with a heart-healthy lifestyle: eating right, exercising, watching your weight and not smoking. However, aortic stenosis is a progressive disease and will likely worsen over time. If it does become severe, it’s time to intervene.

Related: 82-year-old valve patient experiences evolution of heart surgery first-hand

This generally means having a valve replacement procedure. For years, that meant open-heart surgery — cutting through your breastbone, putting you on a heart-lung bypass machine and opening your chest to attach a new valve, which can be a mechanical device or animal tissue. But this complex procedure, with a long recovery period, makes open-heart surgery especially risky for elderly or frail patients. However, without treatment, severe aortic stenosis has a poor prognosis — if the valve is not replaced, survival rates are as low as for some cancers.  

Fortunately, the new millennium brought a major breakthrough. In 2002, French physicians performed the first Transcatheter Aortic Valve Replacement, now commonly known as TAVR. Surgeons inserted a catheter, with the new valve attached, into an artery through the leg or groin and guided it through the body to the heart.

The benefits were obvious: less traumatic to the body, less time in the hospital and a much quicker recovery. TAVR was poised to be a game-changer for people diagnosed with aortic stenosis and in the years since, it certainly has.

TAVR was poised to be a game-changer for people diagnosed with aortic stenosis and in the years since, it certainly has.

The issues to evaluate were whether TAVR was as safe and effective for the long term as open-heart surgery. Medical staff members at Baylor Scott & White Heart and Vascular Hospital have played a big role in that process, contributing to many TAVR studies and clinical trials, and becoming one the leading hospital groups in the country to improve and refine the procedure. In 2011, the U.S. Food and Drug Administration approved TAVR for high-risk patients unlikely to endure open-heart surgery. That approval was extended to intermediate-risk patients in 2016. With more research completed and TAVR becoming more widespread, we believe the FDA approval soon will encompass low-risk patients as well.

Advancements like TAVR are giving people with aortic stenosis better treatment options and a renewed hope for improved quality of life. Your heart shouldn’t have to work overtime just to keep you going every day. Find cardiac care today, or talk to a doctor if you’re worried about your symptoms.

About the Author

Amir Malik, MD, FACC, FSCAI, is the medical director of the structural heart disease program at Baylor Scott & White Heart and Vascular Hospital – Fort Worth.

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